It used to be said that even in adversity, Britons would do all they could to keep up appearances. Putting on a brave face, the stiff upper lip, keep your chin up – the very stuff of Britishness, given a modern twist by the twin glories of the needle and the knife. Until now. Vanity has become the latest victim of the recession.

After a surge in popularity, in which the value of cosmetic procedures in the UK has more than doubled in the past three years to £530 million, those in search of a straighter nose or reshaped breasts have begun to hold off, preferring to wait until the good times return. Indeed, the recent drop-off in procedures has been so steep that it could force nearly 15 per cent of surgeons to shut up shop.

About 45 per cent of cosmetic surgeons performed at least 25 per cent fewer operations in the final three months of 2008, compared with the previous three months. For many the decline was much steeper, according to figures prepared for The Times by the British Association of Plastic, Reconstructive and Aesthetic Surgeons (Bapras). Nor is the demand for liposuction, a facelift or a tummy-tuck likely to rebound soon: 42 per cent of those surveyed recorded a drop of at least a quarter in consultations about procedures in the future.

Cosmetic surgery refers to elective procedures that are done purely for aesthetic reasons, which are not available on the National Health Service nor covered by insurance companies. It is separate from reconstructive surgery that may be necessary after, for example, an accident.

Hamish Laing, a consultant plastic surgeon based in Cardiff and honorary secretary of Bapras, said: “There has been a significant drop across the country because cosmetic surgery is a lifestyle choice. When times are hard, people considering cosmetic surgery may decide to put it off.”

Breast augmentation is the most popular form of cosmetic plastic surgery in Britain, Mr Laing said. In the United States it is liposuction.

Most cosmetic procedures are carried out by the private practices of NHS plastic surgeons. However, the recession, combined with soaring legal costs, mean that it is not viable for many surgeons to stay in business and 14.7 per cent of them are considering closing their practices.

“The cost of legal insurance has gone up a lot for each of the past four or five years and it is now not unusual for surgeons to pay out half of their total income from cosmetic procedures in indemnity,” Mr Laing said.

Insurance premiums are rising because plastic surgery is particularly prone to litigation because it is not strictly necessary and people can be disappointed with the results.

Mr Laing said that a cosmetic surgeon with an income of £50,000 a year would probably pay about £25,000 in insurance, but a considerably higher income would probably not increase the cost of insurance much.

The Bapras survey, which questioned 120 surgeons, also found that for one third of practitioners the demand for “noninvasive” cosmetic treatments, such as Botox injections, had declined by at least 25 per cent.

Cut prices

- Although it is becoming more socially acceptable and more common for men to have cosmetic procedures, women still make up about 90 per cent of the market

- Although prices vary widely, a typical facelift costs about £6,000, while breast enlargement costs about £5,300, according to Bapras. Rhinoplasty, also known as a nose job, costs about £4,410, while a tummy tuck will set you back about £5,720

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