“I’m sure my friends think that I’m the last person to have a facelift, since I never wear makeup and I like wearing shorts and sneakers. I’ve always been sort of a tomboy,” says Maryland resident Susan*, age 60. But a facelift is just what she did. It started when Susan, a trained nurse, was asked by two friends to help them when they had their facelifts. “It got me thinking and doing some research.”

Susan chose Maryland plastic surgeon Dr. Michele Shermak. While talking about a facelift, Susan told Shermak that she had also always been bothered by her 36DD breasts. She ended up scheduling a breast reduction and a lift. And while doing that, she added in an upper eyelift, with more surgery to come.

According to Shermak, clients like Susan represent today’s consumers. “There has definitely been a trend to combine procedures,” says Shermak. “No one wants to undergo surgery and take off from work and other daily activities twice.”

A smiling Susan says, “Having a breast reduction was the best thing I ever did. It made me feel like a new person. I’m now about a medium-C and can wear shirts I never could before, and my buttons aren’t popping open.”

THE PRIZE ON THE EYES
As people age, their eyelids stretch and the muscles supporting them weaken. As a result, the eyelids begin to droop and get crepey. Maryland board-certified plastic surgeon Gregory Dick says, “Upon meeting someone, the first thing we look at are their eyes and we can quickly gauge the person’s mood, health, vitality, and age.”

Susan remembers, “I was beginning to think that I was looking older than my age, which was not something I wanted.” Susan had what is called blepharoplasty, an eyelid lift achieved by removing all of the extra skin that might have accumulated on the eye as a result of aging, gravity, and loss of elasticity. Blepharoplasty gives the patient a refreshed appearance without telegraphing to the world that they’ve had plastic surgery. Patients heal well and scars are very forgiving—often totally imperceptible. It’s not a very painful recovery and results last a long time. Dick says, “That’s why the eyes are the big bang for the buck, the best use of one’s funds.” Susan would certainly agree. She says, “It made me [look] brighter and took years off my face.”

THE FACELIFT COMES OUT OF THE CLOSET
“Today, there’s more information online about plastic surgery. I think when fashion designer Marc Jacobs at 58 had a facelift in 2021 and documented the entire procedure, it gave a lot of people something to think about,” says Shermak. The average age of her patients getting procedures done is 50-plus. The most popular age range is anywhere between 50 and 70, though she says she’s seeing younger people coming in for work, in part thanks to Zoom. “They want to look refreshed and there are many ways to achieve this from a mini-facelift or a neck lift, to a lower facelift, full facelift, to injectables.”

Several months after her first procedures, Susan underwent a lower facelift with Shermak. A lower facelift focuses on everything below the corners of the mouth and includes nasolabial folds (creases extending from both sides of the nose to the corners of the mouth), marionette lines, jawline, the submental (under chin) area, jowls, and the neck. Susan’s surgery was performed in an accredited surgical center, and she went home the same day.

“I went to a work meeting with people I hadn’t seen in a long time and one person was staring at me,” Susan happily remembers. “When I asked what was wrong, they said, ‘I can’t put my finger on it, but you look younger.’ I think it took 10 years off my face. It’s so natural looking, not like the tight Joan Rivers look of years ago.” Susan finished her journey with a lower eyelift in 2022.

THE MOMMY MAKEOVER
Maryland resident Amy says, “I’ve always had a weight problem.” So, after losing 40 pounds and knowing she was finished having children, Amy had a consultation with Maryland plastic surgeon Dr. Michael Cohen about having work done on her breasts and abdomen. This procedure has become known as a “Mommy Makeover.” According to Cohen, “Mommy Makeovers are very popular and it’s mostly for women in their 30s, 40s, and 50s who have had their children. They’ve seen changes in their mid-section as well as possibly in their breasts, even though they lead a healthy lifestyle, exercise, and eat well.”

“Some things just can’t be corrected without surgery,” he continues.

Many women show Cohen pictures of what they think is attractive, which is helpful as it gives a good idea of what they want.

“A “Mommy Makeover” can involve a tummy tuck—removing fat, skin, and tightening muscles—liposuctions and, for the breasts, just a lift or having an implant to restore firmness,” says Cohen. “Other times it’s a breast reduction, and sometimes a woman wants to go bigger.”

Amy, who had two C-sections, had a “Mommy Makeover” in June 2021. The seven-hour surgery involved a tummy tuck, breast reduction and lift, and liposuction on her back and hip area. Cohen says, “Generally recovery is anywhere between three to six weeks.” For her part, Amy is thrilled with the results. “My clothes fit so much better now,” she says. “There are no bulges.”

