Aging the Modern Way
Between the ages 25 and 65, the nose stretches by 10%, on average, its tip moving downward by about a quarter-inch. The brows can sink by a third of an inch, the ears by slightly more, the cheek tissue by as much as a half-inch. Overall, more than 30% of a person’s facial area may drop from above the mid-face line into fleshy folds below.
“At some point you look in the mirror and you just can’t believe it’s you,” said B.J. Roberts, 71, of Los Angeles, who recently had cosmetic surgery. “Everything is hanging, everything is sagging, and you just want to feel uplifted.”
While most people who have cosmetic procedures done are middle-aged, Roberts’ generation is hardly being left behind. The number of cosmetic procedures performed on people 65 and older has more than tripled, to about 450,000, during the past five years, according to statistics from organizations representing plastic surgeons. The most common procedures for this group are face lifts and eyelid surgery, and newer, nonsurgical techniques such as chemical peels and Botox injections, which are used to smooth out wrinkles.
And the numbers are expected to soar in coming years--as the oldest in the baby-boomer generation reach their 60s.
The reasons have much to do with how long, and how well, older Americans are living, researchers say. Seniors are more socially and sexually active in their later years than ever before. Millions of them are staying in the work force into their late 60s and 70s, competing with younger workers for jobs and promotions. And in both arenas, for better or worse, one’s physical appearance matters.
“This is the Pepsi generation, the Viagra generation,” said Dr. Loren Lipson, chief of geriatric medicine at the USC School of Medicine. “You retire now, and there’s no question you could have 20 or 30 years of life left--good, active years. We’re living in a society that is not only aging rapidly but living longer than ever before, and in much better health, because of exercise and better medications.”
As a rule, many doctors who treat older patients are reluctant to recommend cosmetic work. It’s expensive; there’s always a risk of disappointment; and people in their 70s and 80s often have health concerns that are more pressing than looking “refreshed.”
There are no signs, however, that such concerns are dampening the enthusiasm of seniors seeking cosmetic make-overs. The demand for such services is particularly brisk in communities where more affluent seniors have settled, particularly in Sun Belt states such as Arizona, California and Florida.
In retirement enclaves, where active seniors spend their days on golf courses and tennis courts, the usual reservations about surgery and age have broken down. “We’ll see patients at 75 who had a bypass when they were 60, who are taking antihypertensive medications and who have some arthritis. They’ve got two new hips, and here they come off the tennis court saying, ‘OK, doc, I want this, and I want that,’” said Dr. David Morrow, a dermatologist and plastic surgeon in Rancho Mirage.
Dr. Calvin Peters, a plastic surgeon in Orlando, Fla., estimates that he sees about three times as many seniors in his office as he did a decade ago. Other doctors estimate that as many as one in four of their patients are age 75 and older--a sharp difference from a few years ago. As long as they’re medically stable and have no apparent psychological problems, they’re candidates for facial work, said Morrow. “And you better not say the word ‘old’ to these people. They don’t like it at all.”
They don’t like being treated as older, either, especially in the workplace. Many older Americans complain that they’ve been patronized, or made to feel invisible, by younger co-workers, said Clare Hushbeck, who handles workplace discrimination cases for the AARP. This perception is common among seniors across the professional ranks, from clerks to upper management, experts say.
‘No Question This Is a Youth-Oriented Society’
“After a while, it’s just a feeling you get. You notice a change in the way people treat you,” said Eileen Barret, 68, an insurance consultant in New York who recently had cosmetic facial surgery. Younger colleagues “don’t think you’re as sharp, you’re the old lady in the group. Maybe they have a grandmother who looks like you .... But there’s no question this is a youth-oriented society, and if you want to stay competitive, you certainly don’t want to look tired. You want to look alert, rested, like you’ve had a good sleep.”
Barret said she has no intention of retiring soon. “I’m not ready. I love my work, and the fact is I feel the same way I did when I was 40,” she said. After months of research about cosmetic procedures, she concluded: “If I’m to have something done, now’s the time. This is my last hurrah.”
Doctors who specialize in treating seniors say this group is certainly more socially--and sexually--active than any before. Exercise, better health habits and new and improved medical treatments, such as the sexual-dysfunction drug Viagra, have been major factors in these changes, researchers said. “The rule of thumb is that healthy individuals who were highly active sexually when they were young and middle-aged are still going to be active late in life,” into their 70s and beyond, said Dr. Gary Kennedy, a geriatric psychiatrist at Montefiore Medical Center in the Bronx.
Surgery Restored the Face She Wanted
Recently split from a husband of eight years, Roberts, the Los Angeles woman, believes her cosmetic procedure helped restore life and beauty to her face. She meditated for months on her decision. “I was a wife and mother for a long time,” she said, “and I felt that now it’s my turn.”
