Cosmetic surgery is used by thousands of women, who each year spend more than £900 million trying to turn back the clock. But could it actually SPEED UP the ageing process?

Is cosmetic surgery a false way of holding back the years?

When Elizabeth James turned 50 she decided the empty promises of so-called miracle creams were no longer enough. On the recommendation of a close friend, she consulted an eminent - and expensive - Harley Street cosmetic surgeon and booked herself in for a facelift.

A successful lawyer, Elizabeth, now 56, wasn't looking for radical change. She just wanted to look a little younger and more beautiful again.

'I was used to being regarded as quite attractive and had always looked younger than my years, but at 50 I hit the menopause and suddenly looked much older,' she says.

'I decided anti-ageing surgery was worth considering when I went to book theatre tickets and was asked by the girl behind the desk if I wanted a senior rate. Perhaps it was foolish vanity, but I wasn't prepared to lose my youthful looks so readily.'

Elizabeth is far from alone. Last year, 4,468 facelifts were performed by surgeons registered with the British Association of Aesthetic Plastic Surgeons (BAAPS), though many more chose one of the cheaper, riskier, non-BAAPS alternatives.

The number of women having facelifts grew by 37 per cent between 2006 and 2007, a rate that has been consistent year on year since BAAPS began its records in 2004.

Other surgical procedures such as blepharoplasty (eyelid surgery), liposuction, abdominoplasty (tummy tucks) and browlifts are also increasing at a rapid rate. But, controversially, a growing number of aesthetic surgeons, cosmetic doctors and dermatologists are questioning whether these procedures actually deliver the anti-ageing results they promise.

Elizabeth thinks they have a point. At first, she was happy with the results of her surgery and considered it £7,000 well spent.

'My face looked marvellous for months and I felt confident that by choosing a highly regarded and well-known surgeon, I'd guaranteed myself good results,' she says.

A surgeon measures up his patient before making 'improvements'

However, after several months, as Elizabeth's swelling slowly went down, the results became less impressive.

'The degeneration was rapid. Within a year my face was starting to sag again and I needed further tightening. My surgeon said there was only so much tightening of skin and muscle he'd been able to do in one procedure and recommended a further full facelift.'

So, a year after her first one, she paid another £7,000 for a second facelift.

'I thought my second facelift really had done the job and where the bones are prominent, such as on my forehead and cheekbones, the effects have lasted better. But on the lower, fleshier parts of my face - my lips and around my mouth particularly - I look worse than ever.

'I've lost so much volume and elasticity that I need Botox and fillers several times a year to counter the effects of my surgery.

'I suppose no surgeon, however good, is going to spell out the limitations of surgery, but I realise now the real downside comes later. The effects are short-lived, the risks are significant and there are no guarantees.'

Dr Michael Prager, a member of the British Association of Cosmetic Doctors, is convinced from his clinical experience that anti-ageing cosmetic surgery actually accelerates the ageing process.

'Four out of five clients I see regret their decision to have anti-ageing surgical procedures and come to me for non-surgical solutions,' says Dr Prager, who sees a steady stream of affluent, often A-list, clients at his thriving practice in London's Wimpole Street. 'The truth is that you can't improve the state of healthy skin by cutting it.

'If you cut through healthy tissue and blood vessels and detach the dermis from the underlying muscle, you inevitably create scar tissue and reduce effective circulation. Smaller blood vessels will soon grow, but they won't be as effective as the larger vessels that used to supply the skin with the blood and nutrients it needs.

'Skin that's been operated on becomes thinner, and it's volume that makes a face look young. Faces can be stretched, but the effects don't last so you have to keep stretching. But surgery ultimately creates a flat, hollow face without the smooth, round, softness of youth.'

How successful is liposuction?

According to Dr Prager, liposuction - often used as a means of reducing weight increase with age - is equally detrimental.

'After liposuction, you may look OK with your clothes on, but naked the skin becomes rough, discoloured and loose. If a woman has lipo at 30, by the time she's 40 her skin in those areas will look at least 50.

'And because you can't put on weight in areas where the fat cells have been ripped out, fat collects in the surrounding areas, and you can't hide the resulting lumps and dents which can look odd and unnatural.'

Penelope Christoforou, a 50-year-old businesswoman from Pinner, North-west London, decided to have liposuction when she was 43. 'Three pregnancies and a hysterectomy had left me with a floppy tummy that hung over my panty line. I wasn't overweight and I exercised regularly to no avail.

'I became so depressed that I arranged to see a surgeon who'd been recommended by a friend. He said my stomach muscles were so damaged I'd need a tummy tuck as well as liposuction, but that I could expect great results. He said he could give me a flat stomach that looked as good as, if not better than, before I'd had children.