NO SURGERY, THANK YOU
Not everyone who wants to turn back the clock or look refreshed wants surgery. “Today, there are many non-invasive procedures to address a multitude of issues,” says Maryland dermatologist Dr. Robert Weiss, of Maryland Dermatology Laser Skin & Vein and an investigator on many procedures. “And now many products and procedures that were delayed because of the pandemic are becoming available.”

Maryland resident Linda, who is in her 60s, was having her yearly skin checkup when her dermatologist, Dr. Margaret Weiss—whose husband is Dr. Robert Weiss—asked if there was anything she wanted to address. “I was like, ‘I really hate the dark circles and puffiness under my eyes,’” says Linda, who has never wanted injectables.

Margaret Weiss, also at Maryland Dermatology Laser Skin & Vein, told her about a new non-invasive device, Tixel, that could correct that problem. After showing her the literature, Linda went home, thought about it, and made an appointment. “They gave me numbing cream before the procedure, so it wasn’t painful,” says Linda who had four treatments, each about 15 minutes. “I was a little red, but there wasn’t any downtime. And after the treatments, I had people commenting on how beautiful my eyes looked,” says a pleased Linda.

Be On Trend

Curious to know what’s trending?

According to the American Society of Plastic Surgeons, these are the top five surgical procedures of 2020, the year for which there is most recent data:

◼ Nose Reshaping
◼ Eyelid Surgery
◼ Facelift
◼ Liposuction
◼ Breast Augmentation
◼ Other high volume surgical procedures, including tummy tuck and breast lift

AND THE TOP FIVE MINIMALLY INVASIVE COSMETIC PROCEDURES:
◼ Botulinum Toxin Type A (Botox, Dysport, Xeomin)
◼ Soft Tissue Fillers
◼ Chemical Peel
◼ Laser Skin Resurfacing
◼ Intense Pulsed Light (ILP Treatment)
◼ Other high volume minimally invasive procedures:
Noninvasive Fat Reduction,
Nonsurgical Skin Tightening

GAME CHANGERS
Robert Weiss explains that, “Tixel has been available in Europe for about four years and in the States in the last year. It works with thermal energy that is delivered through a titanium treatment head. It’s safe to use around the eyes and during the treatment we use a Zimmer cooler that blows cold air on the skin. Patients report it’s about a zero-to-one on a scale of zero-to-10 for pain. It tightens the skin, improves tone and texture, and lifts eyes for sagging eyelids or eyebags.”

In other words, Tixel is something of a non-surgical eye lift. “My European colleagues say that it can last several years,” he says. “We are also using it to get rid of the lines around the mouth. There is no downtime, and it gets better over time.”

For those who want immediate results on upper lip lines, there’s Redensity, a new category of fillers classified as a dermal booster. It’s superficially injected to boost the dermas. Unlike many other fillers, there are no bumps or lumps, so the final result is a natural look.

Weiss says that he prefers Tixel because it lasts longer compared to Redensity, which, like other fillers, only lasts about a year. Tixel can last up to five years.

Another injectable, DAXXIFY (DAXI), a competitor of the ever-popular Botox, has been getting a lot of hype. Weiss explains that while it was delayed by the pandemic, DAXI is an injectable treatment that promises to be longer-lasting than others on the market, and rather than having three treatments a year, only requires two.

“Patients who are happy with Botox might not change,” he says. “But patients who would rather come into the office only twice a year may find it appealing. Of course, a lot will depend on pricing.”

“Whatever injectable we use, we never want our patients to have that deer-in-the-headlights look,” he concludes.

There’s still more that’s new on the market. The latest of the Restylane family of hyaluronic-acid injectables is Restylane Contour. Used in the cheek area, it volumizes as well as lifts in a very natural subtle way, and lasts about a year.

THE SHAPE OF THINGS TO COME
As everyone knows, it’s easy to gain some weight, and even when we don’t, our weight tends to redistribute, especially as we age. Dr. Shirley Olsen of Maryland says, “One patient came in when she couldn’t zip up her jeans. The funny thing was she hadn’t gained any weight, it had just shifted. And by wearing only leggings, she didn’t know. The good news is that CoolSculpting did the trick. All her jeans now fit.”

Olsen, who has performed over 10,000 CoolSculpting procedures, is now using CoolSculpting Elite. It is used for the treatment of visible fat bulges in the submental (under the chin) and submandibular (under the jawline) areas, thigh, abdomen, and flank. It can also combat bra fat, back fat, underneath the buttocks (also known as banana roll), and upper arm.

