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So, what if your face needs re-arranging?

The first step is to go and see your GP, but unless your problem is causing you serious discomfort, like a badly shaped nose that's giving you breathing problems, you're unlikely to get it on the NHS. Your only hope is to convince him or her that your physical defect is affecting you psychologically, and your doctor may recommend you to a psychiatrist to check that you're disturbed enough to need surgery. If you're one of the few referred for NHS treatment the wait can be anything from three months to a year, so most people opt to go private. Your GP will at least recommend a reputable private cosmetic surgeon in your district.

It is illegal for cosmetic surgeons to advertise in this country, but there are various organisations you can phone to check out a surgeon's credibility, and there will be a list in your yellow pages. Your initial consultation with the surgeon of your choice will cost you around £35.00. And money won't always guarantee you an operation. After you've convinced your doctor you still have to convince a surgeon to agree to treatment.

Dr Anthony Erian, one of this country's leading surgeons, says: "Cosmetic surgery is a serious business, you have to respect a patient's wishes but advise them properly at the same time. Not everyone is suitable for surgery, they might be blaming their physical defect for other problems in their lives which are completely unrelated. I've met people who've believed that surgery would bring back an ex-lover or help them get a terrific job, which of course it won't. The person underneath the skin will still be there no matter what you do to them. I turn down around 20% of the people I see. When this happens I either talk them out of wanting surgery myself, or refer them to a psychiatrist if their hang-up is bad."

Once you've agreed on a treatment there'll be another consultation to discuss what's involved in the actual operation, and for the surgeon to take before pictures and measurements. You can have an operation as soon as you like, and rhinoplasties (nose job), breast enlargement, facelifts, lypolysis (fat suction) and eye bag removal usually only need an overnight stay in a clinic. For smaller operations like skin peeling, chin implants or ear correction they use local anaesthetic, and you can be back home with your new bits in time to watch EastEnders.

Peter Barnet, chief administrator at the West Hampstead Clinic in London, says: "These days people haven't got time to spend weeks in bed recovering from an operation, and patients often prefer to keep their operations secret. Patients will go to any lengths - there was one woman who sent the nurse out to buy postcards of London so she could pretend she was on holiday instead of having her breasts enlarged! Some people save up all their lives for surgery and bring suitcases full of five pound notes to pay for their operations."

We met Sally, who at 25 finally plucked up the courage to have the breast enlargement she'd always wanted. Five foot five inches tall and a slim size 10, she had always been conscious of her 30" chest. "I kept putting the operation off because I didn't want huge boobs, just ordinary ones. Being as flat-chested as I was meant my clothes hung badly and I always felt ugly. I think a person only goes in for this if it's something they've thought very seriously about and always wanted, I wouldn't have anything else done."

We watched her operation which took less than thirty minutes. She was terrified (so were we!) but it seemed amazingly simple and non-stomach-churning. A substance was injected into her breast to stop it bleeding, then the surgeon cut a 1 1/2 inch slit in the base of her breast along the crease. He used a special instrument to hold the cut open with a mini torch on it so he could see inside her breast. Then the breast tissue and muscle were separated from the rib-cage to make a gap to slide the silicone implant into. Silicone is like a roly ball of solid water which the doctor manipulates into the breast rather like stuffing a cushion! Once it was in position, the cut was sewn up gradually from the inside leaving a thread at one end which would pull the stitches out once the wound had healed, leaving a tiny scar about the shape of a pin. Although it all sounds very gory, it wasn't at all and Sally woke up to look down on a new pair of boobs. She was delighted!

Nose jobs are also surprisingly bloodless, and leave no scars except in very rare cases when the skin has to be cut. We looked on while a huge, lumpy nose was reduced to a shapely straight one in 40 minutes. The surgeon does all the work up through the nostrils, first cutting the skin and cartiledge away to get at the bone inside. He then cuts out any bulgy bits, or, most horrible of all, uses a little nail file-like device to get rid of any bumps on bones. Although it's real nails-on-a-blackboard stuff, it's a very efficient way of shaping bones. Not surprisingly, rhinoplasty is the most common form of cosmetic surgery. Dr Erian has righted the conks of everyone from teenage girls to a middle-aged boxer who wanted to get rid of his Joe Bugner-esque profile.

The operation is only the start. Noses can take six months to settle down and breast implants have to be regularly manipulated and checked up on by the doctor to make sure they don't go hard! All operations need regular check-ups afterwards.

About the only operations that alter the way an area feels afterwards are breast reductions and uplifting. Because the nipple has to be moved to fit the new size and shape it results in a loss of sensation on and around it.

Particularly popular with women is liposuction, used to get rid of problem fatty areas on thighs and hips that diet and exercise won't budge. Narrow steel rods are inserted under the skin, and the surgeon injects some stuff that turns the fat to liquid. Sounds disgusting, doesn't it? This fat is then sucked out by a surgical hoover, and the area is covered with a heavy dressing for ten days while the skin settles down. There's a lot of bruising afterwards, and although it works initially, you have to do some pretty rigorous exercises, maybe even go on a special diet, to keep it that way. It's not a cure for dimply cellulite either, which will hang on in there even after excess fat has been removed.

Cosmetic surgery methods are improving all the time. Twilight anaesthetic, a mixture of local and general is being developed to speed up recovery time after an operation. Dr Erian has developed a new form of lyposuction for the chin area that can be done with a syringe instead of a pump, making it quicker, cleaner and less painful. Surgeons here and in America are developing new ways of getting rid of wrinkles. Instead of injecting artificial substances like collagen into the skin to plump it up, they can now transplant fat from other areas of the body through a syringe into the saggy area. It's cheaper, and the skin's less likely to reject it.

Eye bag removal used to leave small scars at the corner of the eye but can now be done from inside the lower lid, leaving no scars at all. Silicone cheek implants can also be inserted through a slit in the same area, and chin implants go in through a cut inside the lower lip so you don't get a scar.

But despite cosmetic surgery's increasing accessibility and it's American overkill, Britain has kept a sensible grasp. If you fancy boobs like Sam Fox you'll have to keep fancying because those sort of operations are still scarce in this country. American boy Valentino Johnson's facial transformation into Michael Jackson's mirror image cost him $40,000 and a gruelling 14 hours of surgery. The surgeon who performed the operation kept in constant telephone contact with Steven Hoffman, who transformed Jackson, in order to get Valentino's tucks and nips in all the right places! That sort of gimmicky surgery doesn't happen here, the British boom in surgery is to make us look normal rather than fantastic. Cosmetic surgery to improve fundamental deformities like sticking out ears or shopping size eye bags is on the increase though. Waving a picture of Michael Jackson at your surgeon and demanding a facial re-hash will still only get you a snort from his perfectly sculptured nostrils!