The bloody pursuit of perfection

There can be few people who find "man boobs" truly attractive (the term refers to the fatty, breast-like deposits that can develop on men's chests) but if you read the tabloids yesterday, they were hard to avoid. With an audit of plastic surgeons showing that liposuction operations rose by 90% last year, both the Mail and Sun homed in on the fact that the number of men having their "moobs" sucked out had doubled. Cue topless photographs of David Gest, Johnny Vegas and John McCririck, all of whom, the visual evidence suggests, have been too sensible to brave the knife.

While this focus gave a new twist to a common topic (also providing a rare instance when the physical "flaws" of men, rather than women, were under the spotlight) it was more than a little misleading. It's not men who are flocking to go under the knife: it's women.

Overall, among the surgeons surveyed (members of the British Association of Aesthetic Plastic Surgeons) operations rose by a third last year, from 22,041 to 28,921 procedures, with a massive 92% carried out on women. More men are having plastic surgery but, when it comes to liposuction, they accounted for fewer than 500 patients last year. The passion for fat-suckage that has seen liposuction procedures leap from 2,099 to 3,986 cases - it is now the third most popular form of plastic surgery - is being driven by women.

So why have British women become so keen on liposuction? After all, while it might be seen by some as a "quick fix", it is an invasive procedure, usually carried out under general anaesthetic and involving a small, but serious, chance of complications.

It is certainly nothing to do with the growing obesity problem. Although there is a popular perception that liposuction is for the overweight, or morbidly obese - an opportunity for all that excess fat to be sucked out in a single operation - a reputable surgeon would be loth to carry out liposuction on someone very overweight, partly because, as plastic surgeon Rajiv Grover, who oversaw yesterday's audit, points out, "the complication risk would be much higher". The other factor is that there just wouldn't be much point. The amount of fat that can be extracted in any one operation is actually fairly small; the surgery is used, specifically, to reduce "problem areas". You might have liposuction on the curve of fat on your inner thigh, for instance, or on the mass of skin that connects the point of your chin to the base of your neck, on the "saddlebags" that sometimes form on women's hips or the tiny bulge that can appear on the back of the leg, just above the knee joint.

"It's body contouring," says Grover, "which means that you have to be at, or about, a normal weight. If, after dieting and exercise, you haven't achieved what you wanted, and you have some stubborn areas of fat, then you would be a good candidate for liposuction." The maximum amount of fat it is possible to lose from a specific area would be 2-2.5 kg, he adds.

Less than six pounds! Is that really so hard to lose in other ways?

On the Bupa website, it is explained that a fluid mixture of salty solution, local anaesthetic and adrenaline is injected into the area to be sucked away, which helps reduce bleeding and makes the fat easier to remove. Then a cut is "made in your skin and a thin metal tube called a cannula will be inserted. This will be attached to a vacuum pump or a syringe and will be moved about vigorously within the fatty tissue to suck out the fat and the fluid."

The surgery is fairly intense, then, (as anyone who has seen it performed on the cable show Extreme Makeover will have noted) and this is reflected in the recovery time. "You'd need to be in hospital overnight," says Grover, "and definitely need to be off work for 10 to 14 days - a week at least. You would need to wear an elasticated garment - like long johns - to try and tighten up the skin after surgery, because you are removing fat from beneath it. That garment would have to be worn for about a month to six weeks. At that stage, you should be able to see about 80% of the result, but it could take two to three months for the slight swelling of the skin to really get back to normal."

Given all these factors - and the cost, which runs into thousands of pounds - it is difficult to understand why so many women are prepared to undergo all this, simply to rid themselves of a small, fairly innocuous, and perfectly healthy, bulge of fat. A big part of the reason seems to lie in the way in which women are encouraged to objectify themselves from an early age. You will find men who are unhappy with their weight. But when it comes to picking our bodies apart, isolating in turn all the many separate areas that we hate, women have a much more highly trained critical eye.

