On the Unfairness of Aging

Whenever we do a cosmetic consult, we ask for old photographs. The reason we do this is so that we can get an understanding of exactly what has transpired in an individual face, whether it’s been the skin that changed, whether gravity was at work, or whether weight loss or weight gain in certain areas of the face was responsible for the changes that have occurred over time.

I am consistently awestruck at the beauty of almost everyone in all their photographs. Of course, we only keep the photographs that we like, and usually photographs are taken during periods of happiness—graduations, weddings, vacations and other events where we have the time and the inclination to celebrate a particular moment. We also tend to memorialize and bring in the photographs that show us at our best.

But youth is beautiful. It is a time where its beauty is usually taken for granted. Where it is thought it will last forever.

But it doesn’t last forever. Nothing does.

I read an interesting blog on Slate this week on what it feels like to have been beautiful but to become old.

The comments are mainly unsympathetic. To paraphrase some of them, “if you think that’s bad, trying being fat and ignored, that’s my life” or others “I am glad that my wrinkles now allow me to be considered not just as an object”.

But, ALL my patients were this way. They were all gorgeous. Even the less attractive ones had something on their side when they were young—youth. There is no question that youth is beautiful. When it’s gone, it’s like a light went out. The woman above was a knockout, with movie star good looks. She’s still a knockout. But things happened. Things changed.

With every patient that I see, I am constantly and critically asking myself: “what’s changed?” and holding up that photograph against the image of the person I am looking at while she (or he) is looking at herself (himself) in the mirror.

The answer is a bunch of little things. A change in the color and vibrancy of the skin. A few wrinkles. A change of less than a quarter of an inch in facial proportions. A drop of 1 cm in the cheek. A drop of 4 mm in the brows, making the eyelids seem loose. A drop of 2 mm in the position of the eyelids. A drop of a lot more in the tissues in the neck. The upper lip drops and covers more of the upper teeth. Lips lose their volume and definition. Changes occur in the consistency, color, (and style!) of the hair.

The underlying face, the visage, remains the same. The eyes usually retain their luminance, the smile still lights the face. She’s still gorgeous.

The most successful surgeries I have ever performed were when both the patient and I entered into an agreement that we would just deal with that bunch of little things. Not where we tried to everything with a single procedure out of a textbook. A facelift won’t remake someone to what they were. But changing the skin’s texture, lifting what’s dropped and adding and subtracting volume where it was lost or gained makes changes that remain attractive and proportional. In the end, we want it to look like nothing in particular was done. The goal is to feel (and look) beautiful.