Nearly 20% of Americans would like to have cosmetic surgery, according to a survey released by the American Academy of Cosmetic Surgery. Although only about 6% have actually had it, far more are interested. This seems to be fuelled by an overwhelming conviction that personal appearance is the key to professional success in the US.

Across the Atlantic, a darker message is being relayed to the profession: that their work is addictive for some patients. Dr Adam Searle, president of the British Association of Aesthetic Plastic Surgeons, has warned his colleagues that some patients are suffering from "imagined ugly syndrome" or "body dysmorphic disorder".

Plastic surgery is booming in Britain, with the number of operations in 2005, including Botox, up 35% on 2004. But often these operations may be unnecessary. "People can become addicted to the anticipation, the excitement and the attention they receive," says consultant psychologist Eileen Bradbury, of Manchester. "There is a short-lived result of feeling fabulous. But the post-procedure high fades, life goes back to normal and all the mundane problems come back so you need to go for another fix."