The Friday Feature: Cutting-edge drama of real-life plastic surgery

Roberto Viel is pulling the kind of face not even a barrel of Botox could smooth. He is watching Nip/Tuck, the US satire airing in the UK from next Tuesday, that follows the squirms and squelches of the cosmetics surgery world, as seen through a clinic in Florida. It is a place of beauty by way of the knife, of the agony and the abdominoplasty, and of the dark thoughts and black eyes that go into remoulding faces and bodies to fit an uncertain stereotype. Expect the programme's catchphrase, "Tell me what you don't like about yourself", to become oft-quoted down the pub, where the ugly, ordinary people hang out.

It is also the world of a certain glamour, pneumatically-assisted sex and suitcases of cash. After all, will aside, not everyone has the $5,000 to get that bump straightened, or $7,000 to get those new bumps inserted. Once the bruising of these post-op stars has subsided, they'll be back to the daily grind of denying their youthfulness is anything other than a consequence of yoga and yak milk, lunching and shopping, especially, one might presume, for a few more mirrors. These are the people most likely to be aged between 35 and 50, old enough that bodily parts have started to head south for the winter of their lives, not old enough perhaps to understand that decay is, in part, what living is all about.

The reason Roberto is grimacing is because he is one of the UK's leading cosmetic surgeons, with his twin brother Maurizio. co-head nippers and tuckers at Harley Street's London Centre For Aesthetic Surgery, and pioneer of ultrasound liposculpture and, for those who come up short, penoplasty (penis enlargement, for which the Viels now gently handle up to six procedures a week). And, while Nip/Tuck might follow in the tradition of compelling, award-winning US super-series exports - such The Sopranos or Six Feet Under - it does not quite lift the skin on an underground world that the Viels recognise. Unlike Christian Troy, one of Nip/Tuck's two felt-tip wielding Frankensteins, they would not take all-comers in the lust for money, promising them perfection. They would never put an "ass implant" in the wrong way. Nor assist a fleeing gangster get a new face - not even if this echoes the origins of plastic surgery (from the Greek plastikos, to mould) in 3,300BC, when forehead skin was first grafted to form a new nose for those who had lost theirs as a punishment for adultery.

"As a fiction Nip/Tuck manages to capture both the good and bad sides of the profession, so it gives even a professional like me food for thought," Roberto says, from beneath a kitschy portrait of him and his twin, stood either side of a lady baring her own new pair. "But I can't say I approve of their procedures. Of course, mistakes happen, but they're pretty unusual because the private sector is so well regulated. As for telling someone one of their eyes is 1mm lower than the other as Troy does....that's just ridiculous. Perfection is impossible, and you should never go to extremes. Not only is beauty sometimes not about being perfect, it depends on where and when you see it, be it the Renaissance or now, Africa or the West. You can't just impose Julia Roberts's looks onto another patient. And though it would be easy to take every job, it's greed and corruption that leads to the disasters."

But certainly, like Troy, Roberto Viel, like his brother, has an insouciant panache about him, the kind that perhaps only a big bottomed salary, and the job of a supreme being might afford. Troy drives a Ferrari, runs a speedboat called Boatox, and the mere mention of his profession is enough to have models dragging him to bed - even after pointing out that their skin's sun damage reveals their true age. Roberto drives a Range Rover, does not own a boat and is happily married with two children (the more extrovert Maurizio is single...). He does, however, admit that cosmetic surgeon is the best line in his passport.

"It can be seen as a glamorous, posh profession," he says. "It inspires a lot of interest because it raises a lot of questions. People know more about it than ever, and want to know what's possible. You have to keep your feet on the ground, because it would be easy to get carried away with the sense of power. But, even then, for most cosmetic surgeons, work is much harder than Nip/Tuck suggests. The high life is possible, if you're prepared to forego your ethics and sell false dreams. But, otherwise, the hours are long, it's competitive, you have to watch your prices and there are very high customer expectations. It's good to go to the parties, but you have to look after yourself in order to operate well. And, frankly, models don't throw themselves at me. I only wish they did."

Yet clearly, with his Italian good looks, his Hermes tie and Rolex, Roberto is groomed in a manner that befits a gentleman used to dealing less with the more acceptable face of plastic surgery - reconstruction after accidents, or ending extreme psychological disturbances resulting from some form of body dysmorphia, the side of the business studies show the public is often ignorant of - as that which places the minutiae of the superficial above all else, of people with money on their hands, and loose skin flapping in the wind. Does he deal with the same moral dilemma faced by Troy's business partner, Sean McNamara? While Troy revels working in "the vanity business", McNamara worries that his job comprises "externalising the hate [his patients] feel about themselves".

