Jessica was at a spa with her friends of more than 20 years when she noticed one stare at her bikini, lock eyes with her and laugh, before asking: “Wait, have you …?” The game was up – eight months after she’d had a secret breast enhancement, she’d been rumbled. Fearing judgment from even her closest circle, she had only spoken to two people who’d had the procedure, for advice, and told a neighbour in case she was unwell after the surgery. “My family still don’t know – most people don’t,” the 42-year-old from London says, including her two children who live between her and her ex-husband. “I’m not alone; I’ve since learned winter is the most popular time for people to get things done, then they can just hide under jumpers while everything settles in, so no one notices.”For years, celebrities have endured public speculation about their tweakments and surgeries – but as procedures become more commonplace, “civilian” patients are facing the same questions from family and friends. And many of them are choosing to go incognito; some surgeons estimate up to 70% of their clients aren’t telling others about their aesthetic procedures. But what are the practicalities of disguising everything from breast augmentation to filler to hair transplants from your closest circle? And why are so many people spending thousands of pounds to alter their appearance – only to hope that no one notices?“I am definitely seeing more patients who prefer not to tell friends, family, or even colleagues that they’ve had aesthetic treatments,” says Allergan Aesthetics’ Dr Sophie Shotter. She has seen a “noticeable shift” from 10 or 15 years ago when procedures such as dramatic boob jobs or big lips were a status symbol intended to be seen. Things have changed. “Today, many patients tell me that the best compliment they can receive is not, ‘Have you had something done?’ but, ‘You look well’ or, ‘You look refreshed’,” she says.It’s not just a case of wanting subtle work, or not broadcasting your business to the world; many are keeping enhancements even from the partners with whom they share homes, bank accounts and their deepest secrets. This is especially the case when the tweakment involves little recovery time, such as with Botox injections, often used to decrease visible facial lines. It has been estimated there are more than 900,000 Botox injections done a year in the UK, across 5,589 clinics. Despite its popularity, there still remains some stigma about the injections, which block the nerve signals that tell muscles to move. But, with costs starting from £150, if there’s no bruising or nerve damage, the injections can remain fairly undetectable both on the face and in the joint bank account.Laura had Botox twice a year for two years before her partner found out. “One day he was looking at me across the dinner table, and said: ‘Why aren’t you scowling?’ And I was like: ‘What?’ He said: ‘Why aren’t you scowling at me? Frown!’ And I tried to frown, and he was like: ‘No, you’ve had Botox.’”It was the stigma that kept her quiet for so long. “He has always been adamant that he likes women who are really natural,” says Laura. “For years, he’s said: ‘Promise me you’ll never get any of that done because everyone looks so fake.’ Also it’s financial as well, because it feels like it’s a waste of money, with the kids.”His objections did matter to her. “I definitely didn’t do it for a while when he said that,” she admits. “Then I started to look at myself in photos and just saw my 11 lines” – the vertical creases between your eyebrows that look like the number 11. “I’ve always hated them, and because of my job being very expressive, being a drama teacher, I think my lines are way worse. Everyone’s always said to me: ‘You’re scowling!’ I did hold off for a little while, but then thought, ‘Sod it. It’s not about what he wants, it’s about what’s going to make me happy.’ So I went for it, and I’ve never looked back.”Her husband was upset about the deception. “He couldn’t believe I’d done that and lied about it. He was cross about me spending the money on it, and that I wasn’t ageing naturally. And then I showed him pictures of me with the scowl and without it. He looked at them and was like: ‘OK, I get why you want it done.’ I did appreciate why he was angry and apologised. But also, it’s my body. I’m going to do what I want.”She jokes about the way her husband rarely notices when she has her hair done and that she had justified the cost of the Botox by not having facials, massages or manicures. Her behaviour chimes with an assertion by Dr Ahmed El Houssieny, a doctor with Allergan Aesthetics, who posits that fewer patients are telling loved ones about aesthetic treatments not “because they’re ashamed; it’s more that, for many people, it’s become part of their self-care routine, much like getting a facial or going to the gym. Many patients simply don’t feel the need to share it.”Daniel, 42, from Kent works in corporate banking and has been having £280 worth of Botox, twice a year for four years without telling his partner of 19 years. He takes careful steps to avoid any bruising by “having it done at a reputable skin clinic and making sure they have digital visibility of any nerves in my face to avoid any potential calamities”. He adds: “I always make sure I get it done when he’s working in London and I’m working from home,” he adds.“I’ve always been into skincare, so I think he assumes that all of the designer anti-ageing moisturisers actually work,” he says. “It doesn’t – it’s certainly nowhere near as effective as Botox.” He’s not shy about anyone else knowing he’s having injections, just his partner. “If anyone compliments my appearance or says that I look younger than my years I literally just go, ‘Botox.’ It takes all the credit,” he says.Daniel says he hasn’t told his partner because they disapprove of the whole aesthetics industry. “He has a complete misconception about what Botox actually is and gets it confused with filler,” says Daniel. Whereas Botox is a solution that relaxes muscle, fillers involves inserting a gel-like substance under the skin to plump up areas. “People don’t seem to realise that you can have the two things done independently and that they aren’t remotely the same thing.”Daniel maintains he doesn’t feel guilty about keeping the secret. “Really, it bears no real relevance to our relationship. It’s a bit like: ‘What he doesn’t know, can’t hurt.’” He thinks eventually his partner will find out. “Probably when he moans about someone looking like they have a trout pout. He’ll say: ‘Look at her with all that Botox,’ and my guard will be down and I’ll defend the needle and educate him.”Daniel doesn’t think it will be relationship-ruining when that moment comes. “What can he say? I think he’ll be a bit sulky for a very short time and then realise nothing’s actually changed and just move on. He will definitely ask where I’m getting it done, to validate that it’s being done professionally and not in the back of a car or something.”Still, though, Daniel admits it does sometimes niggle that he’s never noticed. “But I do think I get more compliments from him about six weeks after I’ve had it done,” he adds. “Just at the point where you have the smoothness but a little bit of flex and more expression without all the wrinkles.”The idea of “so-subtle-you-can’t-tell” is taking over the industry, with the art of “undetectable treatments” being marketed more than ever. “I often say that the best aesthetic treatment is one nobody notices,” says El Houssieny, begging the question: if a tree falls in the forest and no one is around to see it … then what’s the point of the Botox anyway?“People might ask if you’ve been on holiday, rather than asking if you’ve had something done,” he says. “I think there’s been a real shift away from transformation and towards maintenance. Patients want to look like themselves on a really good day.” Aesthetics, then, is no longer about ugly ducklings being transformed. It’s about swans, looking effortlessly unchanged above the water and desperately kicking to maintain that appearance below. Illustration: Jacquie Boyd/The Guardian