So what now?

Even being here feels like an admission of defeat. I tell him this, in his Harley Street office, when he asks me what I want. I tell him I've spent half my life trying to accept my fat face, and I've failed. So I'm here to find out about buccal fat removal. I'm not sure whether it's the right procedure for me but I'd like to discuss options.

From what I can tell, Mr [X] is a respected cosmetic surgeon. His CV – with qualifications from both Oxford and Cambridge – is simultaneously intimidating and reassuring. He sits in an armchair at right angles to me, legs crossed, his posture relaxed and confident. He has my registration form in front of him, my extensive list of medication scrawled in tiny letters to fit into the space provided. He knows I'm a transplant patient, on a bucketful of pills that suppress my immune system and interfere with wound healing, together with a supporting cast of other pharmaceutical delights.

He hands me a mirror and asks me to point out the parts that bother me. The familiar feeling of disgust rises as I lift the glass to my face. I'm braced for this: after all these years it's as automatic as a knee-jerk reflex. I draw a circle around my incipient jowls with an index finger.

Mr [X] kneels in front of me and pushes my cheeks upwards with his hands. 'Would having this shape be enough, or do you want less fullness higher up too?'

God I look good. I should hold my face like this all the time. 'I'd be happy with that,' I tell him, 'though it'd be nice to be thinner further up as well.'

He takes the mirror from me, puts it back on the table and resumes his pose in the armchair. He tells me what buccal fat is, describes the procedure for removing it, the results of the operation (variable but subtle) and the risks it entails. The infection risk would be significantly higher for me but, in any event, buccal fat removal won't give me the result I want. That, he explains, would require a combination of a face lift and liposuction. He goes into some detail about this, too, before telling me that he would be unwilling to perform the operation because, with my level of immunosuppression, the risks would be too great.

'Well I guess I'd better grow a pair of ovaries and accept that I'll always have fat cheeks,' I say. 'Or become anorexic,' I add, 'but that doesn't really appeal. I like food.'

Mr [X] smiles warmly and rubs his own (gloriously slender) cheek.

I stand up and thank him for being forthright and professional. We shake hands. As he opens the door, he tells me he won't charge his usual consultation fee. 'We've only had a little chat,' he says. And I suppose we have, though our conversation was far longer and friendlier than my rendering of it suggests. I am touched and surprised by his largesse.

It is raining outside, so I put up my umbrella and start walking back to Charing Cross station. I joked with the surgeon about anorexia. What I didn't tell him is that I was anorexic in my twenties, with a sideline in bulimia on the occasions when I actually had food in my stomach to puke up. My eating disorder was driven in large part by my desire for a thin face, but even when I was a dangerously underweight five stone ten, it was still disproportionately large. Had I bleached my hair and worn black and white stripes, I could have got a job as a belisha beacon.

It is rush hour: the streets of London are filled with people scurrying through the downpour, using umbrellas and hoods to protect themselves. Others improvise: in a doorway, a woman smokes a cigarette, an upturned Prêt-à-Manger bag jammed on her head as a makeshift hat. I weave through the crowds, lifting and lowering my own umbrella to avoid stabbing eyes out with the spokes.

Why can't I accept my face as it is? I wonder.  Am I really that shallow?

It's an unsettling question because, on this issue at least, the evidence points to a resounding 'Yes'. And that's not how I like to think of myself.

I know I'm not monstrously disfigured; I simply have a plump face that time and gravity are beginning to drag earthwards. I hated my cheeks ten years ago, yet I know that if I look at photographs of my 35-year-old self, I think I look okay. Unfortunately, that doesn't help: I was unhappy then, and retrospective approval isn't going to change that. By the same token, knowing that a 55-year-old Rachel may look approvingly at photos from 2016 doesn't make me feel any better now.

How can I learn to accept this? I ask myself. It is not a foot-stamping rhetorical question; it's a request to my subconscious for aid. Our reserve option – the one we'd trigger only if all else failed – we've just been told it isn't viable. So what now? Help me figure it out.

As I reach the Garrick Theatre I hear a loud voice followed by cheers. I glance towards the noise and glimpse a crowd in Trafalgar Square. Probably something to do with Brexit – I hazily recall there was to be a pro-Remain rally in central London this evening. So much turmoil in the world around me and here I am, consumed by a pseudo-drama concocted entirely by my own mind. I am too tired for self-recrimination, but also too tired to join the demonstration. I keep walking.

My train pulls out of the station and stalls halfway across Hungerford Bridge. The driver of the train in front of us is having trouble closing the doors, so we're stuck here until he moves. Meanwhile, in my head a train of thought starts inching forward.

Maybe what I need to accept is not my fat cheeks, but that I will never be happy with them. Perhaps I need to accept that I may always feel a degree of revulsion when I look in a mirror.

It's a depressing prospect, but at least it sounds achievable.

The driver in front of us has solved his door problem and we're rolling again. So is my train of thought.

If I can accept the disgust, then maybe I'll be able to get some distance from it, see it as nothing more than a series of thoughts, emotions and sensations. And perhaps that, in turn, will start to loosen this noxious plant, however deep its roots have grown.

A glimmer of hope lights up. It is dim and my gut tells me not to cling to it, not to snuff it out with expectation. But it's a possibility. Maybe.

The train has picked up speed; raindrops lash against the windows and commuters sway as we lurch around bends in the track. I try not to cry, but a few tears squeeze out and start trickling. I wipe them away with a tissue.

Sadness, disappointment and hope mingle. 

It's still raining, but we're moving.