Does Shirley Manson really need plastic surgery? Singer's online admission reveals much about the pressure many women feel

AT HOME in the creative, low-key district of Los Angeles where she has lived for the past four years, Shirley Manson was quietly celebrating her 44th birthday last week.

•Shirley Manson grew up in Edinburgh and won stardom as the frontwoman for Garbage. Now at 44, she is pondering whether to have cosmetic surgery.

For the Garbage frontwoman and Edinburgh native who once told the world she was only happy when it rained, it was a happy occasion, but one that seems to have marked a turning point. Just a few days later, she took to her Facebook page to make an extraordinary statement.

"Let me first state my position," she wrote. "I am at odds with plastic surgery, Botox, filler and surgical enhancement. Meanwhile… almost everyone I know is at it. My question is this: Have I lost my mind? I am 44 years old. That is ANCIENT in the world of entertainment. That is even older in the world of music. I feel like if I stay true to myself. I am screwing myself out of a job."

They are shocking words from someone who has modelled for Calvin Klein and turned down Playboy, and who for much of the past two decades has embodied a certain type of strong, confident woman. Manson has always been a rebel – talented, chic, unusual, gorgeous, and as far removed from the sort of identikit popstrel currently stalking the music charts as Hans Holbein is from Rolf Harris. So what on Earth has happened to turn the singer who sold 14 million albums and once told a journalist she bought an orange Fender Stratocaster because it matched her pubic hair into a nervous-sounding woman seriously considering plastic surgery in order to stay popular?

For many women, the idea that Manson might even consider going under the knife at all is disturbing.

"It's very worrying," says Mary McGowne, a friend of Manson's who founded the Scottish Style Awards, which presented Manson with Most Stylish Female in 2008. "Shirley is more stunning and stylish than she's ever been. She's had no work done and she looks amazing, it's one of the reasons she has had such longevity and commands such respect from people, it's because she doesn't compromise."

Another friend, Susie Cormack, who runs her own entertainment management company, agrees. "She's crazy, because she is one of the most unique and stunning females out there. She's uber-talented and gorgeous, one of those women you just cannot help but look at. She's got such a life about her that surgery would absolutely be completely wrong for someone like her, because you would be taking away the character in her face. Besides that she looks a lot younger than 44 – not that there's anything wrong with being 44."

But while there may not be anything wrong with being 44, there is no denying Manson is, as she said herself, ANCIENT in the world of entertainment – a veritable grandmother compared with the likes of Miley Cyrus, The Saturdays, Taylor Momsen and other female artistes still happily paddling about in their teens.

"There is massive pressure now to look a certain way in the entertainment industry," says Selina Julien, assistant editor of showbiz magazine Now. "Shirley's outburst reminds me of Lily Allen's breakdown, where she said she wanted liposuction when she was only in her early twenties. If somebody that age is considering surgery, it just goes to show that those over 35 are going to feel incredibly pressured.

"Men in showbiz are seen as growing old gracefully but for women it seems they always have to compete with younger counterparts – it's a case of, do you conform and have the surgery and the Botox, or do you grow old gracefully and accept you may not get as many opportunities as you might if you had had the work done. It's really quite shocking."

Certainly, the pressure to look a certain way seems to start incredibly young: just last week rumours abounded that Cyrus, the 17-year-old Hannah Montana star, had received Botox injections, while fellow TV star Heidi Montag, of The Hills, revealed in January that she had undergone ten plastic surgery procedures in one day, including brow lifts, a chin reduction, a rhinoplasty and ear-pinnings. She was just 22.

"There is a well-known correlation –people who are young and fresh generally tend to have more successful careers," says Ken Stewart, a plastic surgeon based in Edinburgh. "People who are regarded as visually attractive are generally more successful and there's no doubt that in the fashion world there's a correlation between visual attractiveness and youthful image and success."

Manson's visual attractiveness however – with her flame red hair, sylph-like figure and magnetic eyes, has never been in question.

