Regulation of the private cosmetic surgery industry is to be tightened to offer more protection to patients.
It is not just the rich and famous who are having cosmetic surgery
England's Chief Medical Officer Sir Liam Donaldson has called for better medical training, more information for patients and a reform of regulation.
Cosmetic surgery is on the rise as surgery has become more affordable.
But two reports, commissioned by Sir Liam, warned a more robust system is needed to protect patients, especially with procedures such as botox.
The Healthcare Commission, which inspects NHS and independent healthcare provision, published a report saying some parts of the private industry remain largely unregulated.
It said there needed to be greater scrutiny of non-surgical procedures such as injectible fillers and Botox treatment.
And it also called for specialist training in cosmetic surgery to become mandatory.
The second report by an expert group set up by Sir Liam to look at the industry found, while there was no firm evidence patients were being harmed, the growth of new and different procedures of all types required better regulation.
At the moment, all surgeons have to be registered with the General Medical Council (GMC) and adhere to the Care Standards Act 2000.
But some private clinics are thought to be operating without being registered or regulated.
There is also little regulation of non-surgical procedures.
In response to the reports, Sir Liam said specialist training programmes need to be put in place by the surgical training bodies and detailed information about which practitioners and procedures are accredited.
He also announced non-surgical procedures will be brought under the regulatory remit of the Healthcare Commission, bringing it into line with surgery.
The commission will be able to take legal action against providers who do not register with them and stick to their rules.
Top procedures for women in 2004
Breast augmentation: 3,731 procedures
Breast reduction/mastopexy: 2,417
Blepharoplasty (eyelid surgery): 1,993
Face/neck lift: 1,511
Sir Liam said many people were spending their "hard-earned money" on cosmetic surgery.
"Some are disappointed with the outcome but a minority can suffer serious harm or disfigurement.
"Standards in the cosmetic treatment field must be as high as other areas of health care.
"People have to be confident that their treatment will be safe, that the medical practitioners who treat them are qualified and competent, and that they have the information they need to make informed decisions."
Adam Searle, president of the British Association of Aesthetic Plastic Surgeons, said there was a "desperate need for regulation".
"Surgeons who have been working in the industry are appalled by what has been going on. It is breathtaking.
"Some, and only some, are operating without being regulated. We need a system that patients can feel confident about."
Top procedures for men in 2004
Rhinoplasty: 362 procedures
Otoplasty (pinning back prominent ears): 295
Face/neck lift: 93
The British Association of Aesthetic Plastic Surgeons recorded 16,367 cosmetic procedures in 2004 - up from a total of 10,738 in 2003.
Nine out of 10 were carried out on women, with breast operations accounting for a third of the total.
Nose surgery was the most popular procedure among men.
Simon Gillespie, head of operations at the Healthcare Commission, said: "The safety and quality of cosmetic and aesthetic procedures in England needs to be kept under regular review, not least to understand and respond to new developments."
And Harry Cayton, the government's patients tzar, who was on the expert group, added he hoped patients would be able to make "informed choices" and feel confident the industry was well regulated.