FACELIFTS, fillers and Botox were once the preserve of a youth-obsessed Hollywood, but as attitudes to ageing change more and more Scots are choosing cosmetic surgery to turn back the clock.

And it seems energetic lifestyles and higher divorce rates are fuelling demand for a nip and tuck among pensioners in Scotland.

Ken Stewart, a cosmetic surgeon at the Spire Murrayfield hospital in Edinburgh, said they were now busier than ever after seeing demand dip during the recession.

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“It’s probably at least one and a half to two times as busy as when I started in 2002,” said Mr Stewart.

“More and more men are coming for facelifts too. The ratio probably used to be about nine to one, female to male, but now it’s probably five to one in terms of the female to male ratio for facelifts.

“It’s more affordable, more acceptable – even though most people probably keep it quiet from all but their closest friends. Some of the procedures like facelifts can be done using ultrasonic scalpels rather than a traditional scalpel which reduced the amount of swelling.

“Sometimes, with people living longer, they might have lost their partner and have a new younger partner, so there are people who want a smaller nose or less prominent ears – for example if they have thinning hair and their ears are sticking through.

“It’s not uncommon for people with a younger partner or trying to find a new partner to decide that they want to get the thing fixed that’s been bugging them for 60 years. I think the oldest patient I had in for ear correction was a 70-year-old.”

Awf Quaba, an Iraqi-born consultant surgeon who runs Quaba Plastic Surgery in Edinburgh, carried out two facelifts in an entire year when he first began operating in the capital in 1987.

Last year, he performed more than one every week.

At the time, Mr Quaba was one of only two plastic surgeons in Scotland who performed the procedure; now he is one of eight at the private Spire Murrayfield alone – one of the centres where works.

He was also the first surgeon in Edinburgh to use Botox cosmetically 20 years ago.

As well as facelifts, which carry a price tag of up to £10,000, Mr Quaba’s workload last year also included more than 100 eyelifts – a popular rejuvenating operation which removes bagginess from lower eyelids and excess skin from the upper eyelids to eliminate droopiness.

He said: “The internet has levelled things. One thing which has brought patients in seeking rejuvenation are selfies and people talking over the phone using Facetime. People are looking down and they’re seeing their double chin more often, and it’s this availability of photographs. In the past people would go on holiday and take a picture and look at it. Now, it’s an everyday thing.

“Your kids take pictures of you in the most unflattering moment. It’s not unusual that people bring in these pictures and say to me ‘look, I am becoming more self-conscious about this or that’, so there’s a lot of factors that are contributing to our increased awareness of the ageing process.

“People talk about it all the time and it’s more in the public domain. There’s a hardly a magazine without an article on cosmetic surgery.”

Cosmetic surgery no longer has to mean going under the knife either. An explosion of less invasive, and more affordable, interventions such as Botox, dermal fillers and threadlifts – nicknamed the “lunchtime facelift” – has democratised an industry once seen as only for the rich and famous.

Dr Simon Ravichandran, a former NHS ear, nose and throat surgeon who now specialises in non-surgical rejuvenation at his chain of Clinetix clinics in Glasgow and Bothwell, Lanarkshire, said the changing technology is also delivering better outcomes for patients, and that in turn is attracting more people to undergo treatments.

Dr Ravichandran said: “The modern cosmetic doctor is not just someone who can lift up skin but someone who understands skin and soft tissues and all those techniques. We’ve understood a lot more over the last 10 years about how the face ages, anatomically and physiologically.

“We know that lifting up and cutting off excess skin isn’t rejuvenating; it gives you an operated look. Nowadays we think about replacing the volume and improving the skin tone as well as lifting the skin back up, and that gives you a ‘natural’ result which makes people look younger and fresher.”

A typical “rejuvenation package” for a client in their late 40s or early 50s – comprising Botox, dermal fillers, thread lifting and skin rejuvenation – comes in around £2,500.

Dr Ravichandran, chair and founder of the Association of Scottish Aesthetic Practitioners, said that part of the desire to look younger has been driven by changes in lifestyle as people live and work longer.

He said: “My average patient is 45 to 50. I do see younger patients and I do see older patients – I have a couple of octogenarian ladies who are still concerned about their appearance and want to keep up.

“This is the really interesting thing: nowadays we’re very different than we were in my mother or grandmothers’ era because people remain active for much longer. “They’re active socially and they’re active in the workplace and physically they may be 60, but they feel like a 35 or 40 year old. So there’s this mismatch looking in the mirror between what you see and what you imagine you should be like which is driving a lot of what we do.

“The fact that we are living longer and being healthier for longer is having an indirect effect in the sense that, as we age, our perceptions of how we should be and behave are changing because society is dictating that we need to work longer. We stay in the workforce and we go out more.”