Have you had any work done?

You can't ask me that! Continuing her series tackling socially unacceptable questions, Christine Manby discusses whether you can ask someone if they've been under the knife

Illustrations by Tom Ford (Tom Ford)

“Have you had any work done lately?”

Let’s be clear, we’re not talking about a side return extension or a new ensuite bathroom here. The work we’re referring to is cosmetic surgery and, statistically speaking, the chances are that the person you’re asking this question has indeed had a tweak or two. Particularly if you’re in America, where the American Society of Plastic Surgeon’s annual review estimates that 17.5 million surgical and “minimally invasive” procedures (by which they mean things such as fillers and Botox) took place last year.

The American stats for 2016 show the breakdown for the big jobs – the cosmetic equivalents of a new roof as opposed to a lick of paint – in greater detail. More than 300,000 Americans opted for new boobs in that year. Almost as many lined up for liposuction. Nose jobs counted for more than 200,000 procedures, closely followed by eyelid surgery, with tummy tucks bringing up the rear.

On the subject of actually bringing up the rear, bottom implants and lifts – which were, perhaps inevitably, pioneered by a Brazilian, Dr Ivo Pitanguy – are the fastest growing surgical procedure in the US and elsewhere. The great news is, you can get a two-fer, taking fat from your wobbly thighs and stomach with liposuction before reinjecting it in the right places to achieve that perfectly rounded bubble butt.

Only in America, right? Wrong. The British Association of Aesthetic Plastic Surgeons, which goes by the fantastic mnemonic Baaps, reported that in 2017, more than 28,000 cosmetic operations were performed in the UK. That’s not including Botox and fillers.

It’s quite a number. However, plastic surgery as we once knew it is definitely on the wane. The number of people having liposuction in the UK saw a drop of more than 50 per cent between 2015 and 2017. At the same time, the number of face and brow lifts plummeted by similarly large percentages.

(Tom Ford)

What’s accounting for this fall? Is the effect of on-going austerity making people decide they’ll skip the surgery and just wear double Spanx and a Princess Meghan mask? That’s what Baaps thinks. Their website suggests that the collapse in numbers is due to ‘’a climate of global unrest and bad news overload’’ leaving patients prioritising stability and comfort over big life changes.

Maybe it’s Brexit? Now those legendarily svelte French women won’t be coming over here making us look lardy, we Brits don’t have to bother anymore. Perhaps we can expect to see a drop in hair removal procedures too as travelling to the Costas grows prohibitively expensive. Nobody sees your bikini line when you’re holidaying on the Cornish coast.

Pundits have suggested that the rise of “relatable” social media stars such as Zoella may be part of the reason why people are turning away from surgical enhancement. Given that Zoella is still firmly under 30, I think most people would be horrified rather than inspired to discover she’d cheated time with anything other than a bit of whitening toothpaste. But social media has definitely helped to widen the scope of what we believe to be beautiful.

Whereas previously, the models used to sell us everything from clothes to kitchens were pretty uniform – a certain height, a certain weight, ya-da, ya-da – social media allows us to find role models who look like we do, reminding us that beauty comes in all shapes and sizes.

Former Baaps president Rajiv Grover suggests that the decrease in men having procedures such as gynaecomastia surgery, otherwise known as man boob removal, is a direct effect of “the media’s adoption and celebration of the more natural looking ‘dad bod’.”

It seems equally likely that the continued improvement of non-surgical methods is changing the playing field. The traditional “cut and shut” style face-lift that left so many Hollywood beauties of the seventies and eighties looking like the Bride of Wildenstein seems horribly brutal and unsophisticated now. Dermal fillers allow a more subtle nuanced look without the bruises and the downtime.

There are non-surgical nose jobs. You can even get a non-surgical butt lift. With a traditional butt lift you’re looking at two weeks of having to avoid sitting down. That’s before you consider the usual implications of a general anaesthetic and the possibility of the delightful sounding “fat embolism”.

With the non-surgical procedure, using dermal fillers such as Sculptra to literally pump things up, practitioners claim they can have you looking “bootiful” in an hour. You can get it done in your lunchtime and go straight back to work. The results last for up to two years.

Of course, injectables are not without potential side effects such as allergic reactions. Fortunately, the ultimate cosmetic procedure could be just around the corner. Want a bigger body part that won’t be rejected by your body? Grow your own.

On their website, Stemprotect explains: “People are now very aware that natural is better, but at the same time they want to improve their appearance wherever they can. The result is something that stem cells can really help with, growing tissue from a person’s own cells so that it’s not rejected by the body.

“Nowhere is this more useful than in complicated and sensitive surgeries such as penis enlargement.’’

It should be noted however that stemprotect’s website prefaces this particular piece of good news with the disclaimer, ‘We cannot help you with your small penis. Do not enquire.’

(Tom Ford)

In general, we’re still scathing of people who choose to go under the knife (or under the needle). While there are celebrities who are out and proud about the work they’ve had done – Katie Price filmed her own non-surgical butt lift last year – there are still many more who want to kid us that their fresh new look is just down to “giving up sugar”.

That said, Dr Pitanguy, king of the butt lift, who died in 2016, understood that cosmetic surgery is never just about vanity. Upon qualifying, Pitanguy first worked as a trauma surgeon in one of Rio’s public hospitals. He said that it was performing skin graft surgery on children disfigured by a horrific fire in a circus tent in 1961 that made him realise the impact of appearance on emotional wellbeing.

Pitanguy would later go on to enhance the perfection of such superstars as Gina Lollobrigida and Sophia Loren, which seems like gilding lilies, but he wrote: ”An individual’s suffering is not proportional to his deformity, but to the perturbation caused to his harmony by living with his image.”

As long as there are Instagram celebrities such as Cara de la Hoyde and Emily Ratajkowski pushing such insane markers of beauty as the Toblerone Tunnel (aka the space at the top of your legs), there will be people whose harmony is perturbed by thoughts about their own comparative lack of perfection. Even if we all know the truth about Instagram filters and Photoshop, it can be difficult not to feel as if we should be doing something drastic to close (or rather open) that thigh gap.

Perhaps Pitanguy said it best. “The most important thing is to have a good ego and then you don’t need an operation.”

If only self-esteem came in syringes.

Christine Manby has written numerous novels including ‘The Worst Case Scenario Cookery Club’