So I wait. There is a desk and behind it a chair, with a dark pink Polo shirt, a pair of pressed jeans and a natty blazer slung over its back. Someone's in their scrubs already. In the background, I hear a whooshing sound.

The noise . . . it could be a vacuum cleaner with a case of the gurgles . . . is coming from a door down the corridor that, I soon learn, leads to an operating room. It's not hard to guess what's going on. My appointment today is with Dr Cap Lesesne, arguably the most successful and well-known of America's plastic surgeons . . . favourite face-lifter to the fabulously famous and filthy rich.

Yes, " he confirms, emerging a few minutes later to shake my hand, a young woman getting liposuction to get her started on losing weight . . . to give her the courage to get out there." He had recently removed unwanted breast tissue from her 14-year-old brother and the confidence boost for him had been transformative, he explained. ?His mother wrote me a letter afterwards that almost made me cry."

Damn. My plan had been to poke some fun at this purveyor of phoney youth. I belong to that snooty school that scoffs at the suggestion of ?having work done", so don't tell me about changing the life of a kid. What about the actresses and self-obsessed models? And what happened to growing old gracefully?

The softly spoken, effortlessly charming Dr Lesesne smiles back at me. It died in every culture. It's gone." He then throws me a morsel. He did have a famous actress in this morning for some lower eyelid adjustments. Because he knew I was coming, he did the procedure at 5.30am. I said to her afterwards, 'You have to get out of here.'" I just missed her.

Also in the first minute of our meeting, he lets me know that later in the day he will be flying to Heathrow and from there to Istanbul, where he will be consulting with some very rich patients. And on his way back there will be a longer stop in London and more patients to see.

Indeed, he gets rather a lot of customers from Britain these days, to the point where he would love to open a practice in London, medical certification rules permitting.

He is right now working on a deal to sell his own line of skincare products in Selfridges, the famous London department store. It all started, he confides, with an email from a London woman whose social station is about as lofty as it can get. (He tells me more, but legally I cannot reveal it in print. ) She had had two operations and both had turned out badly. So she crossed the Atlantic to Lesesne, who put it all right.

It's been a slow trickle of British patients ever since, " he says.

Most of us will admit to a fascination with plastic surgeons, even if we disapprove. Guessing who has or has not had their nose planed, jowls pinched or buttocks hoisted has become a whispered game of every cocktail party. Dr Lesesne knows this more than anyone. To the distaste of some in his profession, he has recently written a book. Teasingly called Confessions of a Park Avenue Plastic Surgeon, it comes out here this month.

The book is not quite the juicy tell-all the title implies. It is partly a narration of Lesesne's journey to his perch on Park Avenue. (Almost all of Manhattan's most expensive plastic surgeons are here on a 15-block stretch known as the Gold Coast). And it will probably become a must-read for anyone considering cosmetic surgery for the first time. Of course, he cannot name names, although I swallowed hard at the page where Yasser Arafat walks into this same office. In fact, the Palestinian leader was just lost and should have been on the other side of the road for secret peace talks with the Israelis.

Lesesne, himself a youthful 50 . . . just a little Botox, he admits . . . started writing short stories about his patients for his own amusement. This was a group of pretty funny stories, " he explains. Then in 2004, a literary agent friend urged him to put them together in a book. At first I thought this was the biggest waste of time but he said, 'Just wait.'" When it was done, the book became the object of a bidding war between eight New York publishers.

It's true that he has had experiences that are worth the re-telling, like the case of the gay man who came to his office and asked for breast implants on his back to give his partner something to hold on to when they were making love.

Dr Lesesne says he quite often turns people down if their requests are too narcissistic or risky. This was definitely one of those occasions.

That was right up there, " he laughs, when I ask if it was the weirdest of his encounters. But very close was the episode, also in the book, when he was hired to operate on the queen of a foreign country. He and his anaesthetist were just beginning the procedure when a bodyguard brandished a handgun and informed them that if the patient were to die, they would too. I have diplomatic immunity, " the bodyguard said.

You don't need Dr Lesesne to tell you that plastic surgery is no longer a fringe hobby for a mere fraction of society. No wonder it has become the subject of two highly popular cable television shows in the US, most notably Nip/Tuck.

?It is growing explosively, " he explains. I don't think it takes a large amount of disposable income for people to be interested today. The fastest growing area for plastic surgery is men, especially businessmen. Gay men have been doing it for a long time, but now I am seeing guys from IBM and banks. They are afraid of the competition from younger men."

Dr Lesesne has seen a surge of patients coming to him after losing colossal amounts of weight, sometimes through intestinal bypasses or stomach-stapling. Operations on these people tend to be much more risky.

