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Anyone who regularly reads newspapers and magazines will have noticed the recent splurge of ads for Liposuction, Liposculpture, Spot Fat Removal and other procedures that promise to transform you from a size 14 to a size 8. They all mean much the same thing - the removal of fat deposits - and many of us are buying into the "miracle" cure.

It's no wonder the cosmetic surgery industry is booming like never before. This year has seen a significant increase in the number of women opting for cosmetic surgery. Doctor Jane Ogden, a lecturer in health psychology at London University and author of the book Fat Chance (which looks at why women are obsessed with their bodies) believes the new waif models have put us under huge pressure to be thin. And thanks to cosmetic surgery, a thin body is now within easy reach. "At one time, women changed their shape with the use of figure-hugging corsets, but now we're reshaping what's underneath," explains Dr Ogden. "The eighties preached 'you can be what you want to be' but the nineties say you can also look like the person you want to be."

Liposuction, a procedure whereby fatty deposits are literally sucked from the body, is proving to be the most popular form of cosmetic surgery for young, image-conscious women who don't yet need facelifts or tummy tucks. There are now 200 cosmetic surgeons in this country offering liposuction. Once the fat cells are removed they do not return, but that's not to say you won't put fat on elsewhere. The 25% increase in the number of women opting for liposuction this year is mainly due to the support of women between the ages of 18 and 23. Suddenly, the focus of our lives are those lumps and bumps on our thighs, hips or buttocks and just won't respond to diet and exercise. It is these, and general obesity, that liposuction promises to do away with quickly and efficiently.

How it's done

Liposuction has been practised for 11 years in the UK. It was pioneered in Paris by Yves Gerard Illous and then popularised in States where tens of thousands of liposuctions are performed annually. Carried out by qualified hands, it is a quick and safe procedure.

A cannula (a long thin metal tube) is inserted into a tiny incision (about a quarter of an inch long) made in the skin. It is then rapidly moved around beneath the skin's surface to separate the fat globules, which are then melted and removed by vacuum suction. The operation is normally done on an outpatient basis, and can be carried out under general or local anaesthetic. Depending on the amount of work being done, it takes from about 20 minutes to an hour. A flesh-coloured corset, covering the area from the waist to the knees, is applied after surgery and worn for a week afterwards, and then for a few hours each day.

"The process has come on in leaps and bounds since it was first introduced in this country," says Anthony Erian the senior cosmetic surgeon at Nuffield House, the private wing at Guys Hospital. Erian has performed liposuctions successfully for 14 years and is constantly revising his "keyhole" technique. "In the past, bruising from liposuction would resemble a road atlas. There's no need for that now," he says. The day I met him, he was performing liposuction on a woman and her two daughters aged 19 and 24. "Their fatty deposits are hereditary," he told me. "One girl has what we call saddlebags (fat on the outside of her thighs) and the other girl needs light work on the top of her knees and inner thighs."

I watched him work on 24-year-old Amelia, from whom he removed a litre of pinkish-yellow liquid fat from the tiniest incisions. The process, which I don't recommend the fainthearted to witness, was light years away from the days when the only way you could remove fat was to cut it out. Erian never performs liposuction unless he has fully investigated the medical history, skin elasticity, and self image of his patients. "I turn down fifty per cent of people who come to me asking for liposuction," he says. "Liposuction changes shape but not weight. Some girls' expectations are unrealistic. You can't offer them the earth and then not deliver."

Unfortunately, that's exactly what some of the less scrupulous clinics do. Some adverts selling liposuction offer miraculous changes in no time at all, and even guarantee a totally painless procedure with no bruising. Some promise you'll be in one day and back to work three days later. But according to Erian, there's no such thing as 'lunch-time surgery': "You can't expect this not to be uncomfortable for a while," he says.

Dr Brian Mayhew, consultant plastic surgeon at St Thomas's hospital in London, is considered an expert in liposuction. He is aware of the vast number of 'cowboys' practising in so-called professional clinics around the country: "Because liposuction has become so advanced in recent years, it can be done with only a local anaesthetic and large disposable needles," he says. "For that reason, the field has opened up to untrained surgeons."

