Diane Coyle was born with a facial growth. Why did she wait so long before having the cosmetic surgery that changed her life?
By the time I was a baby of six weeks old, I was well on the way to being utterly disfigured by a growth above my right eye. This is the tale of how I spent a quarter of a century with my life dominated by having a face that strangers would stare at then turn away from - and a hymn of praise to cosmetic surgery.

Not just cosmetic surgery for "deserving" cases like mine, but for anybody unhappy about how their body looks. Another attractive young woman, the novelist Joanna Briscoe, interviewed recently in this section, has trotted out the myth that women are forced by sexism and ageism to submit to the scalpel just to look better. Wrong: the surgeon is the liberator, not the oppressor.

As shown by the few early photographs of me that exist, the growth on my face was horrific. In one my aunt holds me up to the camera, an otherwise fat and jolly baby in a silly bonnet, her face turned away from me as if she could not bear to look. It was a reaction I grew used to.

I spent most of my first two years in hospital. The tumour was removed, and plastic surgeons repaired what they could. In the early Sixties it was a relatively new discipline, and medical photographers recorded my progress for the posterity of textbooks. My mother tells me that my hands were tied to the crib for much of the time to stop me tearing off my bandages. Each day she would travel to the hospital after work and untie me for a cuddle.

By the time my memories begin, when I was four or five, the surgery was all over, although the quarterly trek to the hospital lasted into my teens. I learned to live with damaged sight and a damaged face. The other kids at my primary school called me Chinky because of the nearly closed and slanted eye. Adolescence was hell; with hindsight, I realise that I grew very depressed, although that wasn't the kind of language we spoke in a sombre Lancashire mill town.

Well-meaning friends always told me that when you got used to how I looked, you would hardly notice anything was wrong. Apart from the occasional bout of throwing myself on the floor and howling about the unfairness of it all, I got used to it myself.

Until, when I was 25, a wonderful optician asked why I had never taken the trouble to have some cosmetic surgery. "Does it not bother you?" he asked. I bowled out of his shop straight to my GP for a letter referring me back to hospital - the place I hate the most in the world.

I don't think anybody who has always been attractive can have any notion about the vacuum that looking abnormal in any way creates at the centre of your being. In her book In the Mind's Eye, Lucy Grealy, part of whose face was destroyed by cancer of the jaw, pins down the essential uncertainty. "Was I lovable, or was I ugly?" she wrote. It is not social pressure but human nature that turns people away from the ugly. If you are the one from whom others turn, it is impossible not to take it personally.

So my extra eyelid tuck at the age of 25, a medically unnecessary procedure, was in fact the one that made all the difference to my life. It is the same operation that some Asians have to make their eyes look more "Western".

For the first time I could face the world without hiding behind a curtain of hair, Gabrielle-style. I had the self-esteem to succeed in a relationship with the man who has been my husband for seven years, and to switch to a career that involved meeting lots of people. The surgery was gruesome and painful, and I would do it again in a trice if I needed to.

Maybe there is something more deserving about people who want cosmetic surgery for medical reasons; the NHS certainly thinks so, because it will pay. But anybody can be psychologically scarred by insecurity about a big nose or a sagging jaw. The technology is there, the good clinics are safe, and I applaud women who think it's worth spending money on cosmetic surgery. It's money spent on themselves and their happiness.

Myself, I think boob jobs are frivolous, and done more for men than for women, but I wouldn't presume to patronise the motives of women who have them. What can any of us know about the depth of other people's insecurities?

In an article in the current issue of Vogue, Ms Briscoe presents her novel as an attack on ageism as much as on sexism. She writes: "Our expectations of what people in old age should actually look like have been transformed in a process as powerfully manipulative as it's subtly slick." Women well into their fifties are now supposed to look like babes of 30, she complains, triggering an "epidemic" of brutal cosmetic surgery.

Is this different from the "epidemic" of hip replacement operations that allow women of 80 to walk like 60-year olds? Nature is not kind to females. Medical technology has made possible all sorts of improvements to human life. We are all technological constructs, from our teeth to the muscles developed on a Nautilus machine, from the food we eat to our lipstick. Cosmetic surgery is no different.

So I say to Joanna Briscoe, as to the glamorous Naomi Wolf and Susan Faludi before her: sister, don't tell me what you will permit me to look like. We make the best judgements about our own livesn