As I looked at the four women in the waiting room, I couldn't work out if any of them had just had cosmetic surgery or were considering it. None looked like they needed it. Perhaps, like me, they had only come to inquire about procedures, possible options, to get advice and information. It was a free consultation, after all.
The surroundings were plush. I pushed through a large front door just off Harley Street, the home of The Hospital Group plastic surgery company, to find a beautifully decorated room with sunken, red leather sofas, plasma screens showing videos of patients' success stories, huge windows and fresh flowers on the tables. Everybody was friendly, polite and professional. For a moment I forgot I was inquiring about a life-changing operation, which could take me up to a year to recover from and cost more than £5,000.
This was the first of several surgeries I, a 28-year-old, healthy woman, visited in London over recent weeks to research various cosmetic procedures. They ranged from major operations, involving three hours under general anaesthetic to less invasive, non-surgical processes such as microdermbrasion - a process which removes dead skin cells with chemicals to hopefully give you a glowing look. Each surgery offered more solutions than I could have imagined, from Botox to skin peels, buttock implants to eye bag removal. My first consultations were always with sales people called 'patient coordinators' who would then refer me to a surgeon.
It's a frightening thought that the same member of staff who could advise me on facial treatments would also talk to me about having an operation which would leave me permanently scarred, physically inactive for weeks or, perhaps, months, unable to breast-feed and a possible loss of sensation in my nipples. As a woman with no children, this was not a decision to be taken lightly. As I sat in the waiting room, I was curious to find out what, if anything, would be recommended.
A friendly-looking man called me into his office and asked: 'You made inquiries regarding a breast reduction?' I was quizzed in detail about my medical history. Then we launched straight into the process of the operation. There was something strange about discussing my breasts with a stranger. 'We're a large company when it comes to cosmetic surgery. We do all aspects of it - tummy tucks, face-lifts; you name it, we do it.' As he flipped open a brochure to a double-page spread of the hospital where I would have my operation, my eyes alighted on 'Helicopter Transport' and 'Home to Extreme Makeover stars'.
'This is our hospital and we purposely built it for cosmetic surgery, not general surgery,' the man said. It looked like a hotel. Even the advert read: 'Five Star Hotel environment'. The whole thing seemed wrong. Rather than focusing on why I wanted the operation, whether it would be something that would make me happier, or asking if it was the right time to do it, I was being told why the hospital was so great and the option of chauffeur service.
This man was doing a thorough job of explaining how the operation would go ahead and the risks involved, but I wondered if he was qualified to talk me through a life-changing operation. I felt that the person before would have got the same spiel, just as the person after would. I was part of a production line.
I have no doubt that many of the company's patients are happy with their surgery, or believe it is their only option , but I explained I was hoping to have children in the near future and that I didn't need the operation for medical reasons.
'What about breast-feeding?' I asked.
'No, I would say 95 per cent you can't breast-feed. Ask the surgeon the question as well,' he replied.
My consultation with the surgeon came next and consisted mainly of an examination, more details about the operation and what to do beforehand. Again, no questioning of my emotional state or motivation. So what about psychological side-effects?
'Depression?' he answered. 'I don't think that should happen during your surgery, during the first weeks or first months. You know, there are scars... it takes two to three months for the swelling to go down.'
I asked about breast-feeding. 'It is difficult to tell, if you have a breast reduction, if you can or cannot.'
After an uncomfortable silence, he came back to the pregnancy issue. I couldn't quite understand what he was saying, however, because of his accent but he did tell me his sister had two children after an operation like this and she was fine. If the patient co-ordinator was doing his best to sell the company, the surgeon wasn't selling himself well.
Back in the office, the patient co-ordinator told me: 'He's a bit hard to understand sometimes. He's quite a highly qualified surgeon, but the last patient said the same thing. She booked an operation for breast enlargement. He doesn't do the operation by talking. As long as he's good with his hands. That's why I get patients involved before they see the surgeon, in case it's a little bit hard to understand.'
Then came the issue of money. 'Right, the cost of the operation with one year's aftercare, transport included, there and back, all the service fees, everything included, is £5,350.
'Now, if you [are] happy or look to having it done this year, before the end of December, we have an offer at the moment up until the end of November that is £400 off of that price.' He repeats the offer a couple of times and makes it clear it only stands if I book soon.
In the patient information I was given at my appointment it states it is 'highly recommended' to stop smoking two weeks before and after surgery. During the consultation, the patient co-ordinator told me I needed to stop smoking completely for three weeks before and after the surgery. The surgeon recommended I gave up three or four weeks before the operation and for six weeks after.
After nearly two hours, I felt exhausted. In one afternoon I had come to the surgery, been approved for the operation, told I would get £400 off if I booked by the end of the month and given possible dates for a couple of weeks' time. But was it the right advice?
It would be fair to point out that when asked if I was looking to have it done, I said yes. I also said yes when asked if I wanted some possible dates. But still, the money-off incentives advertised on the website and then explained to me appear to contradict guidelines published by the Independent Healthcare Advisory Services (IHAS). My experience at the next surgery I visited was very different. Transform Cosmetic Surgery Group was a trek to get to, perched in some industrial estate in north London. No sofas or Tatler here. Just the radio.
I met the patient co-ordinator. In exactly the same fashion as before, I was questioned in depth about my medical history.
But then came the clinching questions: 'Do you have a partner?' Yes. 'Do you want to have children?' Yes. 'Do you realise what this operation involves?' Yes. 'Then why are you having this operation? You may lose sensation in your nipples, you won't be able to breast-feed. You need to think about whether you want to get that out of the way first.'
Last time, I was being plied with information; this time I was being put on the spot and questioned about my motives. She booked me to see the surgeon, almost reluctantly. 'Go and get yourself measured and get a good bra,' she said. The sort of thing my mother would say. I was given vouchers offering me a £300 makeover session if I recommended a friend who had surgery - and after seeing the surgeon a week later, with his consent, my patient co-ordinator was then happy to book me for surgery.
This was an insight into a fascinating industry, driven by our desire to look younger, healthier, slimmer, more beautiful. The scary thing about my experience was I felt that booking a breast reduction or having my fats cells destroyed was almost as easy as booking a facial. If cosmetic surgery becomes the norm, the clinics themselves, as my experience has found, must do more to find out why women might want procedures as much as what those procedures could be. That would make women's choices much easier and better informed.
Hospital Group's reply
'We will provide discounts driven by seasonal changes or topical media. The patient will have an extensive consultation prior to deciding if they wish to proceed. All of the procedures we offer are elective surgery, as quoted by the British Association of Aesthetic Plastic Surgeons: "The responsibility lies squarely on the patient's shoulders when it comes to elective surgery." Should a patient choose not to proceed following payment to secure an operation date, we do operate a refund policy.
We advise patients to cease smoking prior to their procedure. The time period may depend on the number of cigarettes smoked.'