But more and more people – mostly women – are making those would-be transformational decisions in the run-up to the party season rather than the aftermath.
Instead of the gym membership or the diet plan, they are increasingly turning to the surgeon's knife or the clinician's syringe. The result has been the rise and rise of aesthetic surgery (the preferred term for cosmetic surgery) and non-surgical "interventions", powering one of the few UK industries whose steady growth has largely defied the recession
According to leading professional body the British Association of Aesthetic Plastic Surgeons (BAAPS), the growth in non-reconstructive plastic surgery, 50% bigger than it was in 2000, has slowed down only slightly since the boom period of the mid-noughties. But even in the depths of a double-dip recession, the number of people undergoing "procedures" has increased year-on-year by around 6%. Recourse to injectable treatments of which botox, dermal fillers and face peels are the best known, is increasing even faster, at around 10% year.
Although the vast majority of patients are women, the de-stigmatising example of Simon Cowell and others has started a revolution for the industry. "Men are the big growth area, with procedures rising 8-9% a year," says Tingy Simoes, a spokeswoman for BAAPS. "Now one in ten patients is a man. Removing man boobs for example – that's the gift that keeps on giving".
The surge in surgical procedures such as breast enlargements/reductions (mammoplasty), "tummy tucks" (abdominoplasty), and face-lifts (rhytidectomy) that precedes the Christmas party season is a well-recognised phenomenon in the industry, as is the growing market in vouchers, either for consultations or for actual procedures, as Christmas presents – although these demand tact on behalf of the giver.
"It's all driven by people wanting to look good for the party season," says Steven Taylor, head of marketing in Scotland for Transform, whose £35m annual turnover makes it one of the UK's largest aesthetic surgery companies.
"This close to Christmas is probably too late even to have even botox, as they take some time to have an effect, but people do take time off between Christmas and New Year for things like breast augmentations, so it does get quite busy."
Although no single body collects comprehensive data, it appears that Scots are no more or less averse to the knife than the rest of the UK, but according to Awf Qatib, a plastic surgeon from the Spire Murrayfield Hospital in Edinburgh: "We [in Scotland] are about five years behind England, which is five years behind the US," in terms of the variety of techniques on offer.
A survey from market researchers Mintel showed Scots to be broadly in line with the rest of the UK when it came to willingness to have "work" done. Perhaps not surprisingly, given our world-beating obesity problems, the most conspicuous stand-out figure from Mintel's survey is that Scotland has the UK's highest proportion of people "likely to consider undergoing a tummy tuck" (8.5%).
Only six out of perhaps three times as many practising aesthetic surgeons in Scotland are members of BAAPS, an association that is fighting what appears to be a rear-guard action against what it calls the "commoditisation" of the industry. Its chief bugbear is the fact that many of the surgeons doing the operations are generalised – perhaps orthopaedic surgeons – and not qualified plastic surgeons. BAAPS objects to what it sees as the rampant commercialisation of the big groups, which include Transform, Harley Medical Group and MYA (Make Yourself Amazing).
BAAPS only represents about 30-40% of the plastic surgeons in the UK, and ruefully admits that a lot of the big chains have a lot of purchasing power, enabling some even to offer "groupons" (daily promotions), seen as wildly inappropriate ways of marketing aesthetic treatments. Simoes is dismissive of Government attempts so far to regulate the industry, which she says are ineffectual.
"We're very against vouchers at Christmas or any other time. It may be a well-meaning gift but it should be the decision of the patient independent of pressure from others," she says. "It commoditises and trivialises the whole process. You don't see 'buy one get one free' offers for any other kind of surgery.
"It means that the public stops seeing surgery as a serious business, often involving general anaesthetics, which always involve an element of risk. We have been campaigning for a total ad ban, particularly in public places like the sides of buses.
"It affects young peoples' body-image when they see pictures of gorgeous models and a line saying 'total body overhaul – book by Friday and get a discount.' These are irreversible procedures that people are signing up to, and it should not be taken lightly.
"In the 10 years I have been doing this job there have been endless Government reviews, and we give our recommendations, but do they get implemented? No."
