In Britain we have only begun to recognise the allure of cosmetic surgery. In the United States, the likes of Marlene Dietrich, Bette Davis and their face-lifts are long dead. For Joan Crawford, plastic surgery was an essential: "Beauty may be only skin deep, but ugliness goes all the way to the bone."

It is not just women who are captivated by liposculpture, chemical peels, tummy tucks, collagen injections and silicon implants. Clark Gable's wives paid for his teeth to be rebuilt and eventually extracted in toto (they were so bad that Vivien Leigh hated kissing him in Gone With The Wind). Both Gable and Bing Crosby had their ears pinned back (glue did not work for Bing). The Kirk Douglas chin dimple is high on the menus of plastic surgeons in Beverly Hills and is just one feature of Michael Jackson's complex reconstruction as an android of uncertain origin.

Nineties Britain, in which the gym has for some become a new place of homage and the flat stomach the Holy Grail, should offer plenty of rich pickings for plastic surgeons. As Angus McGrouther, the UK's first professor of plastic surgery, said in a speech last night, we should recognise how cosmetic surgery can transform a person's self-image.

We do not need to agree completely with the professor when he said: "Disfigurement is the last bastion of discrimination." Yet plastic surgery often does more than pander to vanity. It could dramatically improve the quality of life for many of the two million people who suffer some form of disfigurement.

The health service has better things to spend its money on than creating a better-looking nation. But that does not mean cosmetic surgery has no place in state-funded health care. Children, for example, can be cruelly taunted over disfigurements that can leave them emotionally wounded for life: a sympathetic attitude should be taken in funding their treatment. The removal of an unsightly and ill-judged tattoo might dramatically improve someone's job prospects.

Nor should we be censorious about surgery that it is privately paid for. A liberal society should allow adults to alter their bodies as they please, free from sneering.

The real risk with plastic surgery is not that it allows choice but that it is the bearer of homogeneity: beautiful people, with anodyne good looks, perfect smiles, straight noses and a persona modelled on soap operas from Australia or the West Coast of the US. One of the forces that is driving people to the surgeon's knife is an intolerance of difference.

If this social conformism had triumphed through the ages, imagine what would have become of portrait painting. Instead of the full character of the human face, warts and all, straining with effort, conveyed by the great Russian portrait painters such as Repin, we would have had rows of smiling lookalikes with fake tans. We should defend the right to be different, embrace diversity and take pleasure in what conformists regard as ugly.