This faculty is honed during girlhood - "I wish I could just chop my belly off" - and beyond by the million and one magazine surveys that ask us to evaluate our bodies by cleaving them into the areas that we like and dislike, like a serial killer set on dismemberment. So, for instance, late last year, the Mail on Sunday's You magazine ran a survey in which women were asked to assess which part of their body they liked least out of their breasts, thighs, face/neck, bottom, tummy, upper arms, and legs. (The tummy, that long-time foe, romped home with 45.2%.)

This tendency to pick ourselves apart, put each part of our bodies under the microscope, has been encouraged by celebrity magazines. As a culture, there is plenty of evidence that our body obsessions are making us less and less healthy, with both obesity and eating disorders at an all-time high. And still, in the midst of these two extremes, we remain obsessed with the idea that the human body is perfectible. Each week Heat magazine offers up a "circle of shame" feature, in which attention is drawn to some celebrity's tiny, otherwise imperceptible "flaw". It can be almost anything - from Katie Holmes's knobbly knuckles to Kate Beckinsale's tiny bald patch to a Big Brother contestant with a blemish on her cleavage. The message is strong and persistent. It is not enough to be slim. It is not enough to be toned. It is certainly not enough to be healthy. For women especially, perfection is the only viable endgame.

This cultural shift has gone hand in hand with something else: the widespread acceptance of plastic surgery as just another consumer choice. There was a time, not long ago, when plastic surgery was perceived as something largely suspect, a dangerous, expensive, potentially disfiguring choice of the mad and too-rich. Michael Jackson was, of course, the perennial illustration. But in the past year that edge of criticism has been blunted. Now the media approach to plastic surgery stories is more likely to be a guide to the best procedures and where to get them.

We seem to be on an unstoppable slide - it is hard to imagine a time when our affection for the scalpel will stop. And while it continues, it promotes nothing but dissatisfaction, encouraging all of us, especially women, to scan our bodies in search of new and yet more gruesome "flaws". As situations go, then, it seems much, much uglier than man boobs.

'Christ, get her back under'
Surgery stories

· In 2001, Dr Thomas Norton, a GP with no training in cosmetic surgery or anaesthesia, was found guilty of serious professional misconduct after he left a string of patients permanently disfigured. One woman, known throughout the subsequent General Medical Council hearing as Mrs W, woke up during her £6,000 operation to hear Norton cry: "Christ, get her back under!" Another patient, known as Mr B, woke during his operation to see liquid being pumped from his stomach into two jars.

· Denise Hendry, the wife of former Scotland football captain Colin Hendry, nearly died in her attempt to get the perfect "bikini body" in 2002 when a £2,400 liposuction procedure went wrong. During the operation, the surgeon punctured her bowel and small intestine nine times. She suffered blood poisoning, cardiac arrest and multiple organ failure and was in a coma for five weeks. In December 2006, she was awarded an undisclosed sum of more than £100,000 in compensation after bringing sucessful legal action against the surgeon, Gustaf Aniansson. Afterwards, she said: "I felt so bad when I thought Colin could have lost his wife and my children would have lost their mother. I felt overwhelming guilt at how stupid I'd been."

· Mona Alley, an avid 10-pin bowler, went into the Florida Center for Cosmetic Surgery for liposuction and ended up losing her legs. The surgeon accidentally perforated her intestines during the operation and the resulting abdominal infection caused the veins in her feet to collapse, and when gangrene set in doctors had to amputate both legs above the knee. "I was told that this was such a simple procedure. No downtime," said Alley, on the HBO television documentary Plastic Disasters. "I never recovered and never will."

· Actor Tara Reid, 31, who starred in American Pie, was left with a body she claimed to be embarrassed to show in public after a botched boob job/liposuction operation in 2004. "I got lipo because even though I was skinny, I wanted - I'm not going to lie - a six-pack. I had body contouring, but it all went wrong. My stomach became the most ripply, bulgy thing," Reid told American magazine Us last year. She has since had more surgery to correct the mistakes.
Helen Pidd

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