An estimated 65,000 people had some kind of cosmetic surgery in this country in 1995, 90 per cent of them women, according to plastic surgeon Dai Davies in his book Safe Cosmetic Surgery (Metro Publishing, pounds 9.99). For many professional women, looking young goes hand in hand with maintaining their job and career prospects, and this in turn plays an important part in taking the plunge and submitting to the surgeon's scalpel.
"It's the ordinary person now," says Mr Davies, who works at Charing Cross Hospital in London. "We are all under pressure to conform to what the advertising people would tell us is normal. Employment is one great pressure. Someone in the public eye may feel under pressure. Life is competitive and we live in an ageist society," he acknowledges somewhat reluctantly.
Sixty-eight-year-old Trudy Cameron (not her real name) was facing a potential financial crisis when she decided to take the plunge and have a face-lift. A widow, she is still working as a personal assistant in a small company where no one knows her real age. Fortunately, she had always looked 10 years younger than she was, but she knew it wouldn't last much longer. She didn't want to lose her financial independence by being forced into retirement. "I'm not working for fun, but because I need to," she explains.
"I was getting very crepy round the neck, my forehead was getting lines that made me look permanently bad tempered. And my eyes needed attention. I'd been lucky up until a couple of years ago, but something needed to be done if I was to continue working. I'm a year or so off 70. Although you talk about the fact you shouldn't worry about ageism, it is still there."
Trudy had a full face-lift a few months ago. She first looked into it more than a year before, but couldn't get the finances together at that stage. Eventually she decided to draw on her savings; she won't disclose how much, but the operation can cost up to pounds 10,000.
"I had some reservations," she admits. "You worry about what might happen. But at the end of the day I decided I was going to go for it."
The surgery, which involved one night in hospital, was painless: "You don't know about it, other than coming round afterwards. I didn't ask for a mirror or anything, but when you do see yourself, you look as though you have been in a major car crash."
She was off work for two weeks "on holiday" but then caught flu, which took it to three. After that she was back at work, delighted with the results. There was some bruising and she still gets swelling under her eyes. "People say I look wonderful, but they don't know what I've done." In fact, only three people know, including her ("considerably" younger) boyfriend. "He was a bit worried but has been extremely supportive."
David Harris, senior consultant in plastic surgery at Derriford hospital, Plymouth, has carried out research showing 60 per cent of patients feel better about themselves psychologically afterwards. "But it ought not to be done on a whim. All these operations carry risks," he warns.
It is the risks that worry both Dai Davies and the Labour MP Ann Clwyd, who has been campaigning for several years to introduce regulation of the industry. "You don't have to be a doctor to operate on someone in this country," says Mr Davies, himself a fellow of the Royal College of Surgeons. "There are much tighter controls for operating on animals than humans."
The Department of Health admits that an unqualified person can legally perform cosmetic surgery, as long as they do not falsely claim to be a doctor.
Ann Clwyd, who put down an unsuccessful Ten Minute Rule Bill in Parliament in 1995, is still campaigning for tighter restrictions on the cosmetic surgery business. She claims 20 per cent of the operations carried out by plastic surgeons on the NHS are to correct botched cosmetic surgery in the private sector - a figure the Government disputes. According to the Department of Health, a six-month survey of 135 NHS plastic surgeons, completed late last year, showed only 49.75 hours of in-patient theatre time was used to rectify such problems and that only a "very, very small" use of NHS resources was made to rectify errors.
Ms Clwyd is furious at the survey. "Fifty out of the 134 British Association of Plastic Surgeon members did not even bother to respond to the questionnaire," she says. "The minister was eventually forced to admit that the data was `not sufficiently robust for us to draw any firm conclusions'. In other words, the survey was a complete waste of time.
"The cosmetic surgery industry cannot be allowed to continue in its present unregulated state," she states, claiming she has at least one letter a week from women who have been "scarred for life" by bad cosmetic surgery.
But in the current employment climate, where the pressure is on women to look young and eager, cosmetic surgery has become a consideration. After all, we can colour our hair to hide the grey, use make up to enhance our looks, even turn to HRT. Is cosmetic surgery such a big next step?
For the leading feminist writer Germaine Greer, aged 57, who advocates growing old gracefully, the objection is not cosmetic surgery as such, but the way it is marketed. "Everybody uses cosmetic surgery, whether to replace worn-out teeth or remove unsightly scars. The difference about the way painful, expensive and elaborate procedures are sold to women is that their anxiety and insecurity are cynically manipulated for profit. This is what is known as free enterprise," she says.
"The question you have to ask yourself is whether surgery really does make women look younger. As far as I can see, it does not. It belongs in the same category as expensive wrinkle creams that can do nothing to remove wrinkles"n