He is also seeing patients, on both sides of the Atlantic, wanting work at younger and younger ages, often in their 20s. People are coming in not just to change the ageing process; they are coming in to change the trajectories of their lives."

Expectations, meanwhile, get ever higher. In the book he describes giving liposuction to a model just 72 hours before a photo shoot. Lesesne notes that women are sometimes upset that recovery isn't instant and that often he has to have them back for corrections.

Men tend to be more easily satisfied. In some cases, there is just no pleasing women, ever. I have a patient in San Francisco. We recently gave her breast implants. They are perfect, absolutely perfect. But she is upset because one breast is 1/64 of an inch lower than the other side. I told her, 'I can't do any better!'" I recently celebrated a birthday that brings me closer to 50 than 40. Maybe it's just that I have been in New York too long, but, anyway, out pops the obvious question. Erm, doctor, what would I need?"

I think a little Botox first of all in the crows' feet. Your eyebrows are coming down so we could do a micro eyebrow lift. Then I'd take a little fat out of your neck and take down that bump on your nose. And that's about it." All that in one hour and 15 minutes and for about $15,000, he says.

And what, precisely, would it do for me? You'd probably drop down to your early 30s. And it is so subtle, nobody will know." I leave the Lesesne's office a little dizzy. I even catch myself working out how to raise 15 grand in a hurry. I get what it's all about now. If I had the spare cash would I too submit to Lesesne's knives I am not telling. (In case I do. ) Confessions of a Park Avenue Plastic Surgeon by Dr Cap Lesesne (published by HarperCollins, £6.99) is out now

PLASTIC SURGERY IN IRELAND

SOME plan to buy houses, others to take exotic holidays. And then there are the Irish people who plan to spend their SSIA money on plastic purgery.

Twenty years ago Irish people only had plastic surgery if they'd been injured in an accident. These days almost half the population would consider having it done, according to the latest research on the topic.

What's more, it's no longer the preserve of middle-aged women; it's not uncommon for ladies in their early 20s to have it done, while men of all ages now consider it an option.

So why have we as a nation taken to undergoing the knife in the pursuit of beauty The media of course has helped to promote this modern phenomenon.

'Nip/Tuck' anyone Celebrity obsession too has contributed no end. If Kate Moss wears skinny jeans we rush out to buy them. If Demi Moore has plastic surgery we follow suit. Of course, our thriving economy which has created disposable incomes like never before is also a major factor.

The cosmetic surgery industry in Ireland is estimated to be worth 25m and demand has never been greater. In fact, one Dublin clinic has seen its patient numbers jump by 200% in the last year.

The Harley Medical Group has had to extend its opening hours to accommodate the rising demand for both surgical and non-surgical cosmetic procedures. People are becoming more open minded about cosmetic surgery. It's now attainable to everyone, and is no longer the preserve of the rich and famous, " comments Ed Toland, general manager of the Group.

Another clinic has seen a 20% rise in clients requesting breast augmentation and liposculpture in the last year. We've been in business in Ireland for 13 years and we've never been busier, " says Helena Ashdown Shiels, owner of the clinic.

People see that the celebrities do it and they realise it's safe. They also have more money to spend, or else they're willing to borrow to do it; many of our clients pay with credit union loans. And it's not all women; more and more men are looking for it too."

Plastic surgery is not without its casualties. Last March a Limerick woman died while undergoing surgery in the US.

Kay Cregan (42) passed away on an operating table in New York while having a face lift and rhinoplasty (a nose job).

Those in the business point to the potential danger of undergoing anaesthetic, a danger that applies to any surgery. They add that it is always safer to have the surgery done at home where you can receive adequate aftercare treatment.

In any case, it hasn't put off Irish people who appear more image-conscious than ever.

For those who work in the business, the plastic surgery boom is of course welcome.

But what's it actually like to spend your days cutting flesh to make people more beautiful?

Dr Anthony Ryan Dr Anthony Ryan is one of the best known plastic surgeons in the country. He runs his own business and works in the Blackrock Clinic, Mount Carmel Hospital, the Bons Secour Hospital and the Charlemont Clinic in Dublin.

Ryan, who's in his late 50s, originally trained in Melbourne as a hand surgeon where he worked under the famous Archibald Macindoe, revered in medical circles for healing war wounds. He's travelled the world as a plastic surgeon, working in particular in the UK and Africa where he gained invaluable experience healing tribal warfare wounds of the Zulu tribe.

?I operated on lacerations, cleft lips and stomach tumours the size of footballs. It was very interesting work because they were conditions I would rarely see here, " he explains, adding that these days he works purely from Ireland and specialises in skin cancers, breast surgery, hand surgery, and cosmetic surgery like breast augmentation and rhinoplasty.

