When vanity is the cruellest cut of all

Michael Jackson once said that if everyone in Hollywood who had undergone plastic surgery went on vacation, there would be no one left in town.

As it is, even some of the most famous cinematic faces are becoming harder to recognise.

First Renée Zellweger stunned fans globally at an awards ceremony in California in October last year when she turned up on the red carpet looking so radically different that the assumption was that she must have had surgery (chin implants and lid lifts were variously suggested). She was beautiful still, but disturbingly unfamiliar.

And now Uma Thurman has been photographed while promoting her new NBC miniseries, The Slap, premiering a face that has also launched a thousand speculative comments.

In the pictures, Thurman's familiar broad-browed, prominent cheekboned and frankly majestic face that so perfectly complemented the mesmerising pale blue eyes appeared to have shrunk into a reverse isosceles triangle. Those eyes now seem slanted, in almost direct contrast to Zellweger's - whose naturally Slavic eyes have been left, apparently by cosmetic tweakery, resembling large marbles.

Both women still look amazing. And they are, of course, entitled to do anything they may want to their faces.

But they have unwittingly become the poster girls for what seems to be a new development in cosmetic know-how, an essentially sculpted style that leaves women looking, well, not like themselves. And this in a town that has long considered women's physiognomy a moveable feast.

Yet they're not alone. Look past Zellweger and Thurman, and there's Courteney Cox, who seems to have acquired a more exaggerated and wider cheekbone. There's Catherine Zeta-Jones, who looks - side on - as though someone has popped a spare breast implant under each cheek. Scarlett Johansson, at a youthful 30, has even laid down a marker, saying: "I definitely believe in plastic surgery. I don't want to be an old hag. There's no fun in that."

Crucially, it doesn't seem enough to look "refreshed" any more. Practitioners of the new approach seem to be adopting a design ethic that knows no aesthetic limits.

So what's driving the women on? One Hollywood insider tells me that women are on a desperate trajectory: "Two things are forever on the rise out here: cosmetic science and female insecurity. Merge the two and you get the perfect storm we're now witnessing, where stars seem to want to look like anyone but themselves - and are succeeding. The casting couch long ago went the way of multimillion-dollar lawsuits, but in its place is a far more insidious thing: female actresses are being urged - either directly or covertly - to compete with younger women in the looks stakes, or they will be replaced," she says.

"Cue the desperate measures we are bearing witness to. Out here your looks, after all, are your fortune. And in this age of HD TV, women will do whatever it takes to stay in the game."

She's echoing the words of 50-something Kim Cattrall (the sexually voracious Samantha in Sex and the City), who has said: "You have to be desirable. And that's why so many women of my age or even younger are pushed to Botox and plastic surgery, all the things that make people ask: 'Why do women do this?' But where do you go in your 50s in your career?"

Certainly, Tinseltown is no stranger to visage-shifting stars. One of the first was Carole Lombard who, in 1926, had surgery to reduce the appearance of a facial scar. In 1958, medical records show that Marilyn Monroe consulted a doctor about her "chin deformity", work that was apparently confirmed by the release recently of one of Monroe's first shoots, from 1946, which show a cheery-faced adolescent, with a well-rounded jawline instead of the more familiar heart shape of legend.

Indeed, during the Golden Age of Hollywood, when a starlet could be ordered to change her name or background, physical appearance was hardly sacrosanct. Margarita Carmen Cansino turned into Rita Hayworth by using electrolysis to raise her hairline. Monroe and Elizabeth Taylor are reported to have shaved their faces to produce a downy growth that gave them more of a glow under the cameras. Marlene Dietrich twisted back strands of hair using clips to lift her face and is said to have had her back molars removed to improve the line of her cheekbones.

Once full facelifts were considered safe in the '70s and '80s, actors popularised what is sometimes called the American Widow or Wind Tunnel look - skin stretched back over skeletal cheekbones, as sported by Nancy Reagan and Joan Rivers in later life. A temptation for repeat lifts resulted in the "melted candle" face epitomised by Mickey Rourke, whose appearance in The Wrestler, in 2008, bore no resemblance at all to that of his sexy John Gray in 9½ Weeks from 1986. No wonder US commentator Ben Shapiro said that Beverly Hills looks like a moving Madame Tussauds.

Surgical techniques improved over time but were still not without risk. A friend recalls, back in the '90s, visiting Michaeljohn, the London hair and beauty salon beloved of visiting US stars, and hearing about one A-lister who had just left. This noted beauty - who was said to worry about losing her younger, universally desired husband - had apparently fallen asleep during a facial, and started snoring.

It wouldn't have been so concerning for the therapist had not the eyes of said actress remained open throughout.

Surgery, it seemed, had left her unable to fully operate her eyelids.

More sophisticated half-lifts, brow lifts and chin implants were followed by chemical peels, Botox and fillers, and a fashion for smoother, plumper, younger-looking "pillow" faces.

However, not everyone in Hollywood accepts that cosmetic makeovers are the price of enduring fame. Recently, the Australian actor Guy Pearce said of those who opt for it: "We look at them and go: 'I can tell you've had plastic surgery. You look really strange to me.' But no one's saying anything. We're just accepting the fact that they're strange-looking."

- The Daily Telegraph