“CoolSculpting Elite results in 18 percent more fat reduction than the older Legacy,” says Olsen. “There’s less bruising, it is more comfortable, and can do up to four sites at once. In 35 minutes, the total treatment is done.” The manufacturers of CoolSculpting also say there is some skin tightening. But it’s important to know that it’s not a treatment for weight loss.

Another non-invasive treatment is EMSCULPT. It’s the first esthetic device to build muscle and sculpt your body. Through high-intensity electromagnetic therapy, one can firm and tone muscles. This procedure builds muscles and burns fat without having to hit the gym and do sit-ups to get that six-pack. For best results, four treatments are recommended over the course of four weeks.

“Today the goal with all non-invasive treatments is a better but natural look,” says Robert Weiss. And with so many women—and men, too—exploring ways to ward off aging, there are certain to be more and more injectables and procedures coming to market.

*Some of the names in this story have been changed to protect the privacy of the subjects.

The other night, at a bar, I got ma’amed.

It wasn’t the first time it happened, but it was the first time I can recall a fellow woman directing the term to me, and it stung. I think the issue was that she was in her early 20s, blonde, and being genuinely polite. Ten years ago, I was also a (moderately) polite server with blonde hair slinging drinks and accidentally shocking customers with formal greetings dripping in antiquity.

Currently, I am 34 years old. I’m an elder millennial who remembers landlines and call waiting and didn’t get my first cell phone until college, and even that thing had a walkie-talkie button. I vividly remember Y2K and 9/11 and, perhaps somewhat less culturally significant, the creepy countdown to the Olsen twins’ 18th birthday. I remember being amused as sociologists and ad executives tried to define and understand my generation’s motives. I remember reading endless contradictory think pieces on how we were lazy but resourceful, born of analog but coming of age in digital, entitled but scrappy.

And as with all things when you’re young, the world’s attention on my generation felt somewhere between an eye-roll and being warmed by the sun. We didn’t yet understand that all older generations examine the hell out of the new ones, wondering how we measure up, the ways we might save the world, and the ways we’d be sure to end it. We just knew that we were young, and that this was of deep interest to everyone.

And now we’re all mostly in our 30s, being called ma’am by the kids we used to babysit.

The ma’aming, obviously, struck a nerve with me.

When it was just men using the term, I could chalk it up to politeness. I could let myself believe that these were respectful males who were taught to err on the side of caution—that I was somehow only running into the kind of men who would never assume a woman’s pregnancy or interrupt her during a board meeting. But to this woman, I was thoroughly a ma’am, an exhausted-looking mother of two, trying to fit in a few pages of the books she’s been reading for months while waiting for a friend to show up for post-bath and bedtime drinks.

Once I got home, the ma’aming sent me racing back to my gently lit bathroom mirror to confirm what I generously had been thinking was a self-critical over-exaggeration: I really do look older. The lines around my mouth don’t disappear when I stop smiling. Despite my dogged commitment to the one good thing Paris Hilton ever taught me—wear sunglasses at all times, at all cost—crow’s feet are spreading out from the corners of my eyes. Even the Botox I had tried on a lark last summer was betraying me, allowing me to express a genuine reaction to the neck wrinkles I’d just spotted.

Aging, as with all things human, is weird. In the immediate wake of being ma’amed, fortified by two Negronis, I felt haggard and irrelevant. Without my youth glowing out of my pores, who was I? Until that night, I had never been so old in my life.

But in the harsh light of the next morning’s low-key hangover, and despite an entire night spent aging, I looked—young-ish again? And since then, it’s been fascinating to see how the aging process is both linear and entirely random. There are days I catch myself in the mirror and think I look great for someone with two toddlers who is mathematically in her mid-30s. And then there are the days I walk by a reflective surface and wonder who the crypt keeper dressed head to toe in Madewell is. The good days give me confidence and hope; the bad ones give fat commissions to the skin care team at Sephora.

Curious about the non-surgical ways I could freshen things up a bit, I decided to take action and made an appointment with plastic surgeon Nadia Mostovych at Belcara Health in Mt. Washington. I arrived armed with a picture of the endless bottles, pots, and snake oils that comprise my skin care regime and the need for an explanation about my sudden lurch into early middle-age.

What I learned was a science lesson in the art of decay. It turns out collagen production starts to decline at a rate of about 1 percent each year once we turn 20. It takes a while to notice, which is why so many people cite their early 30s as the time they first begin to see signs of aging. It’s clear that external elements like exposure to the sun, pollution, and nicotine can hasten wrinkles, but there’s not much to be done about curtailing the natural aging process.

