Dead ringers? Not quite

Sitting on a deep leather couch between Roberto and Maurizio Viel with your face exposed by daylight, is to experience a rather unsettling sensation of being discreetly scrutinised, although in a charming and solicitous way. Suave Italians tend to be like this; the difference with Roberto and Maurizio is that you know they are not merely assessing your looks, but making silent professional inventories of how they would improve you, if given the chance. The Viel brothers are twins who were born 40 years ago in northern Italy. Both are cosmetic surgeons with a passion for their craft. They see it as an advantage that they practise together, because they can discuss difficult cases and share mutual concerns. "It is more stimulating," says Maurizio. "It makes life more relaxed," says Roberto.

Roberto has operated on Maurizio, transforming his nose and adjusting his eyelids. Roberto has resisted the temptation of cosmetic surgery for himself, but if ever he feels the tug of time, Maurizio will do the honours.

Both twins have operated simultaneously on their own mother, although they loyally refuse to divulge the cosmetic procedures involved. One can only surmise that their wives will age with exceptional grace. The twins admit that it is not customary for surgeons to operate on family members, but they have broken this rule because they want each other and their families to have the very best. "We operated on our mother as if she were any other patient. Which is to say, we treat every patient as if she was our mother," they say almost in unison.

The Viels - who are registered to practise in four countries - are cosmetic, rather than plastic, surgeons. The latter tend to look down their noses on the former, but the Viels argue that if you want to do something like cosmetic surgery, well, you have to specialise in it. Plastic surgeons, who can reconstruct faces destroyed in car accidents and surgically correct congenital deformities, have a valuable role - and so do they, the Viels believe.

Roberto pioneered penile enlargement and ultrasound liposuction in Paris and Milan and was the first surgeon to introduce these procedures in the UK. Many Irishmen requiring thicker penises have already been his patients at the Harley Medical Group in London. Penile enlargement involves injecting fat from elsewhere in the body into the penis and costs £1,500-£2,500. About 5,000 Irish men and women have made the pilgrimage to the Harley Medical Group in London for cosmetic surgery annually, so many that the group decided to come to them. The Dublin clinic at Herbert Place is the first of four that the Harley Medical Group plans to open in the Republic and the North. Roberto and Maurizio, who are employed by the group, will be practising in Dublin, while continuing to live in London. Roberto also practises in Paris. A third surgeon, Henri Ronan of Paris, will also be practising at the Dublin clinic. They are also recruiting fully qualified Irish plastic surgeons to the team. Minor procedures requiring local anaesthetic will be conducted in Dublin, but all major surgery will be undertaken at Clane General Hospital in Co Kildare.

The clinic will have a "team approach" to its pre and post-operative service, so that patients will have access to quality care, even though some of the surgeons will not be resident in the country, says Veronica McNamara, a registered nurse who trained with the Harley group in the UK and is now manager of the Dublin clinic. The Viels, for example, will come to Dublin for a few weeks at a time to do cases. They will not, they promise, disappear off to London the morning after major surgery, leaving a patient to deal with a local GP. However, patients may be seen post-operatively by other doctors on the team and will also have a 24-hour back-up from McNamara, who promises that she or another member of the team will always be available on the telephone.

Since the Harley Dublin clinic opened 10 days ago, the whole gamut of humanity "from female farmers to ladies who lunch" have been through the doors, says McNamara. She expects to see 7,000 patients for consultations over the next 12 months. Fifty per cent of the Irish contacting the Harley clinic are middle-class, a handful are extremely rich, and a few are not well off at all and have taken second jobs to pay for their surgery. The most popular procedures with men are fat removal through liposuction (£2,300 upwards) especially from the male breast and love handles around the waist; nose reshaping (£2,300-£3,200,) and laser hair removal from chest and back (£90 per treatment). Irish women are most concerned about their breasts and their tummies, and are seeking breast enlargement (£3,200 to £4,200), breast reduction (£4,200) and tummy tucks (£4,300-£4,500), as well as facelifts (£4,200 upwards).

Judging by their enthusiastic response, the Irish public are comfortable with the idea of a private clinic coming to Dublin from London, using surgeons from abroad and advertising widely in the media as a means of encouraging business. The Harley has spent £250,000 on its Irish advertising campaign, and as much again to set up its Dublin clinic. The Viels believe that such advertising is justified if it is done in the interest of informing the consumer, and as long as doctors do not claim that they have unique or superior expertise.

The huge advertising budget sits uneasily with the Irish Medical Council's Guide to Ethical Conduct and Behaviour, which allows only "two discreet announcements" in the social and personal section of the local or national press concerning the commencement of practice. It also states that: "Doctors associated with clinics . . . are reminded that they have a duty to ensure that ethical guidelines are not breached and that they can be held responsible for unethical advertising by private clinics and hospitals."

However, the Medical Council seems to have turned a blind eye to advertising by cosmetic surgery clinics. The Medical Council's PRO, Brian Lea, has refused to comment on the issue, making it impossible to say whether the council feels in any way responsible for standards in the massive cosmetic surgery market that has sprung up almost overnight in the Republic. There are 15 plastic surgeons practising in Irish hospitals, but in addition, another private clinic chain originating in the UK, Advance (formerly Transform), opens its fifth cosmetic surgery clinic in Galway today. The Viels aren't worried. "There is a window of opportunity today in Ireland and heavy competition is good for everybody - good for the surgeons and good for the patients," says Roberto. "It improves the quality of standards because you have to push yourself to give the best service."

But if you can't be bothered with plastic surgery, here's some free advice from the Viel brothers: don't waste money on moisturising creams because anything sold without prescription doesn't work; avoid wrinkles instead by not smoking and staying out of the sun.