Sadly, these 'surgeons' are doing a roaring trade. "They make their profits from exploiting vulnerable young girls," says Dr Ogden. "Many don't need surgery at all."

Curious to find out what a surgeon would say to me, I called two numbers from advertisements for liposuction in a reputable fashion magazine and arranged appointments. At my first, the clinic's nurse took one look at me and very honestly told me I did not need liposuction. As far as she was concerned, the fat globules I'd invented on my thighs indicated my general low self-esteem. However, she agreed that perhaps I could afford to lose a bit here and a bit there, and soon got into full swing about how super I'd look on the beach next year. The cost of having two tiny spots of fat removed just beneath my bottom would be £2,090.

My second consultation was with a formidable woman. Without even looking at me she decided I should have large areas of fat sucked from my thighs. (As far as I was concerned, this so-called fat was non-existent. Still...) This would improve my lifestyle dramatically she told me. When did I want to begin?

I asked about qualifications of the surgeon, the risks involved, and the cost of surgery... and she skilfully avoided answers. "You obviously know nothing about this," she snapped, and proceeded to give me a basic lesson on skin structure (which I'd studied in more detail for my biology O-level). She told me that in order to go ahead with liposuction I would need a skin test to determine how clogged my skin follicles were. According to her, fat cannot be removed until the skin has been thoroughly detoxified. This on-the-spot detox was presented as a part of the 'free' consultation, but when pressed, she admitted there was a cost of £50 which would be deducted from the overall fee of £3,000. On top of that, I would have to pay for a full medical (£90), a consultation with the surgeon (£60), and a range of products essential to my aftercare (£47). When I asked for time to think about it, she told me I should leave a substantial deposit as her fees were about to go up.

This story comes as no surprise to Mr Mayhew. "As soon as you have to deal with a counsellor rather than the surgeon himself, the warning bells should ring," he says. "These so-called counsellors often have no training and are there to pull in the trade. After liposuction, they'll point out that perhaps you could have your breasts enlarged or your nose straightened. All the time they're counting the pound signs."

But even if you do see a 'surgeon', there is no guarantee he's a trained one. Both Mr Erian and Mr Mayhew are contacted monthly by women whose experiences at these clinics have left them with irreversible problems. "Some of those 'after' photos are a real mess," says Mr Mayhew. "I've seen people who have had uneven amounts of fat removed so there is noticeable asymmetry or corrugation of the skin. Sometimes too much fat is taken away, leaving a large hole. There's not much you can do about that. You can't put fat back." Mr Edward Latimer-Sayer, secretary for the British Association of Cosmetic Surgeons, who practices at Highgate and Belvedere Hospitals in London, adds: "It is important to check the elasticity of the skin. If the skin is flabby it will end up being even flabbier. Some untrained surgeons work too close to the skin, resulting in pits. If you don't go deep down into the fat cells the results can be disastrous."

While bruising and swelling will inevitably last for a few weeks after liposuction, work by an unqualified practitioner poses a serious health risk. Some cowboy outfits boast they will remove more fat than other surgeons, but the experts say that removal of more than three litres at any one time is highly dangerous. Some unqualified practitioners have taken up to eight litres of fat from individual patients. "Apart from dehydration, the body can go into shock resulting in circulation failure," says Jackie Sullivan of the Surgical Advisory Service in London. According to Mr Mayhew: "We don't hear about these cases because unsavoury clinics are anxious not to be exposed and often settle out of court."

According to Mr Latimer-Sayer: "There are all kinds of Herberts out there trying it. But liposuction is definitely not a minor procedure. Several deaths have occured in America as a result of liposuctions going wrong."

One controversial practice that many cowboy outfits are latching onto is Liposculpture. Done manually with a syringe, it literally sculpts rather than sucks fat. Some experts feel it is just media hype, a more glamorous term for liposuction which should sculpt anyway. After carrying out secret trials at one clinic offering liposculpture as a more gentle and safer way to lose fat, The Surgical Advisory Service concluded it was not clinically acceptable. "It was a long-winded treatment done under sedation and not anaesthetic," says Sullivan. "Our tester experienced great discomfort with it."

