Health: The bottom line: is surgery worth it?

Research shows that our bottoms are getting bigger. Surgery is a radical option, but is it ever the best solution?

Does my bum look big in this?" This must be the most frequently asked question after a close encounter in a brightly lit, cellulite-unfriendly changing-room. And the bad news is, our bottoms are getting bigger. Latest research says hip measurements are on average 1.5in more than 50 years ago.

Having a derriere that's heading south can be a major source of paranoia, as chronicled in Arabella Weir's book, Does My Bum Look Big in This? (Coronet pounds 5.99). The fictitious diary peddles the idea that life would be perfect with a small bum - and, frankly, many of us believe that to be true.

Body insecurity has prompted a boom in cosmetic surgery. The UK industry alone is now estimated to be worth pounds 180m and is expected to rise to pounds 200m by 2001. No longer the domain of the aspiring starlet, surgery is now more girl-next-door, as an increasing number of people opt for a quick nip and tuck to transform their looks.

However, the pursuit of the perfect posterior can end in tears. Thirty- eight-year-old Anne Evans, a personal assistant from west London, paid pounds 2,500 to have her bottom lifted. She decided to try liposuction, which is now the most common form of cosmetic surgery. A tube is inserted through a small incision in the skin and fat is sucked out, taking out chunks of flab (but, sadly, leaving any cellulite behind).

Anne Evans, who is a size 10, explains: "I've always been self-conscious about my bum because it was big and saggy. At work, girls would talk about low-slung bottoms (LSBs) and I'd think `that's what mine is like'. I've been constantly obsessed with looking at women's bottoms and comparing them to mine. I wanted to be able to wear a pair of jeans without having to have a jumper wrapped round my waist the whole time to cover my bum."

In June this year she checked herself in to the Transform Medical Group, a private clinic in central London. "My surgeon convinced me I could get the bum I wanted," she recalls. "But after the operation, I woke up from a general anaesthetic and the surgeon wasn't around. That night, at home, I didn't sleep. I was in a terrible state. My bottom looked completely flat, worse than before. In a panic, I called the emergency number at the clinic and left a message. No one called me back. So I had to call again. My bum had in fact dropped even more. I now had a flat, low-slung bum with no shape, or certainly not the shape I wanted."

Ms Evans went back to see the surgeon. "I was completely shocked by his behaviour - he was very angry and defensive and said, `you can't possible tell a week after surgery'. I was so upset, I almost passed out. I felt so vulnerable... I felt he was attacking me."

Six weeks later, she returned. "He said `it looks good to me, there is already an improvement', but it was still no better. I pulled out my `before' and `after' photographs - the sight of them made me cry. He just said `you can't tell from photographs, they're taken at different angles'. He also said it would plump out, but I don't see how it is going to suddenly spring into shape.'

Ms Evans is still not happy with the shape of her bottom. "This has been a disastrous job on my bum and I won't give up until it is put right," she says. "I should have listened to my friends, who said `you're mad, you've got a nice figure'. I would have been a lot better off."

David Cooper, managing director of the Transform Medical Group, said: "I can't comment on individual cases - a huge proportion of our business comes from satisfied patients who have been with us a long time. We are keen to demonstrate just how committed we are to patients' treatment. I can undertake to ensure that she will be entirely satisfied with her treatment, and would not rule out corrective surgery or a refund. We have been around for 25 years and are concerned that all work carried out should be to a high standard. We have a national complaints system for such matters."

Although the idea of having a nice, pert bum is appealing, the results of liposuction or a bum lift - which involves snipping the skin and tightening it over the buttocks - are often not very successful. Professor David Sharpe, a plastic surgeon at The Yorkshire Clinic, a private hospital, near Bradford, says: "The majority of plastic surgeons won't do it, but there are people who are happy to take your money - promising things they can't achieve."

"It is very difficult to try to lift the skin in the buttock area - you end up with unattractive scars. For liposuction to work, the skin has to shrink, but the attachment of the skin and fat in that area makes it a very hard procedure to do effectively. If you remove fat cells, the skin just drops. I generally try to put people off. Really, the best thing you can do if your bum is too big is to slim."

Not all cosmetic surgery is a success, or should be done at all, warns Michael Barratt, of the British Association of Aesthetic Plastic Surgeons: "Some of our surgeons spend a considerable amount of time repairing bad jobs done by cowboy clinics. Even something as simple as a nose job can change your personality, and you need to be warned about the risks."

Natural Alternatives to the Knife

Exercise:

For a natural bum lift, try cycling, swimming, the Stairmaster and step aerobics. You won't see instant results, but if you exercise regularly over time, your behind will begin to tone up and look more raised. It will get flabby again if you stop.

Skin creams:

Try Clarins' Body Lift 2000 (pounds 25 per 200ml) which is supposed to reduce thickness of the fat tissues and "lift" the skin if rubbed in daily for a month. You could also check out Clarins' Body Shaping Cream (pounds 28 per 200ml) and Body Firming Cream (pounds 28 per 200ml). The makers recommend shaping cream to tackle "a big fat bottom" and firming cream for "a saggy bottom".

Knickers:

The lazy way out is to pull on some bottom-enhancing drawers. Charnos has launched an improved version of Shapers briefs with the "bottom lift" feature (pounds 12; for stockists call 01159 322191). Or wait for the Aristoc Bodytoner knickers, which will be launched next year, with hidden buttock slimming panels.

When only surgery will do:

For further information on cosmetic procedures, and a list of surgeons who are members, send a SAE to: British Association of Aesthetic Plastic Surgeons (BAAPS) at the Royal College of Surgeons, 35-43 Lincoln's Inn Fields, London WC2A 3PN. Website: www.baaps.org.uk