'After surgery, I duly had a flat, taut stomach again. But as the months went by, the state of my skin visibly deteriorated. The skin in other areas of my body looks bright and vibrant, but on my tummy it's become increasingly grey, mottled and older.

'Elsewhere I have the skin of a woman in her early 40s; on my stomach, I have the skin of a woman ten years older than me.

'I used to think I'd have a facelift at 50, but now I'll never let a surgeon near my face. At least I can wear beautiful clothes and cover up my stomach, but you can't wear a balaclava out to dinner.

A woman prepares to go under the surgeon's knife - but now patients and doctors are concerned that cosmetic surgery is not as safe as first thought

Given that the anti-ageing industry is worth £900 million a year, according to consumer analyst Mintel, it is not surprising that less ethical practitioners are eager to carve themselves a slice of the profits.

Dr Nick Lowe, consultant dermatologist at the Cranley Clinic in London, believes that many of the new anti-ageing procedures simply aren't tested adequately.

'There's often a lot of hype around new procedures which are seen later not to deliver. Threadlifting [an alternative to a facelift that involves placing suture threads under the skin which are then pulled to 'lift' the face] was commonplace two years ago; now it's virtually been abandoned because the threads kept slipping and breaking,' he says.

'When the Fraxel laser system came out, which proved so effective in dealing with post-surgical scarring, other companies scrambled to get in on the act with lookalike alternatives that hadn't been tested properly and weren't as effective or safe.'

Meanwhile, doctors see an ever increasing number of people who want to know if problems caused by anti-ageing surgical procedures can be rectified.

'We can use lasers to reduce scarring, fillers to replace volume lost through surgery, and Botox and Dysport - another botulinum type A toxin - to help correct the facial asymmetry caused by surgery on brows and around the mouth, but other problems are not easily corrected,' says Dr Lowe.

'Loose skin on stomachs and thighs from liposuction is difficult to correct, as is the hair loss at the front and sides of the scalp because of the reduced blood supply as a result of brow and facelifts.'

Concerned about the standards of some UK practitioners, Samantha Hilton, a 34-year-old TV producer, travelled to the States for liposuction to guarantee her dimple-free thighs for her wedding.

Measured up and ready to go: One woman gets ready to go under the knife

'American surgeons have more experience in anti-ageing procedures and their standards are far higher,' explains Samantha, who lives in Belsize Park, North London, with her husband and baby daughter.

'For the first few months I was pleased. The tops of my thighs, just under my bottom, were exactly the shape I'd hoped for, with smooth curves. But four years later, my skin has become dimply, discoloured and lumpy. I bulge in places I never did before, and where I had the liposuction, my skin is paler than elsewhere with purple patches. There's also less elasticity.

'I feel self-conscious when I'm naked with my husband or when I'm on the beach. I decided to have surgery at a time when we didn't really know the long-term effects, but I now know that some areas of skin look older than the rest of me and it can only be the surgery that's accelerated the ageing.'

In America and France, where anti-ageing procedures had been de rigueur for decades, the long-term effects are becoming more evident and many doctors are convinced cosmetic surgery can have an ageing effect.

Dr Sam Hamra, based in Dallas, has developed a successful practice on the basis of his international reputation as the surgeon best qualified to correct the ageing effects of facelifts. Much of his work is now corrective.

'Around 95 per cent of facelifts performed anywhere in the world are based on a traditional technique developed by a Swedish professor, and although most facelifts look fresh and rejuvenating at first, within a year or so the results are less impressive,' he says.

'Within months, as many as 30-40 per cent will lose the initially pleasing appearance, as soon as the face is no longer swollen. And, after several years, the chickens really come home to roost.

A moment on the lips: A woman receives botox treatment

'Wherever there are affluent people, whether it's Miami, Los Angeles or the south of France, you'll find that unattractive postoperative look. Within a year of surgery, the face seems to fall and several areas begin to show signs of tension and pull. The eyes can become hollow which looks dreadfully ageing, and the patient is often left with an unnaturally overstretched look.

'My mother is 96 and she looks great, but that's because she never had any surgery. The minute you commit to surgery on your face, you have to understand the risks of progressive disharmony because the ageing process will continue no matter what.'

Dr Georges Roman, a cosmetic doctor who specialises in non-invasive treatments at his clinics in Paris and London, says there has been a shift in attitude in France.

'Not so long ago, the thinking was that the earlier you started anti-ageing surgery, the better,' he says. 'But we've all seen so many patients who had surgery five to ten years ago and the long-term damage to skin tissue is obvious.

'There is a place for surgery, but it needs to be the last resort. Aesthetically, patients can look much better for a few years if the surgery is good, but if they want to look good ten years later, surgery is not the answer because from the moment the skin is cut, the process of ageing accelerates.

'In ten years' time, there'll be far less demand for aggressive anti-ageing procedures. We're learning that we need to work with the body to maintain youthful good looks rather than against it.'