In the early evening of Friday July 20, Pauline Bainbridge had liposuction on her thighs. The procedure took less than an hour and she was delighted that it had gone so smoothly. By Saturday, she was out of the clinic and drinking tea on the sofa with her husband, Alan. The couple ate supper and watched a DVD until Pauline nodded off.
On Sunday, Pauline got out of bed and collapsed. Alan called an ambulance, but by the time it reached hospital, Pauline's heart had stopped. The casualty doctors treated her for a blood clot. They resuscitated her several times and gave her two blood transfusions. But less than 48 hours after surgery, Pauline was dead. She was 50.
"I didn't think cosmetic surgery could kill anyone," says Alan at their home in Poulton-Le-Fylde, near Blackpool. "You hear about people with boob jobs having them done 20 times. I thought nothing could harm her except for the anaesthetic and that risk is remote if you are fit as a fiddle, like she was." He shakes his head. "It was an unbelievable shock. I still can't get my head around it."
Alan's disbelief is understandable. Over two decades or so, cosmetic surgery has gone from being the guilty secret of the rich and famous to something so everyday and acceptable that you can watch it most nights of the week on television - sometimes live, sometimes pre-recorded so the viewer can instantly compare before and after, sometimes overseen by presenters who frown on featured subjects who have let themselves go when surgical solutions are so readily available. Cosmetic surgery has lost its stigma and become something you get done in your lunch hour, like a leg wax or a haircut. It comes with its own new, euphemistic vocabulary: it's not surgery, it's a "boost"; you aren't being operated on, you are "getting something done".
Sometimes this language goes too far. This week, the Advertising Standards Authority banned a poster campaign by the Harley Medical Group that bore the slogan, "Gorgeous breasts just got easy with cosmetic surgery." HMG said they were surprised that anyone had complained about the advert, which featured a bikini-clad, flat-chested woman frowning for the "before" shot, and then grinning broadly with a bulging chest in the "after" picture. The ASA's ruling was unequivocal: "Because we understood that surgery always carried a risk to the patient, we concluded that, by promoting a surgical operation as 'easy', the approach was irresponsible and misleading."
Surgery can never be easy or risk free - even when the patient can afford the very best care. Last month, the rapper Kanye West lost his mother, Donda, who apparently developed complications following a tummy tuck and breast reduction. Donda was 58, a former professor of English who had given up a 31-year tenured post to manage her son's business affairs. Stella Obasanjo, the first lady of Nigeria, died in 2005, aged 59, after a tummy tuck in a Spanish clinic. James Brown's third wife, Adrienne, died in 1996, aged 47, following an undisclosed cosmetic procedure. In 2004, Olivia Goldsmith, author of the First Wives Club, suffered a fatal heart attack at 54 as she was being prepared for a chin tuck.
No one knows for sure how many people die as a result of cosmetic surgery every year in the UK. The NHS has data on patients admitted to NHS hospitals due to complications from cosmetic surgery - there were 126 last year - but the Department of Health says this is nowhere near the true number of patients with post-surgery problems because many will be treated privately. Neither the Department of Health nor the British Association of Aesthetic Plastic Surgeons (BAAPS) collects figures on fatalities from cosmetic procedures, and death certificates are unlikely to give the cause of death as an adverse reaction to surgery, anyway - it is more likely to be attributed to the immediate cause, such as heart attack, haemorrhage, infection, or blood clot. But one thing is certain: every year in the UK people die from unnecessary procedures, leaving partners and children behind.
The Bainbridges had been told this at their original consultation with Pauline's surgeon. "He said there can always be complications with any operation, but he hadn't lost anyone yet," Alan remembers. "He'd done a couple of thousand operations. He was a proper cosmetic surgeon, the top man."
Pauline was married to a man she had met when she was 17, and together they built a successful textile printing business. Alan describes her as the "hub" of their large extended family, the sort of person who would think nothing of inviting 30 people over for a barbecue if it looked as if it was going to be a warm afternoon. "She did everything on the house," Alan smiles. "She could have been an interior designer. That's what she was like - everything had to be perfect. She was a perfectionist."
She had fretted over the size of her thighs for years. "She was very slim on top, but always what I would call hippy - that was just the way she was built. All she ever wanted was to wear nice trouser suits or jeans and look a bit better. When Pauline turned 50, we had built the business up, we had built the house up, we had built the family up, and everyone was getting a bit older, so she said, 'Right, I'm going to do something for me for once - I'm going to have it done.'
"I was a typical man. I said, 'What are you wasting money for?'" Alan says. But a few weeks later, Pauline rang Alan at his office and told him she was having a consultation with a cosmetic surgeon, and suggested he should come and join them. The surgeon told her she would never have "Miss World legs", but he would be able to trim them a bit, so that she would feel better. Pauline agreed on the spot and signed up for liposuction in three weeks time, at a cost of more than £3,000. It all sounded very simple, and she reckoned she would be fully recovered in time for a break in Florida that they had booked for October.
The trip to Florida went ahead - but without Pauline. Instead, a grieving Alan took their two sons. It was a good opportunity for them to get away from the house, the cards and the flowers, which are still arriving, four months after Pauline's death.
Pauline hadn't told anyone else that she was having liposuction. She didn't want anyone to worry about it, Alan says, and wanted to surprise everyone with her new thighs. So when Alan arrived at the hospital on the day his wife collapsed, and was told that she was in a critical condition, he had to break the news to her family that not only was Pauline dying, but she was dying because of something that she had chosen to do.
