THE SLIM, PALE-EYED young woman with ash-blonde streaks who steps forward with a wide grin and an enthusiastic hug on a sweltering afternoon in New York is certainly attractive. But even from 20 paces there is a detectably chiselled quality about her nose and, on closer inspection, the rest of her face too. This is shop-bought beauty, American style.

Hope Donahue flutters nervously as she settles into a seat in a friend’s nicely air-conditioned Manhattan office and prepares to explain how she became addicted to plastic surgery. “An alcoholic can’t just have one glass of wine. I used to think, just one more procedure — another nose job or maybe another brow lift and I’ll be perfect, beautiful, I’ll be happy,” she says.

Donahue had her first nose job when she was 22, followed by cheek implants, a brow lift, bigger breasts and several lip-enhancement operations before she was 25. She did not need any of it. Ostensibly, Hope Donahue had everything. She was brought up an only child by doting parents into a wealthy, relatively old-money family near Hollywood. She had great looks, plenty of brains and unlimited prospects. “We used to go to Paris for the weekend on Concorde. I was the person other people wanted to be,” she says.

But underneath she was a lonely and miserable teenager. Flailing about for a way to face the world and find love and happiness, she felt a desperate need to be not just attractive but flawlessly beautiful. And she was swept up in society’s growing obsession with cosmetic surgery.

It is shocking to hear this comfortable, sensible, amiable suburban wife and mother describe how that first nose job turned into a galloping fixation with her appearance; and how instead of the operations leading to happiness she sank into a depression that led to theft, debt, a sado-masochistic relationship with a violent man, a dangerous infatuation with her knife-happy surgeon and, eventually, the porn industry.

Donahue has now told her story in the riveting memoir Beautiful Stranger, which lifts the lid on the unscrupulous corners of a greedy industry and explodes the myth of manufactured beauty as a social panacea. She took it to the point where it almost wrecked her life, and she is not alone. “There are millions of women in their twenties and thirties out there now, maxing out their credit cards and spending all their pay cheques on surgeries, whether it is a facelift or liposuction. It’s addictive,” she says.

Even when it goes wrong. Two of Donahue’s surgeries were corrective — one to remove a botched lip implant and the other a five-hour operation to remove the breast implants that had turned her chest into a rock-hard block of painful scar tissue.

Now, at 36, her smooth, slightly bland features pucker asymetrically when she smiles and a peculiar groove is detectable between her right cheek and her nose. When asked about it, she twitches. “I’m still very nervous about my appearance, although I’ve got a lot better. The line? I suppose it’s from the cheek implants.” The middle of her top lip has lost its natural, firm structure and is slightly floppy. “

When I had the implant put in he cut from the inside, I suppose that’s it. My lips are not as full as I would like them to be,” she says quietly. Donahue considers herself lucky. She avoided many of the more extreme procedures, and she lived — unlike Olivia Goldsmith, author of The First Wives Club, who died in January while under anaesthetic for a neck lift.

The latest, worrying craze in the US is for teenage girls to be given breast implants — often as a high school graduation present from their parents — when their breasts have not even finished developing, resulting in all sorts of medical problems later.

In 2003 almost 336,000 Americans aged 18 or younger had cosmetic surgery — a 50 per cent increase on 2002, with breast augmentation up 24 per cent. Americans spent £6 billion on three million cosmetic operations last year. Breast implants and liposuctions have increased fourfold in the past decade. In Britain there are an estimated 75,000 cosmetic operations every year and patients are prepared to borrow up to £ 4,000 to pay for them.

The business is now even a source of entertainment. Nip/Tuck — imported from America, first shown on Sky and now on Channel 4 — positively glories in stomach-churning close-ups of plastic surgery performed by a duo of cavalier, hunky-but-sleazy young Miami surgeons.

And this autumn comes the show that has been transfixing America — The Swan. Sixteen supposed “ugly ducklings” are transformed by surgeons, beauticians and personal trainers and kept in a house without mirrors for months before they are allowed to see the changes — then compete with each other in a pageant.