Americans now spend an alarming $15bn a year on cosmetic surgery in a beautification frenzy that would be frowned on - if there was anyone left in the United States who could actually frown with their Botox-frozen faces.
The sum is double the gross domestic product of Malawi and more than twice what America has contributed to Aids programmes in the past decade.
America has always been the world's plastic surgery capital, but demand for an ever-widening menu of procedures has now exploded to produce a new, younger generation of obsessives, dubbed 'beauty junkies'. A new book by Alex Kuczynski, a self-confessed recovering addict of cosmetic surgery, is called just that - Beauty Junkies
'I just think it will make me look better, and I will feel even better about myself,' Kuczynski, 38, a tall, slim, attractive New Yorker, recalls telling her fiance when she decided on liposuction on her already trim behind. As well as describing how she got sucked into the New York 'subculture' of the expensive and painful pursuit of physical perfection at the age of only 28, she also details the staggering expansion of the industry. Nearly 12 million surgical and non-surgical beauty procedures were performed in America in 2004, including more than 290,000 eyelid jobs, 166,000 nose jobs, 478,000 liposuctions and 334,000 breast enhancements, she reported.
'Despite the fact that those dense, silicone gel European breast implants known as "gummi bears" are generally illegal here [in the US], it's estimated that a third of all artificial breasts are "in trouble",' according to Kuczynski. That has not stopped the number of breast implants rising by 147 per cent in the past seven years, liposuction operations going up by 111 per cent and tummy tucks increasing by 144 per cent.
Botox injections, the controversial treatment where dilute botulinum poison is injected into facial muscles so that the paralysing effect smooths out wrinkles, have ballooned by almost 2,500 per cent since 1997. It costs about $500 to $1,500 a session and takes ten minutes to inject. 'You can get rid of forehead wrinkles in less time that it takes to get a manicure,' Dr Mark Erlich, a Botox specialist on Manhattan's Fifth Avenue, boasted to The Observer this weekend. New procedures include 'umbilicoplasty' (belly button enhancement), 'vaginoplasty' (the laser reduction of loose labial lips), and nipple enlargement . Women have toes shortened to fit into stilettoes. Overweight men have 'breasts' reduced.
Kuczynski, a columnist for the Style section of the New York Times, said she had no interest until she began reporting on the industry, then got lured in. She started with Botox twice a year and regular 'microdermabrasian' laser facial scrubbing at the age of 28, then progressed to liposuctioning a pound of thigh and buttock flesh. 'I am 5ft 11in and weigh 148lb. In Los Angeles this means I am fat, repulsive and cannot find a pair of jeans in any of the boutiques,' she said.
Finally, after eyelid de-fatting and more Botox, a lip-plumping injection went wrong in 2004 and she missed a post-funeral gathering to honour a friend. At that point, she knew she had hit the addict's rock bottom.
'She was gorgeous and tall, smart, a good writer, really beautiful, she never had trouble getting boyfriends. When I read about her surgery tales I could not believe it was Alex and that she had bought into that bull. I thought it was sad, pathetic,' said an acquaintance of Kuczynski from New York's feminist Barnard College, where they studied.
Now Kuczynski is 'cured'. 'Often I see a woman who has had too much plastic surgery. I see in her face a needy quality, a desire to be loved that is never quite fulfilled, the need to be approved that is never quite met ... I don't plan to age into that woman,' she said.