“During consultations, some people say they feel like they look tired,” says Mostovych. “What they see in the mirror doesn’t look like them anymore. People get stuck on how they looked and felt during their late 20s and early 30s and can eventually feel really out of balance when those things no longer match.”

The good doctor began our consult by explaining the bare minimum of preventative skin maintenance—mineral-based sunscreen, retinol, and a good vitamin C serum or any kind of antioxidant serum—but as she moved into the more serious options to turn back time, I physically and emotionally found myself leaning in. In what can only be described as a self-imposed game of “vanity chicken,” I began wondering exactly how far I’d be willing to go with the myriad treatments, factoring in my current age, income bracket, and short-lived tanning bed stint in college.

Surprising even myself, I was willing to bypass traditional facials entirely, and head straight into the realm of procedures, which is how I found myself having my blood drawn on a sunny Friday morning. I opted for a platelet-rich plasma facial, better known to those us of who follow open-book celebrities on Instagram as the “Vampire Facial.” Essentially, blood is drawn and put in a centrifuge to separate the platelet-rich plasma. It is then placed on the skin, and a micro-needling treatment ensues. This treatment is ideally performed three times over the course of three to four months, and it’s meant to leave the patient with smoother, clearer, glowier skin.

2020 is a wild time to be alive.

In the immediate days following my treatment, I looked pretty banged up. I cancelled weekend plans, hunkered down with my generously portioned bag of post-treatment serums, and waited for the bruising and redness to subside. (If you believe we are close enough friends, I will show you post-procedure pictures, otherwise you’ll have to use your imagination or Google.) And after a few house-bound days, I noticed a genuine difference. My skin was tighter, my fine lines kinder.

The procedure isn’t cheap, and there is some recovery downtime, but it’s also painless and the results are immediate and can last more than a year. My toddlers haven’t noticed the improvements (rude), but close friends have, and I’ve been fielding texts and sending updates to the women in my life who are also finding themselves on the less buoyant side of collagen production.

There are clearly plenty of ways to fight the good fight against aging, but the question remains: Why do we fear it? How can a $50.2-billion-a-year industry thrive raging against the one thing our bodies all inevitably do, whether we intervene or not?

To explore that, I reached out to Michiko Iwasaki, a geropsychologist and associate professor at Loyola University. Aging in America, she pointed out, is not like aging in most countries. In her native Japan, she says, “Aging equals wisdom, and there is a more positive perception.”

But here in America, where we emphasize youth and vitality, it’s quite the opposite. “When the term ageism was invented in the late ’60s, people unconsciously accepted that aging is bad,” says Iwasaki. People do plastic surgery to find better work and partners, because looking young gives them an advantage.”

And we’re expected to act youthful, too. How can we genuinely embrace the fact that our bodies are aging when culturally we’re expected to work long hours, say yes to everything that’s offered, ignore accumulating PTO, and work during maternity leave? And with the advent of social media, we’re now keeping tabs on our own selves about just how much we can fit into a day while looking happy and attractive. Energy and activity are our social currency, and physically aging is the way we eventually betray ourselves.

As I considered my conversation with Dr. Iwasaki, I realized the timing of my interest in experimenting with anti-aging treatments isn’t simply vanity—it’s existential. Though I’m not past child-bearing age, I do not intend to have more children. My body is beginning to show wear and tear through, among other things, the cacophony of knee cracks signaling my impermanence each time I lift myself off the floor after playing with my kids. And the fact that my face is starting to look a bit older actually kind of matters. I automatically and subconsciously react to people based on their perceived age every day. I once gave a ride across a parking lot to a much older female stranger mostly because I assumed that, unless she was armed, she posed no threat. And when I encounter high-schoolers, I vacillate between not being able to stand them and wanting them to think I’m cool. If I’m making snap judgments about people based on their age, I think it’s reasonable to assume the same is happening to me.

So, is it possible to age gracefully? It seems, like so many things, that the answer is somehow highly specific to each of the eight billion people on this planet. For some, it might mean decades of plastic surgery, while others might rely solely on sunblock and water as their beauty treatments. For me, it will likely fall somewhere in between. I’m grateful to have the opportunity to get older, but I think I’ll always be a lady perpetually—though non-surgically—on a mission to look good for however old I am. Because, as Iwasaki points out, “Whomever, wherever we are, we are all aging.”

Just be careful whom you call ma’am along the way.