WEEKEND COLUMNISTS You can't see it from the photograph but I have a long, prominent nose. For as long as I can remember, I have always hated it - and spent my plastic surgery attachment in medical school considering what to do about it.
One day a friend and I were bemoaning our noses and asked the consultant surgeon what he might do to correct, camouflage, reshape and remould our faces. We made drawings and pinched ideas from celebrity magazines. In response to our questions he raised his eyebrows (possibly in an amused way, but he was wearing a surgical mask so it was hard to tell) but declined to indicate whether he felt our ideas were good or bad. He did, however, remind us that he had trained in plastic surgery to help people with burns and serious disfigurements. We were gently but suitably chastened.
Not that I was going to be put off. Several years before this another friend, Louise, had refused to believe my insistence that when I had the money I'd have the surgery. "One day," she said mysteriously of my nose, "you'll be glad of it. You have a good French nose." It is true that I have a large helping of Gallic blood but I had no idea what she meant. She, however, wouldn't be drawn any further on the subject.
Today I collected some photographs of a recent trip to Paris. In one picture I am standing next to my daughter in the Jardin des Tuileries. She is one of many children riding a donkey and the group is surrounded by parents. I am in profile - and yet quite distinguishable from the animals. In fact, I look remarkably normal. The reason is clear: I am surrounded by French men and women, also watching and attending to their children. Standing next to these larger-nosed people, I am, if not quite a paradigm of Parisian chic, otherwise unexceptional.
Plastic surgery, Botox and facelifts are everywhere now, from Harley Street to my local beauty salon. The medical press is full of job ads promising big bucks to doctors willing to spend a few hours training so that they can attend to lines, wrinkles and tucks for men and women who want to look slimmer, more ironed, less nasal. They are calling it "appearance medicine".
You can pay by credit card. You can change almost anything you like - or don't like.
Comparative European data for cosmetic surgery aren't readily available but recent reports suggest that 75,000 cosmetic surgery procedures are performed every year in the UK. This doesn't include "minor procedures" such as Botox injected at beauty salons, or plastic surgery carried out as part of a "holiday" abroad. In short it is now socially acceptable, even if some doctors have been upset by reality TV programmes such as Extreme Makeover.
Despite my talk of plastic surgery, I think I have also always known that I'd never have it done. It's not that I object to vanity or spending money on my appearance. I don't think there is anything wrong with make-up, nice dresses, extravagant shoes or hours spent drinking champagne in the hairdresser's chair with tinfoil attached to my head - all in the name of beauty.
But I also think we should accept our individuality and uniqueness - whatever shape it takes - and enjoy it, rather than trying to literally mould ourselves into something that we are not. If I had plastic surgery, then I would be partly responsible for letting down all those other big-nosed people in the world who have decided to live with their noses. I'd be erasing the visible pool of people like me, even while my DNA secretly remained, and this deception troubles me. I'd be choosing to make myself different from what I pass on to my children. Surgically enhanced, I would merely be passing on the pressure to be exquisitely shaped.
People who have had plastic surgery say that our appearance is important. It is what we present to the world - our image and flesh. They say that post-surgery they have so much more confidence, so much more self-esteem. Perhaps they do, perhaps not. There are suggestions that people who have had plastic surgery have more psychiatric problems. It doesn't seem to be true that the surgery causes them but it might be that people with mental health issues are more likely to have plastic surgery. Cultural expectations have certainly made it more difficult for vulnerable people to live with what everyone has - imperfections.
In some cultures prominent noses or ears are desirable, in others they are ridiculed. Cultural definitions of beauty can work against us but sometimes they can work in our favour. I suspect more visits to Paris will do me good.
Margaret McCartney is a GP in Glasgow
More columns at www.ft.com/mccartney
