As the government pledges tougher regulations of clinics, cosmetic surgery is on a winning streak: 75,000 operations were carried out last year, 90% on women. The more we see them on TV, the less alien and more possible the instant fix appears — even though it carries a price tag. Extreme Makeover was these ordinary women's fairy godmother. Charmaine, whose surgery would have cost over £40,000, didn't have money for Christmas shopping with the girls on an outing from the Kensington Close hotel, where all the women recuperated after surgery. Jacqueline Kennedy will not treat herself to a new wardrobe until her son enlists in the army and her food bills are reduced.
Cosmetic surgery has come down in price, and some clinics offer loyalty discounts and advice on financing, which has no doubt democratised an elite activity. In a climate where surgery is, in the words of Peter Arnstein, the consultant surgeon at the McIndoe Surgical Centre in West Sussex who performed much of the work for the show, "only an extension of make-up and ear-piercing", the plastic surgeon is pop star and shaman. But when all individuality is seen as treatable, how do you encourage acceptance? If we can't even put up with thick ankles — on The Swan, women regularly have their puddingy ankles ("cankles") sculpted — what will be the attitude of our children to the disfigured, the unlovely who can't afford or do not choose to be "healed"? When face transplants become an aesthetic option, what will they really think of the likes of Alison Lapper or Simon Weston?
A nurse and single mother of four from Blackburn, 51-year-old Jacqueline planned to have a breast reduction before the programme but — supplemented with a full face-lift, tummy tuck, laser eye surgery, eyebrow tattoos — the "makeover that makes dreams come true", as the show bills itself, has changed her life, starting with being able to see her nipples. She wasn't depressed by any particular feature; but she felt battered by "the knocks of life" — two failed marriages, being left for a younger woman, and a more recent break-up that left her homeless and wondering what was wrong with her. "I was never an ugly duckling," she says, "but I lost a lot of weight, which made me look haggard in the face. As a woman I didn't exist. When I was younger I never thought about make-up. When you have children and you're working, putting your mascara on is the last thing you think of. Maybe I wasn't as feminine as I should have been, and that was my fault. I didn't realise."
But this show says as much about its fans as it does its participants: we need these women as much as they need us. Makeover TV is a modern-day catharsis: each programme culminates in a "reveal", the unveiling of the remade woman, buffed to a glow, before applauding friends and family. It is a river of tears and post-Diana emoting in which everyone's humdrum concerns are exorcised for a few hours, and the story of gum disease and childhood bullying becomes a twinkly fairy tale. The guests are invariably "staggered"; the room is "electric"; the atmosphere is "madness". But the "reveal" also makes clear how different the women look from their unreconstituted friends and family. They stick out like Liz Hurley at Sainsbury's checkout. On her return home, one of the women restyled her image to look more like her old self, because her friends were uncomfortable with the new glamorous version.
The women chosen for Extreme Makeover are mostly self-sacrificing working-class mothers, or suffering from what they see as a "deformity". Their stories make a dubious TV format a personal godsend, an illustration of what the show's executive editor, Richard Woolfe, calls "the power of television to do good for ordinary people". A former producer of Hearts of Gold who understands the selling power of real-life tear-jerkers , he is adamant that they stay in touch with their contributors, offering support and guidance. Alison begs to differ. "Once you're home, you're on your own."
Are they happy? Overwhelmingly so, even if Sandra's chemical skin peel has not lived up to peachy expectations, and Alison is disappointed with the liposuction on her midriff. "They say the fat cells don't come back. Crock of shit! If I'd paid the £5,000 for my lipo, I'd have gone back. The bulges are coming back. I'm gutted."
A serious, thoughtful clinician, Peter Arnstein was initially unsure whether to get involved in the razzmatazz; advice from the General Medical Council was to go ahead as long as patients were properly informed, confidentiality respected. And as Alison cannily puts it, "We got more attention from the doctors than we would have as paying patients. How would it have looked for them if it had gone wrong?" Arnstein is not uncomfortable with entertainment surgery, accused though it was last year by the president of his professional body, the British Association of Aesthetic Plastic Surgeons, of "preying on the vulnerabilities of a society increasingly obsessed with physical perfection". He claims improved techniques and anaesthesia have reduced risk, and results improve quality of life. There have been concerns about multiple-procedure surgery, but Arnstein, who kept his makeovers under anaesthetic for no longer than seven hours, claims a lower incidence of complications — three bleeds in 200 procedures — than the average. This may be because when patients bleed after face-lifts it is during the waking period, when anxiety increases blood pressure; keeping them under anaesthetic while the breasts or tummy tucks are done gives the facial work a chance to settle.
Arnstein was paid £2 per patient for the first series ("Originally it was £1 but I argued for 2 and I asked for shiny coins") and concedes that it provided a showcase that boosted business at the McIndoe. But the bigger reason for taking part is both laudable and worrying: if he didn't do the work, he argues, the programme makers might approach a less reputable clinic. Couldn't the programme makers, Scream Films (for the first series) and Living TV, be trusted to ensure correct principles and procedures? "I don't want to sound rude, but they don't know anything about surgery. They know about making films."
This informed distrust chimes badly with the trusting attitudes of the patients and their families. "These kinds of shows aren't undertaken light-heartedly," Helen Hobbs's husband, Doug, had told me, "so I didn't think there was anything to worry about in terms of the procedures."
Sandra Erridge, 43, is a warm, delicate, birdlike woman in tight jeans with a cascading mane of hair extensions; her Canterbury house is immaculate and adorned with framed pictures of her three daughters — "My girls are all beautiful, with beautiful figures" — and grandchildren, but none of herself before her surgery. No wedding pictures or holiday snaps. Her family has been her refuge from a world she assumed could hardly bear to look at her.
Sandra has lived with self-hate since she was five, with the arrival of her protruding secondary teeth. "I had little chinky eyes and my dad called me Jerry, after Jerry Lewis. I was teased at school for looking like a boy, and looking foreign. Later it was having no boobs that bothered me. I married the first boy that took an interest in me, as I thought I'd never get another chance to have a family. I thought I was too ugly for all of that." She had her first daughter at 17, her inferiority complex sliding inexorably into a distrust of all that lay beyond her loving family life. In the home-supplies company where she worked, she locked herself away in the warehouse, turning down an assistant manager's course because it meant being seen and wearing a suit instead of jeans or tracksuit bottoms. "I worked out of hours or nights so as not to be seen."
Sandra nearly walked out in the first week of her makeover, guilty about "abandoning" her children (aged 18, 22 and 26) and feeling unworthy of having so much time, expertise and money lavished on her. "When I went to see my surgeon at the Lister hospital, there was a little girl of about six in the waiting room, with a big birthmark on her face, but such a happy child. I said to myself, 'What are you doing here? You're a grandmother,' but my kids told me to do it for myself." Almost as thrilled with his uplifted (in both senses) wife is her husband, Mark, who was initially against the process. "After all these years we've been flirting like teenagers. He's bought me sexy underwear for the first time. I didn't even wear a bra: it was a thermal vest."