He loves his job. It is very rewarding to be able to heal someone. As a plastic surgeon, I use skin grafts and flaps. That gives me an advantage over other surgeons." Although much of his work involves healing people who have been involved in accidents, he also carries out surgery on those wanting to improve their appearance.

He points out that it's common to get requests from people who do not need surgery. I often meet clients who have body image problems who actually have nothing wrong with them. Of course, I turn them away if that's the case. I could be doing them more harm than good.

?The public often forget however that for some people, physical deformities severely affect their life. They feel unattractive, they have no confidence and they believe themselves to be inadequate compared to others. Someone with a very bad nose or a woman with no breast tissue for example.

In those cases I take great pleasure in being able to cure them."

At this stage in his career he's able to pick and choose the hours he works. It's one of the advantages of working for myself. If I want to spend an afternoon on the golf course I can. It's up to me how many patients I take on."

As for televisions programmes like 'Nip/Tuck' or 'The Swan' the doctor says he has no time for them. ?I consider those programmes superficial; they don't interest me. I'm interested in helping people.

Yesterday for example I cured a man of cancer of the nose. That's a great feeling."

Dr Patrick Hynes You need a steady hand to be a surgeon, " explains Dr Patrick Hynes, a 40-year-old consultant plastic surgeon at Tralee General Hospital who turned his hand to all types of cosmetic surgery including breast work, nose and eyelid surgery, hand reconstruction and burns. You need to be good under pressure and you have to be able to realise the potential healing power of the operation."

He emphasises that in Ireland there are a limited number of fully qualified plastic surgeons. There are fewer than 20 on the specialist registrar in the Republic of Ireland and it's very important that people choose an accredited plastic surgeon when considering an operation." He adds that he himself is accredited. The number just can't fulfil the demand and those working in the industry are inundated with work as a result.

?Although it can be a stressful and demanding job, I love what I do for a living, " he says. I found earlier on in my career that I was very good at it. It's a very satisfying job, particularly so when I get good feedback from my patients. It's lovely to see the relief in people when the operation has been a success."

But of course operations can go wrong and like all surgeons, Hynes is aware of the fact. Patients can get infections or suffer from bleeding in the aftermath of the procedure. Sometimes the operation has to be redone. But that's the risk you take and most of the time things go according to plan. The patient may also be disappointed with the results and that is why they have to be fully informed before the procedure."

He too often meets people with what he calls 'dysmorphic syndrome'. I have people come to me from time to time who have a malformed body image in their mind. In that case I have a long chat with them and try to get to the heart of the matter. If I'm not happy that they need surgery then I don't do it. I no longer feel obliged to operate."

So does he watch programmes about plastic surgeon on television? I do from time to time, " he says. But they can't be taken too seriously. The person must realise that their transformation is rarely what they see on TV. There is only so much we can do for people."

Dr Hassan Suliman Dr Hassan Suliman can spot a breast job a mile off whether it's in a photograph or real life. As a plastic surgeon working at the Advanced Cosmetic Surgery Clinic in Dublin, Cork and Galway, he specialises in breast augmentation.

Originally from Lebanon, Suliman trained as a surgeon in southwest England and later worked in London before moving to Ireland five years ago. During his time here he's seen a dramatic rise in the number of women asking for the procedure.

?When I first came here, breast augmentation was not as popular, " he explains. Now we are inundated with ladies wanting bigger breasts."

There are two ways of doing breast implants, he says. The implant can be positioned either behind the muscle or in front of it. In recent years it has become more common to have it implanted behind the muscle. That way it lasts longer . . . up to 10 to 15 years, " says the doctor. ?If the implant is placed in front of the muscle, the skin is more likely to become rippled as it thins with age."

He meets women who are willing to fork out thousands of pounds for surgery when they actually don't need it. In that case I arrange a second consultation so they know that they don't necessarily require the procedure, " he explains. At the same time I can't make the decision for the patient. They have to decide themselves."

But do breast augmentation operations ever backfire? The very odd time leakage can occur afterwards, " says the surgeon. ?It used to be more common, now it's unlikely to happen unless there is an impact. For example, I know of two cases where it occurred as a result of car accidents.

Sometimes women experience pain or bleeding afterwards in which case they are treated accordingly, but the majority of the procedures are a success and women go home happy with the results."

He points out that most women with breast implants can still breast feed. I would advise them to wait up to a year before they get pregnant, simply so the healing process can take effect, but after that I see no reason why a woman cannot breast feed with implants and many women do."

Suliman says he very much enjoys what he does for a living. It's a very rewarding job, " he comments. It's great to see satisfied patients. For a woman with a small bust, breast augmentation can change her life."

Erin McCafferty