'When I had my facelift," says Wendy Lewis in her new book, "I wrote ... that 50 was the new 40. Today I think we have surpassed it by a mile. Now, 60 is the new 40."
For many, and certainly for Lewis, this ability to turn back time with a few slashes of the knife represents a major step forward. She is an independent cosmetic surgery adviser based in the US and also the world's first cosmetic surgery columnist, writing weekly in the Mail on Sunday's You magazine. As such she represents perhaps the ultimate sign that cosmetic surgery has gone mainstream. Affectionately referred to as "the knife coach", she isn't a doctor herself, but advises clients and readers on all aspects of surgery. Her latest book, Plastic Makes Perfect: the Complete Cosmetic Beauty Guide, includes topics such as how to shop for a surgeon and recover post-procedure.
As recently as 10 years ago cosmetic surgery was seen as the domain of the weird and famous, of characters such as Michael Jackson and Jocelyn Wildenstein, aka "the Bride of Wildenstein" (who started surgery after discovering her husband in bed with a 21-year-old woman). Back then, most people considered cosmetic surgery highly suspect: after all, who would pay someone thousands of pounds to put them under anaesthetic (always potentially dangerous), cut into their skin, change their looks irreparably, and potentially for the worse?
Well, a lot of us, as it turns out. A recent survey found that almost half of Britons would consider cosmetic surgery, and in the past year 577,000 cosmetic treatments were carried out in the UK - around 90% of them on women. The market has doubled in two years, is now worth more than £900m and looks set to top £1bn this year. It's hugely lucrative, and only loosely regulated. Earlier this month a Which? magazine report found consumers being subjected to high pressure sales, including companies offering three treatments for the price of two, and £500 off breast enlargement surgery if undertaken before the end of January 2008. Lewis says that she is "deeply critical of the commercialism of the plastic surgery industry. It has cheapened it". But isn't she part of that industry, and responsible for advertising and promoting such surgery? "For many women, and some men, they will be utterly miserable if they know they are stuck with a huge nose, or sticky-out ears," she says. "If a simple surgical procedure can bring them happiness, then I say, 'Why not?'"
Advice from Lewis does not come cheap. A one hour face-to-face consultation will set you back £400. Her clients come from "all walks of life", but are mainly middle-aged women. Would she advise a 14-year-old to undergo rhinoplasty? "If she was unhappy enough, yes."
Along with the old favourites, such as tummy tucks, facelifts and nose jobs, Lewis's book also features more unusual surgeries such as vaginal trimming. This reflects the fact that as cosmetic surgery becomes more and more popular, the range of surgeries increases, as does the range of body parts that we are meant to worry about. For instance, last week came news of the belly button "nip and tuck", (umbilicoplasty) the latest offering for women wishing to expose a perfect midriff.
Toe removal also features in Lewis's book. The growth of this procedure is apparently the result of the popularity of expensive designer heels. Second and third toes that poke out beyond the big toe can be shortened, and crooked fourth and fifth toes can be straightened out. The operation involves cutting a piece of bone out of the joint and reattaching the tendon. Another option is the removal of the baby toe to make pointed shoes more comfortable. Like all surgery, this procedure carries a risk of lifelong pain and disablement.
The de-stigmatisation of the nip and tuck has not only led to a huge increase in surgery, but has resulted in far more openness from those who undergo the knife. The first step in removing the negative image of cosmetic procedures was people admitting to using Botox, says Lewis, and after that became respectable, so did surgical facelifts. Subsequently, the floodgates opened, helped along by the huge popularity of television programmes featuring surgical makeovers.
"More celebrities are coming clean about having work done", says Lewis, "whereas in the past they would pretend their appearance was down to good genes, exercise and diet." When I ask what work she has had done, she laughs, and politely refuses to give details. "I have clearly put my face before my body," she laughs.
The weird thing about Lewis is that she seems concerned about the pressures women face, and yet her industry is dedicated to exploiting those physical insecurities. "Women are under incredible pressure to look a certain way from a very early age," she tells me. "Fifteen-year-olds are obsessed with their weight. They are incredibly celebrity focused." What does she think about the growing demand for labiaplasty and hymen reconstruction? "Women already have a full plate of image concerns regarding impending wrinkles, and sagging size and shape. The power of suggest-ion that they may not be 'normal' or 'good enough' 'down there' is just one more thing to fret over." Yet she includes information on labiaplasty and laser vaginal rejuvenation in her book. "There are women who can benefit," she says, "from vaginal procedures for incontinence and overall changes after childbirth, and due to ageing. That can add to their confidence".
Each time I ask Lewis whether she feels that her promotion of an exploitative and badly regulated industry is a contradiction, she simply tells me another story about how happy surgery can make her unconfident clients.
"I do think the industry will continue to become more normalised," she says. "What I hope is that it will become safer, especially in the UK where standards really need to improve. I cannot imagine how we would ever stop this trend."
With books like Plastic Makes Perfect, the popularity of make-over TV, and our slack advertising standards, it is hard not to agree with her. It is also hard to stomach.
