As Marc Jacobs admits to a facelift, is it better to be honest about cosmetic surgery and tweakments?

What people will own up to very much depends on what they feel they can get away with denying. Men are now fairly open about their hair transplants – but having mysteriously regrown a luxurious thatch, there is no way they could pretend they have achieved this by anything other than major surgical intervention. Women who just look a little… fresher, or surprisingly good for their age, can somehow get away with insisting that they’ve just tried some amazing new facial or gone vegan.

The one cohort who do talk in an honest and everyday way about what they’ve tried are the youngest adults, the 18-30 year olds – who I wished weren’t engaging with aesthetics at all. In the 2000s, tweakments were all about softening the obvious effects of ageing. Over the past decade, the emphasis has moved onto general enhancements – beautification, if you like – and these appeal hugely to young women (and some men) who want the lips, the amplified cheekbones and sharpened jawlines that they see on social media stars. They walk straight into the clinics and say: “This is what I want, treat me now,” whereas it can take years for a cautious 40-something to work up the courage.

The truth is, the whole topic of tweakments is still taboo. If stories about procedures make it into the media, you can bet they will largely be negative tales of botched work, of a perilously unregulated industry (true) and of regret at how the patient was left looking. It becomes a morality tale. When Botox was first approved for cosmetic use back in 2002 (it has been used as a medical treatment for muscle spasms for decades), media attitudes were judgmental. How could women be so vain that, in a futile bid to hold back time, they would inject themselves with a deadly poison?

That attitude persists today and helps fuel the strange phenomenon of “tweakment-denial”. This is common among high-profile figures who get a lot of help with their looks, but would never admit it. When interviewed about cosmetic work, these well-known women – it’s invariably women – say with a laugh that they tried Botox once, but it made them look weird so they never did it again. They say they changed their diet, their exercise regime, their sleep patterns – and they look so much better. And people believe them! It’s disingenuous and incredibly unhelpful to anyone who wonders, “Maybe if I try daily meditation, or use olive oil as a cleanser, my looks will improve, too”.