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Cosmetic surgery is on the increase in this country. We may not have quite caught up with the Americans, who give their teenage children nose jobs as birthday presents, but the stigma attached to altering our appearance is on the decline.

Nearly all cosmetic surgery in Britain is carried out privately, although occassionally there may be grounds for NHS treatment, sometimes at a private hospital. Children with protruding ears, for example, may come into this category, as may adults with sagging upper eyelids interfering with vision.

In the Cambridge area, you can now choose between having your operation carried out by NHS consultants at private hospitals or by a surgeon doing private work only at a private hospital.

There are three consultant plastic surgeons based at Addenbrooke's Hospital who do cosmetic surgery. Most of this work is carried out in private hospitals. They will shortly be joined by a fourth surgeon.

They agree that the regulations governing who may carry out cosmetic surgery in this country are not as tight as they could be.

The Addenbrooke's surgeons say the golden rule is always to consult your GP first so you can be referred to a reputable surgeon.

Two years ago, one of them, Mr Robert Campbell, gave his backing to a Private Member's Bill introduced to outlaw rogue cosmetic surgeons.

The Addenbrooke's surgeons are all accredited members of the British Association of Plastic Surgeons and the British Association of Aesthetic Surgeons, the two official bodies of plastic and cosmetic surgery in this country.

Plans are being discussed to draw up a BAAPS register of accredited cosmetic surgeons which doctors would have to be listed on if they wished to practise.

In the meantime, people can find out who is on it by contacting the Royal College of Surgeons.

Cosmetic surgery is a growing business. Anthony Erian, a cosmetic surgeon for 17 years, who opened a private hospital in Orwell about a year ago, specialising in cosmetic surgery, asks: "Why spend £1,500 on a two-week holiday when for the same sort of money you can get rid of the bags around your eyes, which will last a lot longer?"

Mr Erian believes we should not think of cosmetic surgery as something just for the rich. "It is on the increase and it is a neccessary part of society, but it has to be done correctly", he said.

"The defects we see in ourselves may not really be very noticeable but they can have a deep psychological effect. Why not deal with them if it is possible?"

Mr Erian recommends that patients inform their GPs before proceeding with cosmetic surgery.

Lifting spirits with surgical help...

The belief that cosmetic surgery is only for the rich and the vain is a myth. Increasing numbers of men and women are now prepared to admit to having an operation to improve their appearance. But the air of secrecy still persists.

Sarah (not her real name) is 38 and the mother of three children aged between 10 and 3. She lives in a village near Cambridge with her husband, who works in the City.

About 18 months ago she decided to have an operation to increase the size of her breasts. The operation, known as breast augmentation, cost about £2,500.

Sarah, a tall, slim, extrovert woman, is delighted with the results of her operation. This is her story.

"I always had very small boobs - quite firm, but small", says Sarah. "I was about a 34A."

"Then I had three children and breast-fed them all. After the little one, my breasts almost disappeared. They were like squashed eggs. They were also at different heights. One nipple was much lower than the other. They were so ugly."

"I was going to exercise classes at the time and I told the girls there I was considering having surgery. They said there was nothing wrong with them but that was because they did not see them without a bra on. Then one day we went out clothes shopping together and I took my bra off to try on a dress. Then they said they understood.

"I was so determined to have it done. I did not think about any of the problems. I have never made a secret of it. My breasts were a standing joke with my friends. If I had suddenly appeared with boobs everyone would know. When you start talking about it, people want to know more and it encourages them to try. It is nothing to be ashamed of.

"I do not think I would have a chunk off my nose. I do not want to look like a Barbie doll. It was myself I had it done for. I was on such a high afterwards. I think you have to have reached a low point to consider surgery, going in to hospital and going through a certain amount of pain."

"My operation was actually uncomfortable but not painful. Being bandaged up was the most uncomfortable thing. I could hardly breathe."

"Now I am about a 34B. I did not want to become a Baywatch girl and look false. My breasts look natural. I wanted nice, normal breasts and that is what I got. I still haven't got a cleavage. The surgeon said he could not give me that. But you can get bras that will do it.

"I went on holiday this year and I was asked if I was going to go topless. I didn't. I would never have done before. I am not going to flash them around. They are mine, not to show off."

"The scars have almost disappeared now. Looking better makes me feel better. It was better than buying a new wardrobe."

"I have never been overweight but I think it must be something like being too fat and you look and feel awful. If you are overweight, you can do something about it but if you have no breasts you think you are stuck with it."

"My husband was not really involved. He does not like big breasts and did not want me to come back with huge boobs. But now he thinks they are great."

"When I was younger I did not agree with cosmetic surgery. You can be very hypocritical about it until you are in the same position. You cannot pass judgment until you are. I wish I had had it done when I was younger. It would have boosted my confidence. Some people have been hostile. They seem to think that I have betrayed women and just done it to please my husband, as though it was a feminist issue."

"The most embarassing thing about it all was going to see my GP right at the start. You have to pluck up the courage to do it. I could see myself changing my mind and saying I had a sore throat."

"He was actually very good and did not try to talk me out of it. I asked his advice about where I should go to have it done."

Sarah says she has had no problems since the operation, such as hardening of the tissue, which can happen with silicone implants.

The knowledge that her mother had had successful breast reconstruction following an operation for cancer helped her confidence, she says. The process was similar and her mother had had no complications.