The 'nip and tuck' women who will never be satisfied

Women suffering from "perceived ugly syndrome" are demanding plastic surgery as part of their quest to look like the celebrities glamorised in glossy magazines.

But patients with so-called body dysmorphia disorder (BDD) have such a distorted image of their body and their face that no amount of cosmetic surgery will satisfy their needs, a group of leading surgeons warned yesterday.

While most of the women they saw had a healthy attitude towards their body, they said a minority of patients were unsuitable for plastic surgery because they had "unrealistic expectations".

In the most extreme cases, obese, middle-aged women were walking into clinics demanding surgery that would make them look like Kate Moss, the model, or Angelina Jolie, the actress.

Adam Searle, the president of the British Association of Aesthetic Plastic Surgeons (BAAPS) and a consultant plastic surgeon, said it was vital that patients with BDD were seen by a psychologist before surgeons considered performing cosmetic surgery.

"Women with perceived ugly syndrome present themselves with an anomaly, which to us is invisible or minor, but to them has become an overwhelming, absorbing concern that affects the way they lead their lives," he told the association's conference in Bath.

"We need to be aware of this small group of people who have become so incapacitated and focused on their defect that nothing in our tool box is ever going to make them happy. If body dysmorphia is suspected, surgeons may require that patients undergo further psychological evaluation. Ultimately, a reputable practitioner will use his or her best judgment, perhaps in consultation with a mental health professional, to determine whether or not a particular patient can reasonably be expected to benefit from plastic surgery."

The popularity of cosmetic surgery has soared. An estimated 700 clinics in Britain offer plastic surgery and non-invasive treatments such as botox. Figures from BAAPS show that its 180 members performed 22,041 procedures in Britain last year, a 34.6 per cent increase on 2004, and that 19,601 of those cases were carried out on women.

Norman Waterhouse, of the Royal College of Surgeons, condemned as "utterly appalling" medical companies that use marketing gimmicks to draw in business.

The Transform Cosmetic Surgery Group is to offer a discount for a combination of breast enhancement, teeth whitening and botox. Last year the firm offered a £200 travel voucher to women booking a "bikini" package.

Liz Dale, the marketing director of Transform, said every patient was assessed by a surgeon. "We don't target people, they come to us. We've noticed that many women approach us after divorce because they want a confidence boost and they want to reinvent themselves."