She plans meticulously. She buys tanning lotion, sunglasses and sandals, beach bag, plus super-strength painkillers, five sports bras in different cup sizes and a bumper pack of XXL knickers. This is because Jayne is going on a holiday with a difference. She is going on a cosmetic-surgery holiday. It will involve sun, sea and an eight-hour operation. This holiday really promises to make her feel, on the outside at least, 'like a new person'.

The pairing of major 'surgery' and luxury 'holiday' may seem to embody a fundamental contradiction: a holiday typically involves relaxation, enjoyment, exploration, not surgery, severe pain, blood and a period of complete incapacitation. But increasing numbers of British people are signing up to package deals offering luxury accommodation in a luxury location, with a facelift thrown in.

Popular destinations are Cape Town, Eastern Europe, and tropical Cairns, in Queensland, Australia. Gorgeous Getaways, an Australian-based company, offers deals to Thailand, Malaysia and Australia. Since it was launched two years ago, it has catered for 250 clients, aged 19-60 plus, and has bookings until the end of 2006. About 70 per cent are British, the rest are from New Zealand, Australia and America.

How did something that only 10 years ago was regarded as physically risky, prohibitively expensive and socially embarrassing become a holiday? 'Ten years ago, it was all about the stars and the film actors,' says Adam Searle, a consultant plastic surgeon and the president of BAAPS. 'It's not like that today.' Thanks to reality-television shows such as Extreme Makeover and Ten Years Younger, in which unhappy women are transformed by dramatic head-to-toe surgery, cosmetic surgery is now more acceptable.

It is Saturday, March 4, and I meet Jayne at breakfast in the Sutera Harbour Hotel in Kota Kinabalu, in Malaysian Borneo. She is relaxing here for the weekend, at a five-star resort on the edge of the South China Sea, overlooking coral-fringed islands, before flying to Kuala Lumpur for surgery on Monday (part of Gorgeous Getaways' Rainforest Recovery Package). There, she will spend three nights in hospital and then two weeks recovering in a five-star self-contained apartment.

So she gave up, which is why she's eating a 'Full English' and putting up with the disapproving looks. Cosmetic surgery will be her salvation, she says. She has fantasised about having it all cut off for about five years, but thought it beyond the likes of her, until she read about Gorgeous Getaways.

But there is a downside. The cost may be in reach, but the location is far away. Jayne's husband couldn't afford to come and she is still red-eyed from crying into her pillow last night. 'I thought, what am I doing in this strange country?' She has never been abroad without her husband - and was so anxious, she travelled for 12 hours with £8,000 in traveller's cheques stuffed into her bra. She knew she had to pay the hospital direct, but didn't realise they take credit cards.

Her bedtime reading is The Seven Habits of Highly Effective People. Like the cult television show Charlie's Angels, the big boss controlling this fragrant task force is a voice on a speakerphone: Louise Cogan is based in Australia. The girls are instantly like-able. Their tone is complicit, oddly intimate, with that air-hostess knack of seeming personally thrilled at your choice of watermelon juice, and honoured to bring it to you.

Kim, a sweet-natured girl, whose real passion is the piano, brings a spiritual leaning to her customer service. Her father is a Christian minister. 'We are here to care for others and to serve them,' she smiles, demurely. 'And for me I find it happiest to see others happy.' They all live in Kuala Lumpur, and speak a dazzling range of mother tongues: Mandarin, Cantonese, Malay.

It is Monday, the day of Jayne's surgery. Yesterday afternoon, at Kota Kinabalu airport, we hit a hitch. Our plane back to Kuala Lumpur was cancelled and we had to stay overnight in what Jayne describes as a 'horrible back-packers' pit', aka the Airport View Hotel, compliments of Malaysia Airlines. These things happen - on holiday - but it now means that Jayne is to rush from the airport to consultation, and then into theatre, after a sleepless night.

This blending of holiday and surgery is very odd. It's like having two Jaynes. The hospital Jayne and the holiday Jayne. Yesterday the holiday Jayne went for a stroll by the sea, marvelled at the jungle-covered hills and coconut trees, then ate lunch by the pool. Also, like many fair-skinned British tourists, holiday Jayne is suffering from sunburn (she forgot to put her factor 30 on her shoulders), an 'iffy tummy' and angry red mosquito bites on her legs.

But today we are in a consulting room in Ampang Puteri Specialist Hospital, and Dr Abdul Jalil bin Jidon, the head plastic surgeon, is drawing on hospital Jayne's sun-blasted skin like a graffiti artist. 'Is that tickly?' laughs a nurse, as the doctor marks the new nipple location (eight inches higher) on her soon-to-be pneumatic breast.

Ampang Puteri is a private hospital in the affluent eastern side of Kuala Lumpur, popular with ambassadors and the wealthy. Outside is typically tropical: 30C or so, with teeming streets, but inside is cool and hushed, with high-ceilinged corridors and polished floors. This ethereal feel is underlined by the nurses who are mostly Muslim and so wear nursing hats on top of the tudung, the headscarf, giving them the appearance of otherworldly picture-book queens or members of an obscure religious cult.

