Being a beautiful fashion model can be an ugly business.

“I saw a 16-year-old model almost kill herself,” says Sannie Pedersen, a 27-year-old blond stunner who moved from Denmark to New York in 2012 to strut her stuff on catwalks. “She ate cotton balls just to survive.”

The drugstore staples expand in the stomach, making you feel full. Eating them is just one of many over-the-top tactics models employ to keep thin.

Competition in the fashion world is brutal, and models must go to extreme lengths to get cast in shows. Once they get a spot on the runway, they often have to endure harsh conditions and little to no pay.

“Models go through hell to stay skinny,” says Pedersen, who has walked in numerous shows at New York Fashion Week, which kicks off Thursday. Having lived with other catwalkers, she recalls a roommate who popped so many laxatives she had to barricade herself in the bathroom for 12 hours, where she screamed in agony. Pedersen didn’t know whether to knock down the door or call for an ambulance.

“I was so scared for her — she was so obsessed with her weight,” says Pedersen. “She wrote down how much water she drank. It’s terrifying.”

When Pedersen first got to New York, she was so desperate to get cast, she subsisted on a daily diet of 20 cigarettes, a cup of coffee and little else. The 5-foot-11 stunner weighed just 100 pounds at her lightest in 2012, and it hurt just to sit down.

“There [wasn’t] enough meat on my bones,” she says.

Now a healthier 121 pounds, according to her model stats, and living with her personal-trainer husband in Forest Hills, Pedersen is often told she is too fat at castings, even though she’s always been a size 0 to 2.

At Fashion Week last September, “one of the designers called me obese,” she says. Another time, she visited a top global agency where a department head was pleased with Pedersen’s look but its famous founder was not. “It’s my agency, and I like anorexics,” he hissed in front of her.

Victoire Dauxerre, a 24-year-old French former model who did runway work for Prada, Céline and Alexander McQueen, is coming out with a blistering tell-all book on Thursday called “Size Zero: My Life as a Disappearing Model” (William Collins), which details the debilitating eating disorder that drove her to a suicide attempt when she was 18.

During one NYFW, fellow models called her “the catwalk Yeti,” a knock at the coating of downy hair that formed on her arms and legs, a telltale sign of anorexia. “It was as if the body replaced fat with hair to protect itself from the cold,” she writes in the book. The frail catwalker recalls collapsing in NYC in front of her agent, who strategically revived her: “He gave me a piece of chicken when I came round. God forbid you give a model sugar.”

Another model, who declined to give her name for professional reasons, says her period once stopped because she was starving herself so much.

“Designers need you to be a 34-inch hip, 24-inch waist, 32 bust, and that’s what I am,” says the 19-year-old brunette, who is signed to one of the city’s top agencies and runs the buzzy satirical Instagram account @shitmodelmgmt. “I can’t stray from those measurements ever, and it’s scary … Those measurements play in your head every day.”

According to Pedersen, a standby diet for many models is nothing more than a single apple, cut into several slices, a day. She recalls a time when her friend had a leftover slice at the end of the day.

“I want to be good today,” the teenage catwalker had said, proudly.

Some designers want models looking so gaunt, they don’t allow them to drink anything the day of a show, lest they appear bloated.

“We had to sneak into the bathroom to drink water,” Pedersen recalls of one Fashion Week show.

Staying thin isn’t the only form of torture. The unnamed model recalls a friend who appeared in Kanye West’s show last September. No one asked for the models’ shoe sizes beforehand, and her buddy had to spend hours standing with her size-9 feet crammed into size-5 heels.

“[It’s] just another example of not caring for the models … [By the end of the presentation] she could barely walk,” she says. “Kanye was really nice and carried her to the bus because her feet hurt [so much].”

And being great-looking sometimes isn’t good enough. Often, your last name has to be Jenner or Hadid or you have to have already appeared in the pages of glossy magazines to get cast.

“Most of the girls who walk in the shows are the big names — the supermodels,” continues the anonymous model, who has walked for top designers like Calvin Klein, Kate Spade and Oscar de la Renta. “The Alexander Wang show, for instance, is just full of well-known show girls. They might be looking for four new faces from, like, 1,000 girls. I’m not in Vogue, so I don’t stand a chance.”

And there’s little financial reward even when you do get cast.

“Some shows don’t pay at all,” says Pedersen, who adds that casting agents often favor free agents, like herself, as it’s easier not to compensate them. “I’ve gotten clothes as payment multiple times.”

“Unfortunately, this has long been a common practice at New York Fashion Week,” says Sara Ziff, founder of the Model Alliance, an advocacy group. And, she says, it’s not just an issue for free agents. “Agency-represented models are often paid in trade [such as a designer bag or wallet] for runway work, not just freelance models. As a result, models often end up working in debt to their agencies.”

But with competition so fierce, catwalkers typically put up with such treatment.

“You’re nothing but a pretty hanger,” Pedersen says.

But, she notes, the job isn’t without its perks.

“The minute you step out onto that runway, that rush is amazing.”

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