"Personally I think Shirley Manson is gorgeous," says Stewart. "If I were a director of a record label I would want to keep her on my books forever. As a society we should value maturity in every walk of life."

However, in all walks of life plastic surgery is on the increase.

Although not quite at the levels in the US, where Manson has lived for the past few years (and in Los Angeles too, a place where teenagers routinely receive nose jobs for their 16th birthday), there has been a marked rise in the number of plastic procedures carried out in the UK. In 2009, the total figure was 36,482, a rise on the previous year of 6.7 per cent, with women accounting for 32,859 of those.

According to Stewart, the most popular procedure among women aged 40 to 50 is a tummy tuck following a pregnancy, with a breast uplift and enhancement following closely behind.

"Women who have finished having a family quite often go for cosmetic enhancement partly because they might have more free time on their hands, they're feeling the effects of pregnancy on their body, and also because if they are smokers, the effects of smoking start to become very obviously manifest around that sort of age," he says.

For many women too, one of the allures of cosmetic surgery – particularly the non-surgical procedures such as Botox and collagen fillers – is how accessible it now is. Once confined to Hollywood stars, many cosmetic procedures can be found on almost every high street in the country.

"I know friends who nip out in their lunch break and get a little jab on their face to get rid of their crows' feet," says McGowne. "It's almost as common as popping out to get a sandwich. It's really quite tragic."

And while many women talk about the need for acceptance, there are many more ever eager to point the finger whenever an imperfection is revealed to the public.

"We all need to look at ourselves to find the actual culprits," says Cormack. "I think it's women who are putting other women under incredible pressure. You don't have to go far to find a woman criticising another woman in the media for having a few wrinkles or some cellulite. Then there are women who go completely the other way, like Katie Price, who get criticised for setting themselves up as an idolised image of beauty and womanhood. Really, you can't win."

But could there be a deeper and more serious reason for Manson's crisis of confidence? In the past she has confessed to suffering from body dysmorphia, an affliction which gives sufferers a distorted view of their own image. It may even be at the root of her contemplating surgery.

"People like Shirley Manson with body dysmorphia will have that wacky, unique, crazy look as a way of departing from the norm," says behavioural psychologist Jo Hemmings. "You have to depart from what you look like ordinarily, but in her forties she's getting a bit old to look so wild and wacky, so she's now resorting to other ways of dealing with the body dysmorphia – changing the actual physical outside of her body."

And it is not, in fact, the first time Manson has addressed the issue. ln 2008, she talked of growing old, saying: "The only thing that I don't like, that I really find painful, is living with the face and the body ageing. I find that hard. I don't like looking at it. But at the same time, I feel very opposed to plastic surgery and cheating myself in that regard too."

But why use such a public forum to reveal that she was, in fact, thinking of changing her mind? Hemmings suspects that Manson was, on some level at least, seeking approval.

"I don't know if Shirley's doing it consciously, but what she's doing is putting the question out there, asking 'will I still be popular if I carry on looking like this?' And, of course, by their very nature, the people responding, given that they're her fans on Facebook, is that they're going to come back and say 'no, you're gorgeous as you are'. And, of course, that's what she's looking for."

Perhaps then, Manson was just voicing a few ideas out loud after a particularly exuberant birthday party.

"I sincerely hope she had too much gin that night, and that's when she wrote that blog," says Cormack. "I hope she's now looking at it going 'oh my God I shouldn't have done that'."

Ultimately, the battle over image is one that Manson may just have to fight with herself. In 2008 she lost her beloved mother Muriel, and it may be that having that particular ballast removed from her life has led her to this particular self-doubting phase.

In an interview the year she died, Manson credited her mother with inspiring her to be a natural beauty. "I look at my mum, who is 72 and has never had a stitch done to her face, and to me she looks beautiful," she said. "So I just have to remember her when I'm struggling with the image that looks back at me from the bathroom mirror. I just want to learn to live with myself. Because sooner or later, you have to."