Sharleen Johnson McCooey can't remember the exact day she found herself thinking about her looks again. She just knows that at some point in her mid-40s, she caught herself looking in the mirror with the scrutiny of an adolescent.
The moment came as a surprise. "I grew up when feminism was becoming prevalent," says the Victoria, British Columbia-based writer. "I always had a chip on my shoulder about the media's influence on women and how they should look."
But there she was, thinking the unthinkable: Was it time for plastic surgery?
Unlike the 7.4 million Americans who decided in 2000 that cosmetic surgery was the answer to one perceived bodily imperfection or another, Ms. McCooey chose a different route. She wrote a novel, "It's My Body and I'll Cry If I Want To," in which she wrestles with her questions through the experiences of a female journalist who explores the world of beauty clinics and cosmetic surgery.
"The simplest way to solve the issue is for women, or anyone, to appreciate their uniqueness, which is really simple, but who can do it?" she says. "How do you get to the point where you don't judge yourself against media images?"
McCooey isn't the only one struggling to find satisfaction with what she sees in the mirror. A culture fixated on youth and aging has emerged in recent years, from the highly-publicized case of Fox news anchor Greta Van Susteren, who made front-page news with her recent decision to have cosmetic surgery, to the millions of Americans who fuel what's estimated as a $30 billion business in anti-aging treatments and products.
Statistics testify to the trend: According to the American Society of Plastic Surgeons (ASPS), cosmetic plastic-surgery procedures nearly tripled between 1992 and 2000. Popular procedures ticked up dramatically, with liposuction increasing by 386 percent, and breast augmentation by 476 percent. In 2000 alone, 786,911 people had botox injections - to erase wrinkles by paralyzing facial muscles.
And while plastic surgery used to be the domain of older women, 35- to 50-year-olds now account for close to half of patients, with men accounting for more than a million procedures in 2000.
Experts on aging, beauty, and popular culture caution against judging individuals for the choices they make to feel better about themselves. But they argue that the huge growth in the anti-aging business is a dramatic reflection of American society's increasing obsession with youth, particularly as it relates to women, and its negative feelings about growing old. Those attitudes, they say, have deep cultural implications that deserve broader attention.
"We ought to have prevalent public conversations about who this appeals to, and why," says Timothy Burke, a professor and expert in popular culture at Swarthmore College in Pennsylvania. "We're close to normalizing things which, when you step back from them a little bit, at the very least require you to go, 'Whoa.' "
Experts say it's too easy to blame the media alone for the nation's youth fixation. Hollywood images certainly flood cultural consciousness. But more subtle factors are also at play. Some center on workplace relations and perceptions about who gets promoted and why. Increasing strains of consumerism, with their promises that satisfaction can be had for a price, also play a role - as does the presence of more disposable income and the falling prices of some antiaging procedures. Then, of course, there's an aging baby-boomer population that has long defined itself in terms of youth culture.
Helen Dennis, an expert on aging, employment, and retirement, says the trend also suggests something even more unsettling: a growing cultural distrust that individuals, especially those who are older, will be judged on the basis of who they are and what they have done.
"Individuals aren't going to risk either being nonhireable or noncompetitive or less desirable," she says. "It's a feeling that our physical presentation is of enormous importance.
"The feeling is that people are making up their minds about other people in 20 seconds, based on appearance," she says, "and that youth is better than looking old, whatever looking old may be."
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."