Saving face

Proponents of plastic surgery argue that's harsh criticism. Edward Luce, president of ASPS, and a plastic surgeon for 27 years, says that many people who come to him do so because they feel they've maintained healthy lifestyles and feel young, "but when they look in the mirror, they feel that what's reflecting back to them is not their inner self. They feel younger than they appear."

He says he's perfectly comfortable with his own wrinkles. But, he argues, there's nothing sinister about people spending money to look their best. "Why not just wear the simplest of clothes then?" he asks. "Why not dispense with lipstick and earrings? Why shouldn't men just wear clothes sufficient for protection against the elements?"

Dr. Luce says plastic surgeons have a responsibility to inform patients of possible complications, depending on individual circumstances. But he argues the procedures are simply one way for people to improve their self-image.

"If surgery is performed," he says, "and people have a better sense of self-esteem, have better self-respect, then there's a benefit there."

Still, although the numbers of people turning to plastic surgery are multiplying rapidly, they remain a relatively small percentage of the population. And little research has been done to examine differences in attitudes between suburban and urban areas, rich and poor, or even between different regions of the US.

"I wonder how much of this is located in particular parts of the US, and among particular sectors of women, and increasingly men," says Kathy Peiss, professor of history at the University of Pennsylvania and author of "Hope in a Jar: the Making of America's Beauty Culture."

"When I think of things like the rates of obesity, and the way so many women are just struggling to put food on the table and feed the kids," she adds, "I wonder how much time and preoccupation they really have with this issue."

Historians argue there is no mandate that current notions of youth and beauty are destined to become engraved on our cultural consciousness.

Plastic surgery is a relatively recent phenomenon, growing out World War I and the development of medical procedures for reconstructive facial surgery. For years, cosmetic surgeons were looked down on, and cosmetic surgery itself was kept as a secret rather than openly discussed.

And, as Dr. Burke of Swarthmore College notes, American culture has offered multiple visions of female beauty, including a period between the world wars when being slightly overweight was considered desirable. "These things have a history, they change over time," he notes. "There is nothing necessary about our current national philosophy on these subjects. It's not inevitable."

What's more, the influence of some 76 million baby boomers may skew perception of longterm trends. Post baby-boomer generations, including Gen Xers and the younger so-called millennials, are much less wrapped up in identifying themselves with youth. "The narrative of baby boomers' lives is centered on their youth. They were celebrated and self-conceived as a young, giant group of people who were going to change the world," says Dr. Burke. "And they are unable to get over the idea that they're getting old.

"Gen Xers have such an ambivalent attitude about being young," he says. "They're cynical about being 20. I don't think they will be hung up on staying forever young. They don't have a self-image that says my best years were in blue jeans and tie-dye."

Until that time, however, millions of Americans still find themselves grappling with multiple pressures to look good - young - and coming to terms with their own sensibilities about age and beauty.

Even author McCooey says her struggles over self-image and cosmetic surgery are far from over. Although her fictional reporter finds resolution, McCooey herself still hasn't ruled out plastic surgery.

"I don't think I'll ever do it," she says, "partly because I'm concerned about possible side effects. But it's something that I occasionally think about. I haven't really resolved it. I think I have a few more years before I have to think about it seriously."

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