Gia Gvaramia's patients can't wait for him to get his hands on them. Literally. At 56, he is a pioneering plastic surgeon who opened Georgia's first cosmetic surgery clinic in 2000. Since then business has bloomed in line with an explosion in consumerism for a growing middle class. Average household incomes have risen nearly 50% since the war with Russia in 2008. Gia now has a further six clinics. Every year he and his colleagues see 3,000 new patients. Georgians, young and old, come to his surgeries for Botox, nose jobs, breast enhancement, liposuction and other treatments, luxuries not everyone can afford. He is surprised by the popularity of his business "When I began my business people asked me if I was crazy. They'd ask: 'Who needs this business in Georgia?'" Gia says he has since proven people wrong. "Now we have so many competitors it means plastic surgery is a business people need." Back in Gia's family home, his wife, daughter and grandchildren discuss how work is going over coffee and cakes. Has he ever had to perform plastic surgery on any of his family members I ask. "Yes, sometimes," he says with a wide grin though not yet on Marika his wife, he confides. "There are things I think I could do for her," he says as Marika gives a wry smile.