But their manner is playful, buddy-buddy, particularly the English-speaking ones. They say they make special British food: fish and chips, baked beans and frankfurters. What is the first thing British patients ask for when they come to? 'Kentucky Fried Chicken!' They are also enthusiastic about a particular cosmetic-surgery ritual: presenting patients out of theatre with buckets of their freshly collected fat, all cellophane-wrapped. 'I honestly thought I was getting a gift,' says one patient from Bradford, who is here having a tummy tuck and liposuction to her back.

The patients are allocated to a general surgical ward made up of individual rooms, overlooking tower blocks and clogged traffic on a flyover, with en suite bathroom and televisions linked to HBO and CNN.

Jayne is now in Room 517, in between an angio-gram and lung surgery. The head of the ward is Sister Ameerunnisa Hamid, a popular and motherly lady, who is well versed in Gorgeous Getaways principles. 'Guess how old I am?' she asks, taking me into a quiet corner near the laundry chute.

As well as being surgeon to Gorgeous Getaways patients, Dr Jalil, 50, has his own private list and a reputation as a surgeon to Malaysian stars. He also has a parallel career as a do-gooder, operating on congenital defects and facial cancers for free. This, plus his delicate hands - he started in paediatrics - reassures Westerners, who are happy to have him tinkering in their breasts. Indeed, many even consider him a heart-throb, even though he is tiny and has to have the operating table so low it only just skims the floor.

His second wife, an air hostess, is the Face of Malaysia Airlines. Dr Jalil is also one of those high-energy people who needs only four hours' sleep a night (he often plays badminton from 11pm to 1am) and can work for hours at a stretch. This energy suits cosmetic surgery, or the version of it here, where procedures are piled up in one session, like job lots. Operations can last up to nine hours.

But the excitement on today's list is a new nipple for Kalvanita Fortson, a 27-year-old from Texas, who is based in Iraq, as a government contractor, organising housing for the US army. Last year she had a botched breast reduction in Budapest (£2,200). The surgeon took too much off. She lost a lot of blood and her right nipple. So Dr Jalil is to reconstruct a new one out of skin from her vagina. Plus, augment her breasts, do some liposuction and a 'body lift' to pull up saggy skin - the result of dieting - on her arms, legs and back.

His next case is Jayne, who is now an anaesthetised body in the operating theatre. Somehow, in this context, she is magnified. She is Gulliver in Lilliput, a Moby Dick among minnows. She couldn't look less like the tiny theatre assistants with their minuscule hips and slight, pre-pubescent-type bodies.

Every time Dr Jalil touches her, her body wobbles. Most Western clients are here to get the fat from well-fed bodies surgically removed, and I speculate what these pared-down people think of all this pinky-white flesh travelling so far to off-load in a tropical setting. Particularly when Dr Jalil rolls her tummy away to reveal a subcutaneous layer of white fat which he cuts out and drops in a kidney dish.

But, apparently, obesity is a growing problem here, too, thanks, partly, to the strengthening presence of Western fast-food outlets. There is a KFC, McDonald's and Dunkin Donuts just outside the hospital. Dr Jalil worked on Jayne from 5.30pm to 1.30am, to the accompaniment of Led Zeppelin, and a tropical storm, stopping only for a take-away pizza, cigarette and bottle of water.

There are six Gorgeous Getaways women recovering from surgery in four five-star hotels in Kuala Lumpur this week. (Clients typically leave hospital after two to three days.) Kim Huntley, 36, a beautician, with her husband, a property developer, is lying by the pool at the Legend Hotel, just opposite the Putra World Trade Centre. She has had a tummy tuck and liposuction because her post-children tummy 'looked an awful mess'.

She will wear her wrinkles with pride, she says; stretchmarks she couldn't take. Now she has a hip-to-hip scar in the shape of a smile, which Dr Jalil has not covered with dressing. 'Patients can have fun in the sun,' he says. She would, were it not for her swollen body encased in a compression garment - a giant elastic body stocking - crucial after liposuction, apparently, to flatten skin.

She is sweltering under her sarong, but has still managed to walk, slowly, to pick up some bargains at Mango and Topshop in the Twin Towers, where the air conditioning freezes sweat. Perhaps, this is why Gorgeous Getaways clients spend so much time shopping. It is the only cool place to be when your body has the bound-up look of a giant sports injury.

The real test of stamina for the Gorgeous Getaways girls is in the emotional minefield after surgery, when their vocabulary starts to include words such as 'stitch breakdown' and 'fluid build-up'. They make daily visits to clients, walking through the revolving doors of top-end opulence, to hand over painkillers and antibiotics and calm worries about chronic wind.

In the meantime, business goes on. There are more clients arriving today: Amber from Hawaii; Layla from Saudi Arabia; Linda and Annie, best friends from the UK. Plus there is the US market to grow. And there is talk of a competition for the best Gorgeous Getaways makeover. Cosmetic surgery holidays? No problem.

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