Ready to rev your beauty routine up a notch or more? Consider cosmetic surgery – but consider it very carefully. Botox, line fillers, lip fillers, lifts … it’s a whole new world of treatments and a big beauty leap to make, after all. Dr Rastogi, one of the country’s busiest, most respected and most interviewed surgeons, takes time out of his hectic schedule to answer some of the questions you may have.

What should you consider before starting any cosmetic surgery?

“Why you’re doing it. You need to define exactly what it is you want to achieve. You can’t just say, I want to look better. You have to know the end result you want – whether that’s leaner thighs or a smaller nose. Then you can easily communicate this to a surgeon who can achieve it for you.

You also need to ask yourself what your motivation is. If you’re generally unhappy with your life, it may not be reasonable to do any cosmetic surgery. If it’s because you’re trying to fix a bad relationship, it won’t work - if your marriage is on the rocks, it’s not because of your nose. However, if you want something altered to allow you to feel more comfortable in your own skin, then that’s a good reason.”

Are there any other reasons a candidate might be unsuitable?

“The primary one would be if someone has a distorted view of themselves. The classic example is anorexia - someone who is painfully thin but still thinks she’s fat. That’s one very sharp end of the body dysmorphic spectrum. Body dysmorphics are unsuitable people for surgery. As is anybody who has a significant illness that will affect their ability to heal.

More or less, unsuitability is based on psychiatric and medical grounds. But we also need to consider emotional ones, too. Maybe surgery is the right thing but it’s not the right time. If you’re in the throes of a break-up or you’re changing your job, maybe you should hold off. We only have a certain amount of emotional reserve and if at this point in time your emotional reserves are stretched to the limit, then it’s not a time to add another strain.”

What is the usual age women begin cosmetic surgery?

“The major group would be aged 35-55. This is the stage when the body changes, from life events such as having children, and from the effects of your diet. These are the women seeing those first signs of ageing. Botox is by far the most common procedure. This usually leads into dermal fillers, some lip definition, and skin treatments like intense pulsed light.

In terms of rhinoplasty, it’s reasonable for a girl in her late teens to have this done, because it can be emotionally scarring to go through life with a nose that doesn’t do you justice. In terms of liposuction and breast augmentation, it’s more when a woman is emotionally mature. The last thing you want to do is change her idea of self before she has a good idea of self.”

What is the craziest request you’ve had?

“I sometimes get asked to do outrageously large breasts, like a double E, but it’s not something I do so I respectfully decline. If I hear someone mention Jordan, I know it’s a job I don’t want to take.”

Who are the celebrities women most commonly reference?

“Women aren’t so much asking for a certain celebrity’s eyes or nose anymore. There’s an acceptance that we have to work with our own facial structure. However, many will say that they want to look natural like Michelle Pfeiffer, and point to Melanie Griffiths as an example of how they don’t want to end up. Having said that, a lot of women love Angelina Jolie’s lips and ask if they’re possible to emulate.”

Are lips seen as more of a fashion accessory then?

“It is definitely possible to change the look of lips. If, say, someone feels that they have small lips that make them look a little mean, we can give them a fuller look that is more sensual and inviting. But the other component to lip work is that it’s a sensible anti-ageing strategy. Lips do change – they suffer the ravages of age. They lose their bulk, become more sunken and, of course, lines and wrinkles develop along the edges. So what we can is add plumpness back in, define the lip margins, and get rid of lines and wrinkles.”

What are the main trends in cosmetic surgery right now?

“Botox gets bigger and bigger. But the trend, thankfully, is less is more. Women no longer want zero movement. The perception of good botox now is not a frozen look, but is whether you’ve maintained character and look natural, but just look a little more youthful.

Increasingly, botox procedures are about enhancement procedures – lifting corners of mouth, raising eye lids … It’s not just about removing lines and wrinkles. We can also adjusting the signs of ageing by relaxing the muscles that work with gravity and therefore giving the anti-gravity muscles an advantage.

The other big thing is facial fillers. One thing that happens with age is that you lose fat from the face. When you lose this plumpness, you end up with saggy jowls. The big movement is to use hyaluronic acid – such as a great new product called Restylane SubQ - to enhance the face, lift the cheekbones, to present the jaw a little more prominently. Basically, if you restore plumpness to face it tightens skin again.”

What are you most excited about right now?

“Restylane Vital. It’s a finer form of hyaluronic acid that we deposit droplet-style into the dermal layer of skin not to fill lines, but to generally plump up the skin and give a more youthful look. Natural hyaluronic acid levels deplete over time, so it makes so much good biological sense to inject moisture back in and boost the body’s natural stores. It’s especially great for women in their mid thirties, whose pore size is starting to increase, and when smile lines and crow’s feet are starting to become more prominent. Vital is also ideal for using on the neck, décolletage and hands.”

So how much can we actually push back the scalpel these days?

“It’s not necessarily that we’re pushing back the lift – but that we’re getting better results. Cosmetic procedures mean that skin quality and tone stays better for longer. Women are starting to have lifts at perhaps around the mid-forties, and they’re getting better results. Once upon a time, you waited until everything dropped and then you had a lift. That’s not the case anymore. With botox, fillers and treatments like IPL and fraxel laser, you don’t have to now look old before you can look young again.”

What about skincare – what topicals do you advise your patients use?

“I recommend they see a beauty therapist who specialises in cosmeceutical brands, such as Environ. The active products, like those featuring glycolic acid or vitamin A derivatives – they’re still the mainstays. And, of course, a really good quality moisturiser with suncreen.”

Any final words of wisdom?

“Choose your surgeon carefully. Cosmetic surgery is sculpture and you need someone with an artistic aesthetic. The best way to locate someone us undoubtedly word of mouth, so ask around.”