Each year in Britain, close on 90,000 cosmetic operations are undertaken with the patient hoping surgery will give them the appearance they seek. Sue Smart talks to a local plastic surgeon about why so many people are choosing to go under the knife.

THE dramatic increase in cosmetic surgery in recent years could be largely due to the media keeping it a hot topic with its non-stop television shows about 'makeovers' and constant magazine and newspaper articles.

Is it just a fad or is it here to stay because cosmetic surgery may profoundly change people who are lacking in confidence when it comes to their body image?

"Cosmetic surgery might not save lives, but it may give a better quality of life," says local consultant plastic surgeon Mr Fahmy S Fahmy.

"Most cosmetic surgery is about perception and self-esteem, one way or another.

The most common positive effect from the surgery is feeling good about yourself and the increased self-confidence. There is a significant change in their lifestyle after the surgery."

Mr Fahmy says: "It is all about the patient's perception of the problem.

"This is a very individual matter that should be recognised and well respected."

The most common private cosmetic operations he performs are breast enlargements, which he says can be done from as young as 18 to the late 60s.

His second most popular cosmetic surgery is 'tummy tucks', where muscles are tightened and excess skin removed, leaving a firmer, flatter abdomen, although patients are left with a scar along their bikini line from one hip bone to the other.

Next is breast reduction, of which he says a large number are related to physical difficulties such as sweat rashes, shoulder and back pain, which comes with having very large breasts.

There has also been an increase in facial and eyelid surgery. "The demands and pressures in our society are different from the demands of years ago," says Mr Fahmy, adding it is not just women who are going under the knife to get the look they want.

"We are seeing an increase in the number of men asking for cosmetic surgery, especially face surgery such as baggy eyelids."

Other popular cosmetic surgery requested by men include the reduction of large male breasts, liposuction and tummy tucks.

The surgeon divides his time between reconstructive, plastic and hand surgery for the NHS at the Countess of Chester Hospital, after situations such as skin cancer and accidents, and performing cosmetic surgery for private patients at Yale Hospital in Wrexham.

He explains the word 'plastic' comes from the Greek word 'plastikos', which means moulding or shaping.

Since he was at medical school, Mr Fahmy says he wanted to be a plastic surgeon because it is a fascinating, creative and perfectionist job.

"Each reconstructive and cosmetic surgery offers something different and motivates me in different ways. It's the nice thing about it, the mix between the two, and there's always something new and challenging coming up."

He says the most rewarding aspect of his work is the satisfaction he gets from his patients.

With cosmetic surgery, he says, there is more cultural permission and openness.

"Now a large number of patients are more open and happy to discuss freely the surgery they may have had. This is certainly contrary to the pattern in the past."

In this age of fairly easy credit, there is a growing trend to use it to pay for cosmetic surgery. After car loans, says Mr Fahmy, loans to pay for cosmetic surgery are the next most popular.

"The timing of exploring the surgery differs from one person to another. It can be simply having the courage to take the step to see a surgeon, as a problem has been nagging them since school days or for relationship reasons or simply they did not have the finances to do it before," he says.

When it comes to cosmetic surgery and weight loss, he says, "a big number of patients have tried to lose weight before they come for cosmetic surgery".

He says: "I've found there are two types of people who come in – some come after they have lost weight and can't improve any further. For others, cosmetic surgery is their motivation to go on and lose weight afterwards. It can facilitate that."

By the time patients see a plastic surgeon, he says they have researched the operation to a great extent on the internet, in magazines and newspapers and they have really thought about it for a long time.

Does Mr Fahmy ever recommend someone does not proceed with a particular surgery?

"Yes, there are cases where they are not suitable for what they are asking for and it's very important to have realistic expectations and understand the limitations of surgery. It's like any decision we make, there is an element of risk there and they need to be aware of the benefits versus the potential risks involved."

Mr Fahmy believes more people will be opting for cosmetic surgery.

"We know to a certain degree, the risks are more controlled or there are not as many risks with advancement in surgery and the financial facilities which might not have been available before are available now. You hardly pass a day when there's not something in the media about plastic surgery.

Mr Fahmy says: "It is apparent there is a link between body image and self esteem. If you're happy with your body image, you feel confident in yourself and you project in a different way."

Mr Fahmy calls the huge number of people in Britain – 92 per cent of them women – choosing to undergo cosmetic surgery staggering.

"In the old days, you would not think people would ask for an operation," he adds.

"If you can afford the operation and it can be done, provided of course there are no health hazards from that and it makes you feel better and gives you a better quality of life, then why not?"

l Mr Fahmy trained in south west England and he has been a consultant plastic surgeon in Wrexham and Chester since 2001.

He is a member of the British Association of Aesthetic Plastic Surgeons and is also a member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons.

For further information about plastic surgery and surgeons, visit the national website of the British Association of Aesthetic Plastic Surgeons at www.baaps.org.uk or the British Association of Plastic, Reconstructive and Aesthetic Surgeons at www.bapras.org.uk