The queen of cosmetic surgery

An ornate silver hand-mirror is the only tool Wendy Lewis requires for her peculiarly modern line of work. Visitors to her New York or London office are asked to gaze at their reflection and expound on what it is that ails them. A too prominent nose perhaps? Drooping eyelids? Or perhaps a pencil-thin mouth which they would prefer resembled Salvador Dal''s voluminous lip sofa.

The quest for eternal youth has taken a perplexing turn. Suddenly there are myriad choices for those who seek to mitigate the ravaging effects of time, from glycolic acid-peels to fat transfers, Botox injections to laser resurfacing, browlifts to liposuction. But exploring the plastic-fantastic realm can be a stab in the dark, and with increasingly devastating results.

A new professional has emerged to help patients make sensible choices: the cosmetic-surgery consultant.

Wendy Lewis has been called "the Zagat guide to cosmetic surgery", yet she acts more like a Sherpa to this decidedly complex world, helping individuals locate Dr Right, arranging private nurses and post-surgery treatments and smoothing over any accompanying anxiety with her winning bedside manner.

Unlike some consultants, Lewis is not affiliated with any doctors, nor does she receive fees for her referrals. She is an independent medical matchmaker who, for the past two years, has advised many women in England.

Along with her website (www.wlbeauty.com) and beauty journal, WL Beauty Watch, Lewis is releasing a book this month pitched specifically at the UK market.

The Lowdown on Facelifts and Other Wrinkle Remedies stitches together information on cutting-edge techniques with real-life case studies, insights from leading surgeons and, indeed, everything you wanted to know about "face rejuvenation" - as it's called in the biz - but were too afraid to ask.

At the heart of the book is a recognition of the marked disparities between the New York and London sets. "The difference between the British and American scenes is mostly about acceptance," says Lewis, perched daintily on a chair in her Upper East Side Manhattan apartment, her 41-year-old visage looking, as you might expect, remarkably unlined. "Botox is considered radical in London - here it's nothing. It's like having your nails done."

English women, it transpires, are less likely to shop around for a doctor than their American counterparts, and more inclined to schedule surgery when it's too late. (New York dermatologist Patricia Wexler advises patients start minor treatments as young as 30.) What's more, the availability of services is far more extensive Stateside; so is the number of practitioners.

American women are also more open about the process. "You can go to Eat for lunch on Madison Avenue and the woman at the next table has just had laser surfacing and she's oozing all over her tuna salad," says Lewis, "and we don't even pay attention."

Though Lewis laces her book with scientific buzzwords, including glabella (the area between the eyebrows in the centre of the forehead), blepharoplasty (an eyelid operation to delete superfluous skin or muscle) and endoscopic browlifts (an operation in which hairline incisions are made to smooth out the forehead), it is written in an engaging, page-turning style, and with the occasional flourishing of a joke. For instance, she describes such cosmetic surgery junkies as Jocelyne Wildenstein as "escapees from Madame Tussaud's", and decries a porcine collagen as "a waste of a good bacon rasher".

At the same time she doesn't sugarcoat the graver details. "If a client asks me if she could die from liposuction, it would be misleading of me to say no," she says.

When Lewis first came to London, making contact with The Royal College of Surgeons and the British Association of Aesthetic Plastic Surgeons (BAAPS), she encountered a chilly reception. "They looked at me like, 'What does she want? What is she doing here?' I never really thought I would see patients in London. It just evolved." These days the consultant crosses the Atlantic every four to six weeks. From an office in Sloane Square, she receives clients from all over the country, charging £150 for an hour-long consultation. In her time she has detected a deep-seated antipathy in some patients for local practitioners. Many women flit to Paris or South Africa for treatment. "A lot of them don't think there's anybody good in England. There are good doctors in England, there just aren't enough of them."

Of Barry M Jones, president of BAAPS, Lewis says: "He could operate on me!" The best surgeon, she explains, is someone with an aesthetic eye (in her book, Welcome to your Facelift, Helen Bransford notes the importance of chic décor in a doctor's office), highlyhoned technical skills and an appreciation of women. "Some of the Brits are ... well, there's a lot of anger," says Lewis. Another problem is the imbalance in the sexes. "What plastic surgery in the UK needs is more women surgeons. I've found five."

Quite often her work involves redressing operations that have gone awry. One client, a woman in her late fifties, came to see Lewis for advice on a botched face-lift, the legacy of which was excess scar-tissue and uneven skin on her neck. "My neck area looked quite ugly; it looked like a ploughed field and I was loath to go back to the surgeon who had done it," says the woman, who asked to remain anonymous. Lewis gave her a list of five surgeons, and the client chose Dr Daniel Goldberg, an American plastic surgeon in London, who corrected it. "When I met Wendy I just felt as if I was in the hands of somebody who knew what she was doing. I'd really lost my confidence."

Lewis made the transition to consulting after 12 years of working as an office administrator for two aesthetic plastic surgeons in New York. She attends all the major conferences and even watches surgeons operate - if it's being done she knows about it. Twenty per cent of her clients are men, busy executives with inquiries about eliminating love handles, though she draws the line at advising on penile augmentation, pectoral or buttock implants.

She is, however, more than willing to "peel thyself". Her trigger-point was turning 40. "Psychologically, I looked at my face differently." Lewis has had injections of Botox (botulinium toxin temporarily paralyses muscles), collagen and Hylaform in the nasal labial folds or smile lines. "The next thing for me is the eyes. I'm also looking at a face-lift in the next couple of years."

Cosmetic surgery, she contends, is not for everyone. A 35-year-old woman from Edinburgh came to see her recently. Lewis sent her to a priest instead. "You don't need any of this stuff; it's elective and you've got to want it and you've got to be appropriately motivated for it. If you're on the fence about it, don't do it."