"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.