Pauline's sisters came to the hospital, along with her 23-year-old son, Danny. Her elder son, Paul, 26, was on holiday in Cuba and Alan finally managed to contact him while his mother was being resuscitated. "I said, 'You've got to get yourself home, right now. Your mum's seriously ill in hospital'," Alan remembers. "He started screaming and crying down the phone at me. It was awful. I never want to go through that again. What the hell do you do? Do you tell him? Do you wait until he gets home?
"Some people were angry when they found out she'd had the surgery. One of her sisters said, 'Stupid, stupid woman!' But nobody blamed me for letting her have it done, because they knew she wanted it, and she was a very strong person."
When the consultant came to break the news that Pauline had died, he was met with a room full of her extended family. "He looked at all our faces - we were so distraught - and he just said, 'I'm sorry'. You can imagine what that room was like. And my son was there to see it too." Alan falters. "We came out with nothing, and we just ... went home."
Alan doesn't hold anyone responsible for what happened to his wife and doubts the results of the forthcoming coroner's report will make any difference to the way he feels now. "I know in my mind that I have to carry on because I've got two lads, I've got a house, I've got a business, and people rely on me," he says. "But after 33 years together, it's just horrendous.
"I wouldn't recommend anyone having cosmetic surgery done ever, ever. I don't think you should have an operation anyway, unless you really need one."
Pauline's story is shocking, but by no means extraordinary. Alexandra Mills was only 20 when she died after a procedure on her jaw two years ago. She had attended performing arts college near her home in Cirencester, and dreamed of becoming an actress. She was taking a gap year, working as a waitress to save up money for drama school, when she went in for the surgery.
"When she was little, she was teased at school because of her chin, so she didn't want to let it stand in the way of her career. That's why she had the operation," her mother, Jane, said after the inquest into Alexandra's death last year.
The eight-hour operation to break and reset Alexandra's jaw was a routine procedure and part of a long-term plan to correct her jawline. Surgeons initially hailed it as a success, but after the operation, a tube to monitor her blood pressure shifted, and pierced her heart. The potassium she was given to aid recovery then leaked into her heart and triggered a massive heart attack. This freak set of post-surgery complications left her with extensive brain damage and Alexandra died four days afterwards. "Everyone who knew her loved her and thought she was wonderful. She was full of life and spirit," says Jane. "We don't cry as much now, but it's still terribly difficult."
Neither Pauline's nor Alexandra's surgeons were to blame - surgery carries a risk and both patients were fully informed. But even in cases where relatives have successfully sued, the loss of a healthy loved one during routine surgery is no less bewildering. Lorraine Batt left three children behind when she died in 1999, aged 36, following a £5,500 tummy tuck. Once again, the operation seemed to have been a success, but the following day Lorraine complained of headache and nausea. She fell into a coma and died from swelling of the brain three days after surgery.
Her husband, David, has described Lorraine as someone who "loved clothes and always wanted to look her best". She wanted to lose the weight she had gained after having children, and to correct loose skin and scarring on her stomach left by a caesarean section. But according to her father, Eddie Fisher, Lorraine didn't have much weight to lose. "She weighed just nine-and-a-half stone and was a smashing girl."
David won £260,000 compensation in 2004 after an inquest heard evidence that Lorraine should never have been allowed to have the procedure in the first place because she had already been diagnosed with an underactive thyroid. He gave up his job as a builder in Wickford, Essex, to look after their daughter, Kayla, who was only seven when she lost her mother. "This is the end of a terrible episode for my family," he said after the court ruling. "The money doesn't ease the pain. The figure is ridiculous and it is not what I hoped for. But I think I would have been disappointed with any amount."
Dr Steven Chan, who conducted the inquest, did not mince his words. "I have no doubt of the determination of the deceased when she agreed to go through with major surgery," he said, "but the point must be made that all surgery could result in complications with devastating effects. There is no safe surgery."
Few of those who have been bereaved by cosmetic surgery are prepared to speak at length about their experiences. Their loved ones had put themselves at risk voluntarily - and often needlessly - for the sake of looking better. In a way, this robs them of the dignity in death that others who have died suddenly can expect, and makes it especially painful for relatives to go over what happened to them.
Equally, those who have come close to death after cosmetic surgery may feel ashamed of the recklessness of their decision to have it done. Denise Hendry, who is married to the former Scottish football captain, Colin Hendry, was back in hospital last month, five years after botched liposuction left her in a coma for five weeks.
"I had done all this out of vanity and put my family through all that worry. I just wanted a quick fix after having four babies," she said after the surgery. "I felt so bad when I thought Colin could have lost his wife, my children would have lost their mother, my mum and dad lost a daughter and my sister would have lost her sister. I felt overwhelming guilt at how stupid I had been."
Douglas McGeorge, consultant plastic surgeon and president of BAAPS, says is it "incredibly unusual" for a patient to die from cosmetic surgery, and dismisses the idea that cosmetic procedures are unnecessary risks. "These people have got a problem, in the main. We have things that can be done to improve their problems. At the end of the day, aesthetic surgery is done for improving quality of life.
"It is, by definition, surgery of choice, and you don't do it on people who run significant risks. We're not operating on obese people, we are not operating on people who have cancer," he says. "In reality, it's probably more dangerous driving to hospital for most of these individuals."
But these operations are certainly riskier than having counselling, wearing control pants, buying a padded bra or going on a diet. As cosmetic surgery becomes an increasingly normal part of our culture, we are in danger of forgetting just what makes it different from conventional beauty treatments: when you sign up for surgery, you risk dying to look good.
