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well lived

Smile if You Love Botox

The new face of middle age is a new face.

 A woman with with a white cap on has the blue gloved hands holding her head still and injecting something into the sides of her face.
Photo credit: Getty Images
A doctor examining a woman's face

The care you need for the results you want

I’m staring at a woman on the TV, hyper-focused on her face. She is one of my favorite Housewives on my guilty pleasure reality show, but tonight she looks different—smoother and a little more pulled. I pause the screen and scrutinize. She definitely had something done and it’s obvious enough that I don’t mean it as a compliment. I am fascinated that women as attractive and well-off as she and her friends are seem to overdo the “face maintenance” on a regular basis—and on national television. Is this the look she’s going for …?

Now I’m staring across the table at my friend. We are having our monthly sushi lunch, and she looks good. Damn good. Her face glows with something I’m no longer familiar with—I believe it’s called youth. Her smooth skin flushes with life and vitality. “Are you pregnant?” I joke, since we are clearly beyond that phase. She lifts her wine glass and smiles back mysteriously. Hmm ...

It seems the new face of middle age is literally a new face. Everywhere I look, creamy, tight skin and juicy lips pout back at me. Yes, it's the celebs in the magazines, no longer just photoshopped, they are now airbrushing themselves in real life, with fillers, Botox and lasers. But it's not just the Real Housewives of every county, it's the woman in my book club. It's the mom behind me on the pickup line. It's my friend sitting across from me at lunch. They are everywhere, these ladies seeking to erase the lines of their past and present age. 

For years I rejected the idea of fillers and injectables. I mean, I don’t even wear makeup. But of course, as my years and lines expanded, my position softened, and I am now curious to know more. I’m not alone. According to the American Society of Plastic Surgeons, the number of minimally invasive cosmetic procedures has grown nearly 200 percent since 2000.

Maybe it’s because, as plastic surgeon Dr. Neil Tanna, associate program director of plastic surgery at Northwell Health, points out, “The risks of Botox or fillers are much less than surgical procedures.” It is also accessible and easy. You can literally do it on your lunch hour. In fact, according to Dr. Tanna and the women I spoke with, the main wrinkle (ha!) is the cost.  

Jen* (age 53), decided to try Botox a few years ago after finishing with her plastic surgeon for breast cancer. Feeling empowered, she treated herself and found that it really made her feel pretty. “If it weren’t so expensive, I’d definitely do it more often,” she says.

Amy* (age 48), agrees. “I feel old-looking and it makes me look younger. Small tweaks help us feel better. If only it weren’t so costly!”

A male doctor with dark hair wears a white lab coat and holds an ipad as he speaks to a female patient who is sitting on an examination table. The woman is wearing a navy, turquise and yellow patterned shirt. They are both smiling.

Look and feel your best.

Is everyone doing it?

Despite the cost (which can run anywhere from a couple of hundred to thousands of dollars, depending on what you decide to get), many of the women I spoke with either did noninvasive cosmetic procedures or wanted to—and the regulars were all hooked.

“It’s today’s version of not getting braces,” says Laura* 45. “You still look normal with slightly crooked teeth, but once everyone is getting braces, you end up looking like crap when you’re standing next to everyone with their teeth perfectly straightened.” What she says makes perfect sense. We recently did a landscaping project on our home, and now when I walk around my neighborhood, all the neglected lawns jump out at me. Once you’re attuned to something, you just can’t help but notice it more.

“If you’re going to do it, do it now,” Laura advises. “You want to start a little ahead of the curve. You don’t want to wait till you really need it.” I think of the creases in between my brows that have been forming for years. Oh no. Am I already too late?

“More patients today are taking a proactive approach, often starting in their 30s and 40s. If you intervene earlier there will be less progression of these lines, but there’s never a point where it’s too late,” reassures Dr. Tanna. “It’s really about enhancing someone’s natural beauty and features and that can be done at any age.”

“It seems the new face of middle age is literally a new face. Everywhere I look, creamy, tight skin and juicy lips pout back at me.”

Talk about what you want

I’m relieved, but even with the glowing reports from many of the women, I’m hesitant. A lot of people I see look frozen, and I’d kind of rather look old than weird.  

“The other thing is to make sure the patient really spends time conveying their expectations,” Dr. Tanna warns. “There is no standard. Plastic surgery, whether surgical or nonsurgical, is all patient-specific and customized. Don’t just assume that the provider knows what you want. Spend time to discuss expectations, goals and objectives.”

Gina* 48, understands that too well. “I didn’t love the last time I did Botox. I thought I was too frozen around the eyes and it made my smile weird.”

As a photographer, Laura sees it all the time. “I’m constantly staring at people’s faces. When I say smile, and they say, ‘I am,’ I’m thinking, ‘You literally can’t, can you?’”

I’m so curious. Is that the look they want, I ask her?

“I don’t know,” she says. “It’s not like I ask.”

Fair point.

“Some people want a look that is clearly augmented, for example with their lips, while others want a more natural look,” Dr. Tanna says, reiterating the importance of communication with your doctor.

“You need to be careful,” Jen agrees. “I don’t want to be 50, looking 50, but trying to look 30. I just want to be a better looking 50.”

I can’t argue with her results. She looks fabulous. And, of course today, appearance is even more relevant. Just scroll through Facebook or Instagram. It’s not hard to see how obsessed we all are with ourselves. “The selfie trend has increased people’s self-awareness of how they look and has gotten people more attuned to their face,” says Dr. Tanna. “Selfies are a game changer.”  

But is that a good thing?

“I think it’s a good thing as long as patients are doing it for themselves. If they’re pleasing other people, it’s a bad thing.”

Jen says, “If I can fix something, why not? Why do you wear nice clothes? Why do you wear makeup? We all want to feel good about ourselves.”

The case for going au natural

Who can argue against feeling good about yourself? Certainly not me, but I can also argue in favor of being happy with the skin you’re in—no matter what that skin looks like. Is it so bad just accepting what nature has to offer? I’m back and forth.

Andrea* 50, sums it up for us on-the-fencers. “For me, the ‘extra stuff’ is just too much. I try to be consistent every day with my health and appearance so that I keep everything sort of in check. I watch my diet. I try to get a good night’s sleep and manage my stress. I definitely put money into my hair.” She smiles and gives her hair a shake, the shine and volume clear as day. “And, with all that other stuff, I’m afraid something will get screwed up. I’ve seen it happen.”

We all have. Although Dr. Tanna explains that even though Botox and dermal fillers are safe to use, they can create an unnatural appearance if used to excess. That’s why it’s important to find a professional who is board certified in plastic surgery or experienced in Botox and fillers.  And it’s so important for the patient to convey their expectations and objectives with treatment. Still …

For now, even if some of my new-and-improved friends look better, I’m comfortable aging naturally. But I never say never, and if I do decide to take the plunge, well, I’m hoping you’ll never know.

*Shhh! All the women I spoke with asked that their names be changed. They prefer to be known for just looking fabulous.  

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Published February 25th, 2019
A doctor examining a woman's face

The care you need for the results you want