Between the ages 25 and 65, the nose stretches by 10 percent, on average, its tip moving downward by about a quarter-inch. The brows can sink by one-third of an inch, the ears by slightly more, the cheek tissue by as much as a half-inch. Overall, more than 30 percent 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 are middle-agers, Roberts' generation is hardly being left behind. The number of cosmetic procedures performed on people 65 or 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 baby boomers 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 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 University of Southern California School of Medicine. "You retire now, and there's no question you could have 20 or 30 years of life left -- good, active years."
Don't say 'old'
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 more pressing than looking "refreshed."
There are no signs, however, that such concerns are dampening the enthusiasm of seniors seeking cosmetic makeovers. 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, Calif.
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 is age 75 or 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, Morrow said. "And you better not say the word 'old' to these people. They don't like it at all."
Many older Americans complain that they've been patronized by younger co-workers, said Clare Hushbeck, who handles workplace discrimination cases for the AARP.
"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. "This is a youth-oriented society, and if you want to stay competitive, you certainly don't want to look tired."
Plastic surgeon Dr. James Wells of Long Beach, Calif., 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.
Not everyone comes away pleased, of course. Like any cosmetic surgery patient, seniors run a risk of being disappointed with the results; about 10 percent to 20 percent may feel that way after a procedure, doctors estimate.
Nor is every senior citizen a good candidate. To undergo a face, neck or eye job, for instance, patients are heavily sedated or put under general anesthesia for hours. The drugs can be dangerous to anyone with an unstable heart condition, said Dr. Raymond Roy, chairman of anesthesia at Wake Forest University, in Winston-Salem, N.C. Cardio-vascular 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 as compared with an average 30-year-old, cardiologists say.
Also, in seniors, perhaps more than those in middle age, a strong desire for cosmetic work also raises questions about mental health. Does the patient expect a nip and tuck to alter her life? 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 Dr. Sandra Swantek, a Chicago psychiatrist who has worked with elderly plastic surgery patients.
Once committed to battling gravity with the knife, most patients are in for the long haul. Said Betty Critser, 70, of Rancho Mirage, Calif., a recent face-lift patient: "I told the doctor: 'I plan to live to 100. How many times can you do this?' "
Benedict Carey is a reporter for the Los Angeles Times, a Tribune Publishing newspaper.
More makeovers for seniors
The number of cosmetic procedures performed on Americans age 65 and older has more than tripled in recent years. Here were the most popular procedures last year:
Botulinum toxin injection 90,030
Collagen injection 83,050
Chemical peel 71,399
Blepharoplasty (eyelid surgery) 29,310
Source: American Society for Aesthetic Plastic Surgery