“You come, Miss Gradwyn, without a letter from your GP.” It was stated as a fact, not a reproach. His voice was deep and attractive but with a trace of a country accent which she couldn’t identify and hadn’t expected.

“It seemed a waste of his time and mine. I registered with Dr. Macintyre’s practice about eight years ago as an NHS patient, and I have never needed to consult either him or any of his partners. I only go to the surgery twice a year to have my blood pressure taken. That’s usually done by the practice nurse.”

“I know Dr. Macintyre. I’ll have a word with him.”

Without speaking he came up to her, turning the desk lamp so that its bright beam shone full on her face. His fingers were cool as they touched the skin on each cheek, pinching it into folds. The touch was so impersonal that it seemed an insult. She wondered why he hadn’t disappeared behind the screen to wash his hands, but perhaps, if he considered it necessary for this preliminary appointment, this had been done before she entered the room. There was a moment in which, not touching the scar, he scrutinised it in silence. Then he switched off the light and sat again behind the desk. His eyes on the file before him, he said, “How long ago was this done?”

She was struck by the phrasing of the question. “Thirty-four years ago.”

“How did it happen?”

She said, “Is that a necessary question?”

“Not unless it was self-inflicted. I assume it wasn’t.”

“No, it wasn’t self-inflicted.”

“And you have waited thirty-four years to do something about it. Why now, Miss Gradwyn?”

There was a pause; then she said, “Because I no longer have need of it.”

He didn’t reply, but the hand making notes in the file was for a few seconds stilled. Looking up from his papers, he said, “What are you expecting from this operation, Miss Gradwyn?”

“I should like the scar to disappear, but I realise that’s impossible. I suppose what I’m hoping for is a thin line, not this wide sunken cicatrice.”

He said, “I think with the help of some makeup it could be almost invisible. After surgery, if necessary, you can be referred to a CC nurse for cosmetic camouflage. These nurses are very skilled. It’s surprising what can be done.”

“I’d prefer not to have to use camouflage.”

“Very little or none may be necessary, but it’s a deep scar. As I expect you know, the skin is layered, and it will be necessary to open up and reconstruct those layers. For a time after the operation the scar will look red and raw, a great deal worse before it gets better. We’ll need to deal, too, with the effect on the naso-labial fold, that small droop of the lip, and the top of the scar where it pulls down the corner of the eye. At the finish I shall use a fat injection to plump up and correct any contour irregularities. But when I see you the day before the operation, I shall explain in more detail what I propose to do and show you a diagram. The operation will be done under a general anaesthetic. Have you ever been anaesthetised?”