Why lips are getting bigger

Despite celebrity 'trout pouts', there's a rush on for lip-enhancements. Is this about vanity, or something more sinister?

Lillian McGill has got her first Christmas present alread:, a set of new lips. At a cost of £330, a series of injections has given her a fuller, more voluptuous and youthful-looking mouth, ready for the start of the party season.

The 50-year-old receptionist from Newcastle is one of a growing number of people, mainly women, who are opting for revamped lips. Undeterred by the much-ridiculed "trout pout" of the actress Leslie Ash, and not put off by the post-lips career downturn of Coronation Street's Lynne Perrie, the number of people seeking lip-enhancement has increased threefold.

A reported pre-Christmas rush for new lips means that many partners will experience a new kissing experience, although exactly what they will be kissing under the mistletoe is uncertain. Beneath those new, fuller lips may be body fat re-sited from the kisser's backside; a layer of collagen; skin from an unknown donor; or GoreTex (a material used in anoraks and rucksacks), among a range of other materials.

It is estimated that up to 60,000 people in Britain now have cosmetic surgery or enhancement of some kind each year. Every week, in excess of 1,000 women, and men, have faces lifted, noses reshaped, breasts enlarged, ears pinned back, cheeks accentuated, wrinkles smoothed, chins shrunk, and fat removed with the surgical equivalent of vacuum cleaner.

Pumped-up lips are fast becoming one of the most popular types of cosmetic surgery, because one of the problems with lips is that, left to their own devices, they get thinner as they get older. While wrinkles, eye bags, bellies and ears get bigger with age, lips get smaller because of the loss of natural material. And as voluptuous lips are regarded as a sign of beauty and sensuality, it is perhaps not surprising that those wanting to retain the looks of youth should make use of available medical technology.

The main way to restore lips to the fullness of youth is to inflate them with some kind of implant. Just what that implant is varies between techniques and surgeons. There is GoreTex, a non-reactive porous material that can be implanted in various thicknesses and sizes, and that maintains its size once implanted as well as staying effective for a considerable time. Some American surgeons believe that the dream team is GoreTex for the lower lip, and an implant material made from skin stored in tissue banks for the top lip.

Injectable materials such as collagen are highly effective, too, especially for those who don't want surgery associated with implants, and there are also fat injections. Leslie Ash had collagen injections, while Lynne Perrie had fat injected into her lips. A downside of some of the injectables is that the effect doesn't last as long as some of the surgical implants.

The fundamental requirements for lip materials, as for many other types of implant, are that they are soft to the touch, have no sharp edges, and don't move around under pressure, or migrate up towards the nose or down to the chin when in active service. Lip shapes can go out of fashion. While fuller lips are almost always in demand, the shape may change: "Fashion has a dramatic impact on the most sought-after mouth shape - this season, the pout is out and has been replaced by "the wave", with many customers being influenced by the current Sixties revival and looking for a Julie Christie-style lip look that accentuates the overall shape of the mouth, with an extra boost to the lower lip,'' says Louise Braham, director of the Harley Medical Group, which has 10 clinics around the UK. She says that treatments such as lip-enhancing are now such a regular part of many people's beauty routines that they are slotted in like a trip to the hairdressers.

The increase in demand for cosmetic surgery is put down to a number of factors, ranging from longer lifespans, and greater body awareness, to higher rates of divorce, more middle- aged men and women looking for partners, and celebrity worship. It is not uncommon for customers to ask cosmetic surgeons to reproduce the physical features that they admire in a celebrity. The irony, of course, is that as celebrities are the biggest users of cosmetic surgeons, that perfect nose and those prominent cheekbones that customers desire may be Hollywood-made rather than heaven-sent.

Dr Virginia Blum of Kentucky University, the author of a new book entitled Flesh Wounds: the Culture of Cosmetic Surgery, says that as well as celebrity worship, people are attracted to the cosmetic-surgeon's knife because they want to conform to what society sets as the current fashions. She likens it to shopping, and says that it doesn't work because people always want more. "Cosmetic surgery is not just about beauty, it is about transformation. It is about people wanting to change themselves, which they can never really do," she says. "There is a puritanical view that it is bad for the individual to give in to the seduction of appearance, and bad for the culture to put such value on appearance. I don't think that persuades anybody not to do this stuff. What worries me about this is that it suggests that cosmetic surgery really does work, and that it is something fabulous and fulfilling.

"I say that it is not that great. It is like a shopping high. The postoperative period is the most intoxicating period, and people are blissfully happy at this stage. But that effect wears off.

"It is like buying a new outfit. When the newness wears off, suddenly you don't look as good as you thought. Your nose looks better but perhaps something else now doesn't. It can make people feel worse."

Another much less talked about, and more serious, side of cosmetic surgery is that a small number of people who seek to change their appearance may be ill. In body dysmorphic disorder, or BDD, sufferers have a preoccupation with imagined or minor defects in their appearance. They are often dissatisfied with the results of their surgery. It is a difficult condition to diagnose, but some practitioners believe that if a patient says their self-image is contributing to romantic problems, or keeping them inside the home, or preventing them from holding down a job, it may be an indication of BDD. Sufferers may also always wear a hat to cover their perceived defect, or multiple layers of clothing, or excessive amounts of make-up.

In the first study of its kind into BDD and cosmetic surgery, psychiatrists at Pennsylvania School of Medicine found that seven per cent of cosmetic-surgery customers met the diagnostic criteria for BDD. Professor David Castle of the University of Melbourne has also warned that BDD is more prevalent, and dangerous, than many other mental illnesses, including schizophrenia. Researchers at the Royal Free Hospital and University College London who looked at 25 sufferers of BDD found that they had undergone 46 different cosmetic-surgery procedures.

But for many people, such as Lillian McGill, altering one's appearance can be a positive experience: "I am 50, and my lips were much thinner than they used to be years ago,'' she says. "I was conscious about them all the time, and I'd been thinking about having the treatment for two years. Two weeks ago, I decided to have it done in time for Christmas, when I go out more and there are more parties.

"I had both lips done. Once they were frozen they injected Restylane into them quite a few times. It took 40 minutes. People say that the difference is tremendous. I feel more confident. You hear horror stories about huge lips, but mine have turned out really well - and just in time for Christmas, too!''