Long Beach plastic surgeon Dr. James Wells said many of the older patients he sees are widowed or divorced. “They’re starting a second life, they’re looking for a partner, and appearance is very much a part of the equation,” he said. “They may not say it in exactly those words, but that is the gist of it. They feel fine, and they want to look as healthy as they feel.”
This is especially true of people who are accustomed to being the most attractive person in the room, or who have relied on their looks in their social or working lives, said Dr. Sandra Swantek, a Chicago psychiatrist who has worked with elderly plastic surgery patients. “As they age, people like this begin questioning their vitality. They fear ageism, and for good reason,” she said. “The real issue is that our society we do not respect the honor and beauty of people growing into their own skin.”
Pete Jolliff, 62, a Long Beach investment advisor, recently had cosmetic facial surgery because he believed he looked older than his age. At 6 foot 2 and 212 pounds, Jolliff, who is single, is only slightly over his college football playing weight and still plays basketball with men in their 30s. “I felt great. The only thing wrong was my face looked 80 years old,” he said. “When you’ve got a lot of excess skin on your face, it doesn’t look good, period, and I couldn’t help feeling bad about it.” Since the surgery, Jolliff said, “I’m ecstatic.”
Not everyone is so pleased, of course. Like any cosmetic surgery patient, seniors run a risk of being disappointed with the results; about 10% to 20% may feel this way after a procedure, doctors estimate. Maybe an eyebrow is too high; maybe the face is pulled too tight; sometimes patients are obsessive about their looks. Even some relatively minor procedures, such as laser treatments and dermabrasion--which remove layers of skin--have caused burns and discoloration. “The fact is there’s a lot of bad work out there,” said Dr. Barry Weintraub, a plastic surgeon in Beverly Hills. “If you don’t believe me, we can take a walk down Rodeo Drive.”
Nor is every senior citizen a good candidate for surgery. To undergo a face, neck, or eye job, for instance, patients are heavily sedated or put under general anesthesia for hours. The drugs doctors use can be dangerous to anyone with an unstable heart condition, said Dr. Raymond Roy, chairman of the anesthesia department at Wake Forest University, in Winston-Salem, N.C. Cardiovascular disease is not always evident, either. By virtue of age alone, the average 70-year-old has about double the risk of suffering silent heart disease than an average 30-year-old, cardiologists say. “This is the No. 1 thing we worry about in older patients,” said Dr. Scott Bartlett, a plastic surgeon at the University of Pennsylvania.
People with dementia, even mild forms, can wind up confused or disoriented for hours after surgery, anesthesiologists say. And these patients are not always easy to identify. “If the person is alert enough to argue politics with me, then I don’t worry about the anesthesia,” Roy said.
For Some, Reasons May Be Tied to Mental Health
In seniors, perhaps more than the middle-aged, a strong desire for cosmetic work also raises questions about mental health. Does the patient expect a nip and tuck to alter her life? Is the person compulsively worried about some perceived defect? Most plastic surgeons say they carefully check would-be patients for mental problems, but some geriatric psychiatrists are not convinced.
“I wonder how many older people who have cosmetic surgery are really suffering from low-level depression,” said Swantek, the Chicago psychiatrist. What’s considered minor depression in younger people can have a profound impact on seniors’ ability to function, she said. Its hallmarks are social isolation, feelings of worthlessness, underlying sensations of guilt and shame--precisely the sorts of emotional undercurrents that could push someone toward cosmetic surgery.
The shame and guilt about admitting you’ve had cosmetic work done seems to be dissolving, by degrees, say seniors. In much of the country, plastic surgery is still seen as a mark of excessive vanity. Yet the popularity of topical skin procedures--the so-called “lunchtime peels,” for instance, and Botox injections--is helping to break the stigma. Many women who have peels regularly even compare them to facials.
Merle Schwartz, 65, a former teacher and real estate agent originally from Connecticut, said she never would have considered plastic surgery until she began spending winters in the Palm Springs area. Though she has had only peels herself, Schwartz said, facial surgery “seems to be OK with people here in California, and I find I no longer have strong judgment against it. It’s so commonplace.”
Little wonder that cosmetic surgeons call peels and laser treatments “starter” or “entry-level” procedures. “These are very simple, inexpensive things that jump-start how you look,” said Dr. Scott Aaronson, a Palm Springs plastic surgeon. “From there many people consider doing bigger things, for bigger results.”
And once committed to battling gravity with the knife, most patients are in for the long haul. If they can afford it. Said Betty Critser, 70, of Rancho Mirage, one of Aaronson’s recent face lift patients: “I told the doctor: ‘I plan to live to 100. How many times you can do this?’”
