One cold afternoon in 2010, in an office just around the corner from Harrods, I sat very still and watched a woman in her 20s undergo a "15-minute nose job". It was slightly quicker than that, in fact, the process of injecting a mixture of anaesthetic and Restylane filler into the bridge of her small, straight nose and massaging it firmly into place to fill an imagined dent. I think about it often – the fine, bent needle and the squeak of the doctor's baggy rubber gloves and, walking out through the Harrods beauty hall, between the tight-eyed women and their identical daughters, the way it made me feel so differently about cosmetic surgery, how its speed and simplicity scared me. That was the year that the injectable and laser market blew up, the demand for chemical peels increased by 306%, and, in a survey, almost half of British schoolgirls said they planned to have plastic surgery one day. The British market alone was worth £2.3bn.

Two years later, thousands of women's breast implants ruptured and industrial-grade silicone gel intended for mattresses leaked into their body; the resulting PIP scandal shone a bright spotlight into a dark corner.

Last week, questions began to be asked by the Department of Health. Why hadn't the EU regulatory system detected the PIP fault earlier? Why was it so difficult to trace the women who had received the implants? Are vulnerable people put under excessive pressure to undergo procedures and are they properly informed about the risks?

Most important, is the private cosmetic sector properly regulated?

It's a dark and complex world, the world of cosmetic surgery, one constantly on the defensive, often unwilling to interrogate the reasons for its success, that fog of manipulated insecurity that leads women (and increasingly men, whose demand for gynaecomastia has risen 28%) to their small, bright rooms above shoe shops and salons.

In June, bullied 14-year-old Nadia Ilse received $40,000 in free cosmetic surgery from the Little Baby Face Foundation, an American organisation set up to help children with facial deformities. Ilse's deformity was that her ears stuck out. So she had them pinned back, had her chin reshaped and some minor rhinoplasty, and now she's pretty, she's happy – the bullying seems to have stopped.

Ilse has grown up in the shadow of Cosmo-culture, where drastic measures are encouraged if beauty, and therefore confidence and "empowerment", is the end result.

The death of Cosmopolitan's Helen Gurley Brown, plastic surgery pioneer, has brought some of her choice quotes to the surface.

"Self-help," she said to Nora Ephron, explaining the methods she used to improve her flaws. "I wish there were better words, but that is my whole credo. You cannot sit around like a cupcake asking other people to come and eat you up and discover your great sweetness and charm. You've got to make yourself more cupcakable all the time so you're a better cupcake to be gobbled up."

The formula she laid down for Cosmopolitan in 1965 relied on constant renovation, improvement and a continual quest for achievement, where anybody can be beautiful, if only they try hard enough.

This is how we live now. Anything that makes us feel better about our appearance, whether it involves needles, knives or acid, is acceptable. Anything that takes us closer to an imagined ideal, whatever the risk or the cost. Price, a survey by ComRes confirmed, is a far more important factor for customers of cosmetic surgery than the qualifications of the person performing the procedure. And loans for those who can't afford the work they want are rife. The demand for surgery in Beirut has even led to banks offering loans directly to female customers. "You cannot find a job in Lebanon if you are not good-looking," says Maher Mezher of Beirut's First National Bank. "People will reject you socially."

These social structures are already in place. These beliefs that perfection is attainable, that beauty is the goal. Of course the industry should be regulated. Of course two-for-one deals should be banned, and a complaints system strengthened, and a register of people with implants should be established. Of course dermal fillers, the collagen or hyaluronic acid injectables used to smooth out foreheads, fill lips and reorganise noses, should no longer be classified as "medical devices" rather than drugs. Regulations about who can administer them would be tighter and their side-effects discovered before they're tested on women, even if this threatens to send business underground.

Of course there should be better education about the risks of surgery and the fact that most breast implants have to be replaced every 10 years. Of course vulnerable patients should be psychologically screened before being accepted for surgery. Of course an industry that cuts into our bodies should be regulated. Of course.

But this sidesteps a larger issue, one that concerns all of us, even those who opt out of surgery. It's the issue of the importance of "beauty" itself. That we feel our bodies, our sagging eyes and furrowed brows, are defective. It's that our desire for individuality and independence is remoulded into a longing for a perfect and therefore neutral body.

It's the idea that cosmetic surgery is acceptable if it makes us feel acceptable. The idea that self-esteem comes from feeling confident about the way you look, so whatever it takes to find that confidence – whatever you have to buy, usually – is unobjectionable. That beauty is worth paying for – that we should be saving for new boobs rather than fighting against the structures that demand them.

It's this issue that leads these customers to become patients, leads them into what the Department of Health admits is a "grubby" industry, currently self-regulated. It's the fact that so few of us feel comfortable in our bodies. We can regulate the liquids that we inject into our faces and the qualifications of the people we hire to insert saline sacs into our breasts. We can regulate the aggressive advertising of such operations, the offering of "mummy makeovers" that trivialise invasive surgery. But how do we regulate self-hatred?