Confessions of a Park Avenue plastic surgeon

He's nipped and tucked film stars, supermodels and even royalty. And now he's set to reveal the hidden face of cosmetic surgery. David Usborne gets a personal consultation with Dr Cap Lesesne

"The doctor will be with you in a moment," the nurse says, ushering me into a consulting room. So I wait. There is a desk and behind it a chair, with a dark pink Polo shirt, a pair of pressed jeans and a natty blazer slung over its back. Someone's in their scrubs already. In the background, I hear a whooshing sound.

The noise - it could be a vacuum cleaner with a case of the gurgles - is coming from a door down the corridor that, I soon learn, leads to an operating room. It's not hard to guess what's going on. My appointment today is with Dr Cap Lesesne, arguably the most successful and well-known of America's plastic surgeons - favourite face-lifter to the fabulously famous and filthy rich.

"Yes," he confirms, emerging a few minutes later to shake my hand, "a young woman getting liposuction to get her started on losing weight - to give her the courage to get out there." He had recently removed unwanted breast tissue from her 14-year-old brother and the confidence boost for him had been transformative, he explained. "His mother wrote me a letter afterwards that almost made me cry."

Damn. My plan had been to poke some fun at this purveyor of phony youth. I belong to that snooty school that scoffs at the suggestion of "having work done", so don't tell me about changing the life of a kid. What about the actresses and self-obsessed models? And what happened to growing old gracefully?

The softly spoken, effortlessly charming Dr Lesesne smiles back at me. "It died in every culture. It's gone." He then throws me a morsel. He did have a famous actress in this morning for some lower eyelid adjustments. Because he knew I was coming, he did the procedure at 5.30am. "I said to her afterwards, 'You have to get out of here.'" I just missed her.

Also in the first minute of our meeting, he lets me know that later in the day he will be flying to Heathrow and from there to Istanbul, where he will be consulting with some very rich patients. And on his way back there will be a longer stop in London and more patients to see.

Indeed, he gets rather a lot of customers from Britain these days, to the point where he would love to open a practice in London, medical certification rules permitting. He is right now working on a deal to sell his own line of skincare products in Selfridges. It all started, he confides, with an e-mail from a London woman whose social station is about as lofty as it can get. (He tells me more, but legally I cannot reveal it in print.) She had had two operations and both had turned out badly. So she crossed the Atlantic to Lesesne, who put it all right. "It's been slow trickle of British patients ever since."

Most of us will admit to a fascination with plastic surgeons, even if we disapprove. Guessing who has or has not had their nose planed, jowls pinched or buttocks hoisted has become a whispered game of every cocktail party. Dr Lesesne knows this more than anyone. To the distaste of some in his profession, he has recently written a book. Teasingly called Confessions of a Park Avenue Plastic Surgeon, it comes out here this month.

The book is not quite the juicy tell-all the title implies. It is partly a narration of Dr Lesesne's journey to this his perch on Park Avenue (almost all of Manhattan's most expensive plastic surgeons are here on a 15-block stretch known as the Gold Coast). And it will probably become a must-read for anyone considering cosmetic surgery for the first time. Of course, he cannot name names, although I swallowed hard at the page where Yasser Arafat walks into this same office. In fact the Palestinian leader was just lost and should have been on the other side of the road for secret peace talks with the Israelis.

Dr Lesesne, himself a youthful 50 - just a little Botox, he admits - started writing short stories about his patients for his own amusement. "This was a group of pretty funny stories," he explains. Then in 2004, a literary agent friend urged him to put them together in a book. "At first I thought this was the biggest waste of time but he said, 'Just wait.'" When it was done, the book became the object of a bidding war between eight New York publishers.

It's true that he has had experiences that are worth the re-telling, like the case of the gay man who came to his office and asked for breast implants on his back to give his partner something to hold on to when they were making love. Dr Lesesne says he quite often turns people down if their requests are too narcissistic or risky. This was definitely one of those occasions.

"That was right up there," he laughs, when I ask if it was the weirdest of his encounters. But very close was the episode, also in the book, when he was hired to operate on the queen of a foreign country. He and his anaesthetist were just beginning the procedure when a bodyguard brandished a handgun and informed them that if the patient were to die, they would too. "I have diplomatic immunity," he said.

You don't need Dr Lesesne to tell you that plastic surgery is no longer a fringe hobby for a mere fraction of society. No wonder it has become the subject of two highly popular cable television shows in the US, most notably Nip/Tuck.

"It is growing explosively," he explains. "I don't think it takes a large amount of disposable income for people to be interested today. The fastest growing area for plastic surgery is men, especially businessmen. Gay men have been doing it for a long time, but now I am seeing guys from IBM and banks. They are afraid of the competition from younger men."

Dr Lesesne has seen a surge of patients coming to him after losing colossal amounts of weight, sometimes through intestinal bypasses or stomach-stapling. Operations on these people tend to be much more risky. He is also seeing patients, on both sides of the Atlantic, wanting work at younger and younger ages, often in their twenties. "People are coming in not just to change the ageing process; they are coming in to change the trajectories of their lives."

Expectations, meanwhile, get ever higher. In the book he describes giving liposuction to a model just 72 hours before a photo shoot. Dr Lesesne notes that women are sometimes upset that recovery isn't instant and that often he has have them back for corrections. Men tend to be more easily satisfied. In some cases, there is just no pleasing women, ever. "I have a patient in San Francisco. We recently gave her breast implants. They are perfect, absolutely perfect. But she is upset because one breast is 1/64 of an inch lower than the other side. I told her, 'I can't do any better!'"

I recently celebrated a birthday that brings me closer to 50 than 40. Maybe it's just that I have been in New York too long, but, anyway, out pops the obvious question. "Erm, doctor, what would I need?" "I think a little Botox first of all in the crows' feet. Your eyebrows are coming down so we could do a micro eyebrow lift. Then I'd take a little of fat out of your neck and take down that bump on your nose. And that's about it." All that in one hour and fifteen minutes and for about $15,000, he says. And what, precisely, would it do for me? "You'd probably drop down to your early thirties. And it is so subtle, nobody will know." I leave the Dr Lesesne's office a little dizzy. I even catch myself working out how to raise 15 grand in a hurry. I get what it's all about now. If I had the spare cash would I do submit to Dr Lesesne's knives? I am not telling. (In case I do.)

Confessions of a Park Avenue Plastic Surgeon by Dr Cap Lesesne (published by HarperCollins, £6.99) is out now. To order your copy with free P&P call Independent Books Direct on 08700 798 897