Qatib says: "There is a fine line between a business and a profession, and mostly it comes down to the code of practice, I tell trainees that if you want to be very wealthy you cannot be a doctor working strictly within medical guidelines. The distinction is sometimes a fine one but it is clear.
"We at the BAAPS have a code of practice and we are governed by general medical council regulations. We are up against clinics that can advertise quite aggressively to patients, through glossy mags, thorugh the internet, radio, you name it. We think patients need protecting more than they are. And when it comes to "dermal fillers" and botox (one of about 150 injectable treatments available), the market is completely unregulated. Anyone can offer these."
"I had a lady who signed for breast enlargement in commercial clinic. She was phoned up and told she would have a different surgeon, and when she said no, she wanted the surgeon she had met, they said they would slash the price of operation. She cancelled it altogether, as she lost confidence in the process."
The private clinics counter that their surgeons are not "on the register" because it is only open to surgeons working in NHS hospitals. Their private-sector surgeons devote all their time to specific aesthetic surgical procedures, and are anyway subject to monitoring by the Care Commission, and the Advertising Standards Authority as well as having their own internally-imposed standards.
Transform's Taylor does however hint that 2013 may see further self-restriction on advertising and marketing practices.
Says Timoes: "Aesthetic surgery isn't a very well-regulated sector, and it's not even a recognised discipline. All our members have held consultative posts in the NHS and get audited once a year. We are not implying if you are not a member of our organisation you are a quack, but at least you know you are getting the highest level of qualifications possible. The truth is that anyone can call themselves an aesthetic surgeon. Unfortunately there are no restrictions, even after the PIP implant scandal."
She is referring to the the industry's biggest setback to date, when hundreds of thousands of women worldwide – up to 40,000 of them in the UK – were put in danger by cheap silicon implants made by a French firm Poly Implant Prosthèse. The fallout was a rash of company administrations and instant new company registrations as practitioners rushed to put themselves out of reach of legal action and claims for the costs of reversing the procedure.
At the moment the industry seems to be riding a wave of demand, perhaps all the more for being previously suppressed by high costs (breast enlargements used to cost at least £8000, now they are £4000 to £6000) and stigma about having this type of surgery. According to Qatib, the residue of this stigma causes problems, as patients behaving furtively, for example going abroad or to another part of the country for treatment, can make them vulnerable to charlatans.
"There are people posing as consultants, who are seeing patients in hotels, taking deposits in advance, and sending people off for procedures in Poland, North Africa, India, you name it."
Nevertheless, he believes that the normalisation of the transaction is a positive social good. "A lot of the people who use plastic surgery are not wealthy individuals, they are just ordinary people who feel strongly about their bodies and have tried this and tried that. If they are carefully counselled and their expectations set correctly, the majority are happy. The counselling is important, as when it goes wrong, it's a big problem for the surgeon and patient."
'People want to look their best'
For Taimur Shoaib of Glasgow cosmetic surgery clinic La Belle Forme, and consultant plastic surgeon at Glasgow's Royal Infirmary, pre-Christmas holidays is always hectic as is the run up to the summer holidays, as the thought of beach wear looms.
"People want to look their best for the festive period, also they have some time off, if they are thinking of a surgical intervention it's a good time to consider this."
Founded six years ago, La Belle Forme is a thriving business with 20 employees and a £750,000 turnover. Although it's website lists a menu of priced treatments, Shoaib is careful to stress the limits of the clinic's commerciality.
"We don't sell surgery, we sell advice. We sell our experience and our expertise and we don't mind what people do with that advice."
"We want people who come to us to consider the question, 'What is it you don't like about yourself and what are you hoping to achieve by coming here? We then put together package which might include cosmetic, surgery or maybe just beauty treatments."
But La Belle Forme is not so clinical as to forego selling gift vouchers, is it? "Yes we do sell vouchers, but these are not for surgery, they are for consultations. People can then consider their options. Yes people are buying them Christmas gifts, but we encourage them to use them with care. Anyway, it's hard for people to say to their wives "Here's a voucher for some botox".
We certainly don't encourage people to buy vouchers for something that would lead to divorce proceedings".