"We get all sorts of people in, because, here, costs are not crazy money, as they can be in the US where people want a 'name' surgeon. And it's true that there doesn't always have to be a psychological motive for surgery," he explains. "In the past it may have been called 'Cinderella surgery', but I don't think cosmetic surgery is just about vanity. To succeed these days you need confidence and self-esteem. If you can change a face and change the way someone feels about themselves, that's very satisfying. It's a good thing that we're moving towards a society in which all ways of improving life are available, be it health, life expectancy or, yes, one's looks. Soon the cosmetic surgeon will be regarded as no more than the GP of the aesthetic side of well-being."

They certainly queue up to be cut up by the Viels. Just like his fictional counterparts, who are booked up six months ahead, the twins are busy men. Roberto conducts around 350 procedures a year. It is a thriving industry: in 2002, some 25,000 cosmetic surgery procedures were conducted in the UK, according to the International Society of Aesthetic Plastic Surgeons. That's not a snip on the American figures, though. In the US, the same year saw some 860,000 procedures (150,000 of them on men) according to the American Academy of Cosmetic Surgery (AACS), the professional society which would count McNamara and Troy among its members - were they real.

That's nearly a quarter of a million Botox operations (by far the most popular procedure now), 100,000 chemical peels and 70,000 rides on liposuction's gloop hoover. More invasively, it also includes 40,000 sclerotherapies (the removal of veins), 10,000 nose jobs (or rhinoplasty, as it is unkindly called in the trade), 9,000 tummy tucks, not to mention the tummy-churning likes of calf implants, fat transplants and gynecomastia, the definition of which one can only guess at.

"I like to think of this as the artistic field of medicine, in which all the medical training is necessary, but in which you also need a certain sense of beauty," says Roberto. "Maurizio and I trained in medicine, but our mother is an opera singer, so we grew up with an artistic leaning which we wanted to express. The techniques are becoming more and more sophisticated, so that what used to be a complex operation is now pretty routine. But, this is still surgery. It is not like popping to the hairdressers for a new style."

Indeed, for all the artfully hidden scars and tidy results, it is easy to forget that these are often invasive procedures with long names, governed by organisations that view the body much as a mechanic might an old banger in need of an MOT. Last year, for your comfort of mind, the AACS issued guidelines suggesting that no more than 5,000ml of sticky, yellow fat should be removed during liposuction, and approved the use of a certain kind of thread in a face lift technique, trademarked as The Feather Lift (well, this is America). It was also concerned that ABC-TV's series Extreme Makeover, which involves real cosmetic procedures, might, said its president, "leave the public with the wrong impression. Cosmetic surgery is not something that should be approached lightly. Programs [sic] like Extreme Makeover can lead the public to improper conclusions as to the risks and rewards associated with cosmetic surgery." Is Nip/Tuck guilty of the same?

"Overall it's a largely negative impression of the industry, because sadly it's not all fast cars and speedboats," says Roberto. "It's not a particularly accurate portrayal of surgery either. You can't go shoving tubes around like these two do during liposuction, for instance, because then you end up with waves and ripples in the flesh. And you don't take out all the fat. Just what leaves the patient with better proportions..."

Yet for all the blood - quick cuts, of the editing variety, ensure there is not too much lingering around Nip/Tuck's operating table, but there is the odd spray of red stuff, and the stuffing of flesh - Viel suggests the series is unlikely to dissuade those punters who feel they have lost out in God's lottery or, perhaps like one of Troy's patients, they don't just want to be an eight out of 10, but a 10 out of 10. After all, the number of procedures has increased by more than 200% over the past six years, and that despite the lessons of numerous celebrities with rock solid breasts, permafrozen faces and Zeppelips - pouters blown up like airships. Eventually Roberto Viel may even have some surgery done himself.

"It's part of my job, so I can't help assessing people I meet, though of course I don't share my thoughts," he says. "That assessment is turned on myself too. I know I have a prominent nose and a small chin, but neither are a problem for me. But, when the chin starts sagging and the eyelids get puffy, I'll probably have something done. If I'm in a business that's all about looking good, I had better look good myself."

'Nip/Tuck', Sky One, Tuesday, 10pm.

'Male Plastic Surgery Laid Bare,' Sky One, Monday, 9pm.