Another popular method of sculpting is fat by 'transfer'. Here, fat is taken from one part of the body and injected into other areas where there some dimpling of the skin. "But," says Mr Mayhew, "the transferred fat doesn't attach itself to the blood supply. It just dissolves away. You pay thousands of pounds for non-results." Another new method is ultrasonic liposuction, which dissolves the fat before removal and shrinks the skin. According to Mr Latimer-Sayer, this gives better results. However, Mr Mayhew is more concerned about the new use of ultrasound to dissolve fat. "It's actually slower than liposuction and takes away less fat," he says. "Even its manufacturers don't claim it's better than any other technique." Mr Erian is also sceptical. "It's only been around for two years. We don't yet know what the long-term effects are."

While liposuction carried out under supervised hands is by far the best method of fat removal, it should only be the last resort. All doctors are in agreement that liposuction is no substitute for diet and exercise, nor is it a slimming treatment. "Only when a woman has tried everything but still cannot shift genetic fat deposits will I even contemplate surgery," says Mr Erian, who is continuing in his quest for an even simpler method of surgical fat-busting.

What is it like?

Straight from the patient's mouth

Debbie Foster is a 30-year-old fitness instructor. She had liposuction 18 months ago with a registered surgeon she found through the Surgical Advisory Service. Work done on her knees, thighs and bottom cost her £2,300 including a consultation and six months of aftercare.

"I've always been thin. But I began to notice fluid areas above my knees and on parts of my legs. I didn't like looking at my legs and would hide them in changing rooms. I'd heard a lot of bad stories about liposuction, but I was desperate enough to risk it. I went for consultations with different surgeons. A lot of them tried to rush me into it and made me feel uncomfortable, but I found the people at the Surgical Advisory Service much more informative and understanding. After my surgery, I felt sore and tender - the pain was the worst thing about it. I also had bad bruising on my thighs. My legs were a rotten purple colour, but I'd been warned about that. Because I had a lot of work done, I stayed in hospital overnight and was put on a drip to stop my body going into shock. The first steps out of bed were agony. I didn't like wearing the garment (corset) very much. You have to keep it on for a week, and it has an opening under the crotch so you can go to the loo. Taking if off felt like taking off one of those clay wraps that set on you. But I did notice an improvement straight away."

"After a while, my leg swelled up, though only temporarily. Six months later there was a big improvement, but it took a year for the scar tissue to completely heal. My surgeon was honest with me from the start. He told me my legs woulnd't be perfect, but for what I put in front of him he did a really good job. The improvement wasn't just physical for me. It has made me more self-confident. Provided you shop around for a good surgeon and don't expect the earth, I would recommend liposuction."

Mary, 22, is a temp with an advertising agency. She had liposuction when she was 19, and her Harley Street surgeon was recommended by her GP. Work on the outside of her thighs cost her £3,000. "I was desperate. I had a fixation with my bum, which I thought was the biggest in the world. Nothing would dissuade me from having liposuction. I went to the first surgeon I heard about, so I suppose I should have been a bit more discerning. I let him talk me into doing whatever he wanted to do. I wanted a lot of fat sucked out from all over my legs and bottom, but in the end he actually only took fat away from the sides of my legs."

"The result? Well, I've still got my huge behind and most of the fat is still there. The surgeon told me he takes the same amount of fat away from each person, which seems ridiculous because I'm a lot bigger than the average person. The only difference I noticed was that my skin was smoother. I think I have a high pain threshold, but after surgery I felt like I'd had the stuffing completely kicked out of me. I was bruised everywhere. I couldn't sit down and going to the loo was agony. The pain lasted for around five days and the bruising took five weeks to go. It was a tidy enough job, the scar was pathetically small, but having paid £3,000 for what I consider to be a poor result, I felt conned. I believed having the fat sucked out of my thighs would be the end to all my problems and sadly, I was wrong."