Eye witness: Nips, tucks, Botox and breast jobs – brace yourself, this gets bloody

Plastic surgery is no longer the province of the ugly rich. Britain is now third in the league table for cosmetic operations

Squeamish? Avert your eyes then, because this is going to get bloody. The lady who is now flat on her back in the operating theatre, arms spread out wide, was a bit shy about letting me see her breasts a few minutes ago. She was sitting upright, with a straight back, in the consulting room as the plastic surgeon marked her skin with a purple pen.

"This lady feels time has taken its toll," said Alex Karidis, the handsome, confident and wealthy surgeon in whose hands she had literally placed her bosom. "We are going to try to do something for her."

He measured the distance from her collarbone to each teat. "See this nipple here? We are going to lift it nine or 10 centimetres, and it will point upwards instead of downwards. It's a bit like dressmaking: we have to cut exactly according to the pattern."

The lady smiled nervously, though she was not new to plastic surgery. Her tummy had already been tucked, and her love handles sucked away. Next on her wish list was a chest as pert as it had been in her teens, two or three decades ago.

Her breasts were not unsightly. Cosmetic surgery is not only for the ugly rich or celebrities like Julie Christie these days: last year there were 24,336 operations in this country, the most in Europe. A world league table has just been published showing, as you would expect, that Americans go under the knife most often. Brazil, where there has long been a cult of beauty, came second. But Britain was third, with twice as many ops as Germany. We spend £180m a year having our bits cut, pumped up or remodelled. The most popular treatment is Botox, a paralysing agent injected under the skin to smooth the signs of ageing.

Alex Karidis squirts Botox into his wife's face every four months or so, and he has also sucked the fat cells from her stomach. She is a dentist by training, but now works with her husband at his private practice in St John's Wood and Harley Street, London.

Mr Karidis is currently scraping the top layer of skin from his latest patient's right breast with a scalpel, leaving a withered brown nipple surrounded by the glistening white dermis. To stop the blood he cauterises the exposed flesh with what looks like a soldering iron, sending up tiny wisps of smoke. The meat turns brown, like mince in a frying pan, and the sickly sweet smell makes me nauseous.

"I suppose you get used to that?" The nurse, who is leaning over the body, sucking away the smoke with a little plastic tube, shakes her head.

"Fire away," says Mr Karidis. "I can talk and operate." Fine, but I'm not sure I can watch this and ask questions. Yellow globules of fat spill out from between his fingers as they push further under the skin. It is as though he has sliced open a balloon, packed with pasta curls in a wet tomato sauce, and is now trying to stitch it back up again in a different shape. The pile of bloody swabs gets higher.

"This is not as gruesome as a facelift," says the 40-year-old surgeon, who likes to sing along with the radio as he works. "Then we basically take your face off and stick it back on your head."

Mr Karidis was born in Montreal, but got his medical degree in Greece in 1986. He came to England soon afterwards, and worked in the NHS for a decade before going private. The increase in demand for cosmetic surgery since then is down to the economy doing well, he says, and Britons becoming more style-conscious.

"It used to be regarded as freakish; now most of us know somebody who has had something done," he says, looking up from a stitch. "The internet means people are coming to consultations knowing all about what we do. Some of the older surgeons are not happy about that: 20 years ago they were gods, shrouded in mystery; now they have 20-year-old women asking what sort of incisions they use."

His patients include taxi drivers and teachers as well as the very rich. Some do not have obvious defects. "A lot of good-looking people come to see me, because they are perfectionists. They get a little addicted to surgery, to be honest. Still, it's their life."

Earlier I saw him suck two litres of fat from the thighs and buttocks of a 31-year-old woman, by pushing a thin metal pipe through a series of small incisions. He jiggled it about until the vacuum pump on the other end pulled sticky pink blobs into a flask.

"Some people have lovely, soft fat," he said. "In other people it's like chewing gum and you really have to work hard."

Mr Karidis also did a nose job, another liposuction and tweaked some eyelids today. He put in the last stitch nearly 12 hours after starting surgery, having earned at least £1,000 an hour.

The bleep of the heart monitor reminds me there's an anaesthetised woman under the blue sheets, ignorant of what has happened to her body. It will be 10 days before she is well enough to go back to work, and start saving for another snip. The scars will take longer to heal. Her lover will have to keep his hands off for quite a while.

For the operation, the hospital bed and the aftercare, she will pay £4,500. As they wheel her away, poorer but perter, I can only hope she thinks the results are worth it.