Ian, Hazel's boyfriend, is so pleased with Hazel's new pout that he has bought her not one, but three new lipsticks from L'Oreal - a bright red, a purple lilac, her favourite, and a brown. Hazel, a youthful 38, with attractive, nut-brown eyes has just purchased a permanently pouting new top lip at a cost of pounds 1,500.
The permanent pout is a relatively new surgical procedure, using freeze-dried skin tissue from America. Before this new procedure became available, women wanting Pamela Anderson pouts have had to undergo repeated collagen injections, which dissipate into the body after three months.
I first met Hazel just days before the operation, and then she was brimming over with excitement, rather like a child before a birthday. She explained, then, why she wanted a proper pout and why she was so excited about it: "I have always had really thin lips, and they are also slightly uneven. I have tried to compensate by putting loads of lipstick on, but I always end up going over the edges.
"I have wanted to do something about them for a long time now. Unless you have really thin lips, you can't understand perhaps, why anyone would actually want an operation to make them bigger, just like I suppose someone with a perfect figure can't understand a woman wanting liposuction or breast surgery. I looked at collagen injections, but they don't last, so the AlloDerm seems like my best option."
AlloDerm is a sterilised, rehydrated skin tissue taken from human corpses and only available from one company based in the United States. The surgeon makes two incisions, on either side of the mouth, and threads the tissue under the surface of the lip, in a procedure lasting just a few minutes. The tissue, which fuses with the patient's own dermis, has been used for the last three years as a skin graft for burns treatment and for scar reconstruction. This is the tissue's first purely cosmetic use and in Britain only a handful of Harley St practitioners use it in this way. British plastic surgeons, such as Richard Downes, who inserted the material into Hazel's upper lip at his clinic at 103 Harley Street, purchase the material direct from the American manufacturers.
AlloDerm is freeze-driedskin tissue rendered inert by the removal of the cells, leaving a human tissue matrix made up from what is left - capillary walls and collagen. Before rehydration in saline solution, AlloDerm looks like a sheet of off-white, thin, flexible cardboard.
Whereas in Britain it is illegal to trade in human body parts, the company which manufactures AlloDerm is licensed to sell the tissue to surgeons. The company, LifeCell, which is based in Texas, is aware of the potential for controversy that the use of donated tissue for cosmetic purposes provokes. "LifeCell has never promoted AlloDerm for lip augmentation," says Jane Lee Hicks, the company's product development manager. "We have a licence to promote the tissue as a skin graft for burns. Once the surgeons have purchased AlloDerm, we cannot stop them from using it for other purposes."
Ms Hicks admits that the use of AlloDerm in purely cosmetic procedures has opened up a grey area, but she argues that it is very difficult to define in plastic surgery what is purely aesthetic and what is not. "Reconstructive surgery for cleft lip can use AlloDerm, and some people have such thin lips that they interfere with their speech patterns. Neither of these conditions is medically life- threatening, yet surely you would agree that they are suitable candidates for surgery using AlloDerm.
"Similarly, if someone does not like the look of their mouth and if that person becomes stronger and more confident by having an AlloDerm augmentation, then who should arbitrate over whether they should have access to AlloDerm or not?"
AlloDerm is derived from pieces of skin tissue, usually taken from the back or stomach, and LifeCell markets it in varying sizes, from 7cm by 7cm for large wounds, to 1cm squares for smaller procedures such as gum grafts. The tissue is sold for a sliding scale fee, starting at $50 for a 1cm square, rising to $400 for a 3cm by 7cm sheet.
Plastic surgeons specialising in burns treatment here in Britain argue that they are not yet convinced of the tissue's safety and would therefore only use it in a medical emergency, rather than for a non-urgent cosmetic procedure. "I am not sure whether all the potential for virus transmission has been solved," says Mr Bill Dixon, consultant plastic surgeon specialising in burns at Morriston Hospital, in Swansea. "Where at all possible, I prefer to use skin grafts from donor sites on the patient."
Hazel Lansdale is not concerned about the provenance of her new lips. "It's not like they don't clean it or anything first. It's completely sterilised. They use it for burns, so it must be safe,"she says.
John McGregor, a consultant plastic surgeon who specialises in facial surgery both within the NHS, at St John's Hospital in Livingstone, and in private practice, has not used AlloDerm in treating either his private or NHS patients. "It is an expensive material to use for burns. As for something like lip augmentation, you might be prepared to donate some of your skin for a relative or for someone with serious life-threatening burns, but you might not be particularly happy if your skin is being used to make someone's lips bigger," he says.
Whereas AlloDerm costs surgeons approximately pounds 30 per square centimetre, fresh frozen skin sold to burns units via NHS skin banks costs just 34 pence per square centimetre.
Jackie Sullivan, who runs the Surgical Advisory Service in Harley Street and who has arranged Hazel's operation, argues that AlloDerm is available commercially on the open market and no one is losing out. "If there were a shortage of it, that would be another matter," she says.
After the operation, during which Hazel says she felt no pain at all, "just rather a pleasant sleepy feeling", her new top lip takes about two weeks to settle down and another week for an inflamed area, where she inadvertently tugged at her stitch, to heal. During this time she has applied antibiotic cream and Vaseline to her lips, to prevent infection.
Before the operation, Ian had been saying he was looking forward to Hazel looking like Pamela Anderson. Does she feel like Pamela now? Hazel demurs. "It's all very new. I really like it. So does Ian. I don't know how he feels about kissing me yet, because my lips have been too swollen to kiss up until now," she says.
"I'm very very happy with the Surgical Advisory Service, who arranged the operation for me and I'm already planning to have my facelift there, which Ian is giving me for my 45th birthday present."