It’s a dilemma that many older women (and some men) confront: Whether to allow your face to age naturally without “intervention” or whether to embrace procedures, either (or both) small or large, to limit the effects of gravity, the loss of collagen, skin eruptions and other facial factors that affect our appearance, and often our self-image. Some women are content to allow nature to take its course and leave the lines, wrinkles, stretching, and other changes alone. But if you are at all a consumer of social media or beauty magazines, you may have difficulty avoiding the onslaught of near “perfect” (if not photoshopped) images of women entering their later years looking pristine and untouched by time. As Beauty Editor Valerie Monroe (creator of the Substack “How Not To F*ck Up Your Face”) has remarked, “Research consistently shows that constant exposure to images of idealized beauty standards damages self-image. Doesn’t it make sense, then, that seeing representations of realistic aging might support self-esteem?” Unfortunately, those representations of realistic aging seem few and far between.

And statistics on cosmetic procedures seem to bear this out. Data from 2022 reports that 1.87 million surgical cosmetic procedures were conducted in the U.S., and over a third were among adults aged 50 to 70 years. According to a recent article in Forbes, in 2023 even more procedures were performed, with a 5% increase from 2022 in plastic surgeries and a 7% increase in minimally invasive procedures, such as fillers and Botox. Almost 9.5 million procedures involving neuromodulator injections (Botox and similar substances) were done in 2023, and 5.3 million procedures involving dermal fillers were performed. Facelifts and neck lifts were among the most popular cosmetic surgeries performed. Experts suggest that some of this increase in procedures is attributable to the use of such weight loss medications as Ozempic or Wevogy, which may cause facial “sagging” or a hollowed-out look.

Whether you determine that you want small “tweaks” that may need to be repeated over time or instead a more major “lift” procedure, involving all the risks of surgery but leaving you without further need for intervention for likely a decade or so, is an individual choice. The pros and cons are confusing. While fillers or Botox may seem like minor and safe interventions (in fact, so readily embraced that young women appear to be seeking them out proactively to put themselves on a course of ongoing injections for the rest of their lives) they can cause problems and may lead to life-threatening complications. There is a real problem of fake Botox on the market and not all providers of these services are professionals or well-trained. Even such “minor” procedures as microblading, eyelash extensions, or chemical peels can lead to infections or scarring.

If you instead think you might prefer a facelift, the question is when to seek such an invasive procedure and what risks will you encounter? There appears to be some expert advice that the earlier you receive a facelift the more successful the result will be (apparently women as young as 45 are undergoing the knife), as older skin may already have irreparable damage and may not “bounce back” as quickly. There is also some debate as to whether earlier “tweaks” such as injections or fillers may complicate a facelift. Yet others suggest you hold off on surgery, given the success of so many lesser tweaks on the market these days. A recent article in Vogue reported that many women are foregoing the fillers and embracing the “one and done” feature of the facelift, which these days can be performed to look much more natural than the stretched faces of yore.

Whether big or small, it seems likely that women considering some type of cosmetic procedure can agree on one thing: the beauty images of older women in the media appear to set impossibly high standards for mere mortals. Most of us never looked that good in even our younger years, and attaining that level of beauty is an expensive, time-consuming, and perhaps ultimately impossible goal for most. While no judgment is being passed on those who seek out these procedures, is that how we want older women to spend their time, money, and attention? That’s a dilemma to likely confront us far into the future if current trends continue.