“Good Work”: Can Cosmetic Procedures Ever Be Done for the Right Reasons?

Jane Fonda, looking stunning at 72, appeared on Oprah a couple of weeks ago. When Oprah asked her what she sees when she looks in the mirror now, she responded, “good work.”

My first response was “how sad.” From my perspective, Fonda had always been a beautiful woman and could have continued to feel that way without resorting to radical measures. As a psychologist who works with women on how to age beautifully, I wished I had gotten hold of Fonda before she went for her third round of plastic surgery. But then I thought, “who am I to judge what works for her?” Even if my idea of helping women is to provide them internal solutions to feel attractive at any age, I also know it’s important to keep an open mind. For Fonda, angst about aging on screen may have contributed to her cosmetic decisions, a pressure she shares with actors, models and pubic figures. For others, it may be something else. So, I decided to write this article about what women tell me about their ‘good work,’ so I could share it with others and see what they think.

As we all know, there are a multitude of cosmetic options available for those seeking to revitalize their appearance. From creams to fillers, to lasers, lifts, tucks, contouring, augmentations, and resurfacing –a list that begins to sound like a construction site — these choices can be overwhelming and confusing. Not only is it difficult to identify which one may make sense for you, it is even more difficult to know if they will provide any long term satisfaction. Some websites present details about treatments that include before and after images to help visualize the results. They list board certified practitioners and encourage a consultation. But objective information is difficult to discern from self-serving promotion. We all know women who have walked out of doctors offices hearing about procedures “uniquely” suited to them, including ones they didn’t even think they needed. In short, more confused and depressed than they went in!

Then there are sites that present images of plastic surgery gone wrong. Former beauties and celebrities, whose faces have been distorted, plasticized or even worse disfigured by ‘bad work’ leave us fearful of every going under knife. Some politically minded bloggers see women engaged in age defying actions as victims of a beauty obsessed society and suggest that any cosmetic attempt to remain looking youthful means folding under cultural pressures. Jane Fonda herself has confessed to mixed emotions regarding her cosmetic work: her politics may have said one thing, but her desire to look as good as she feels, said another.

As a psychologist who fosters a thoughtful approach to life, I discourage impulsive, quick fixes to dealing with an aging appearance. As a former fashion model, I acknowledge that we live in a world where looks matter, and support the notion that mental health includes paying attention to both how we appear and how we feel. When I go around the country talking about my point of view (see Face It: What Women Really Feel as Their Looks Change), I’m struck by how often I am asked whether I believe in plastic surgery or condemn it, as if I need to take sides on the issue. People want to know what I think about the cosmetic ‘work’ they are considering and want to tell me about what they had done. Below, is a description of the procedures most often talked about with words like, “it was the best thing I ever did,” or, as Fonda said, “it helped me look more like how I feel.”  Keep in mind, I am not a surgeon, dermatologist or cosmetologist. I have no product to sell or procedure to promote. But I have listened carefully to many people who have shared their cosmetic experiences both publicly and privately. This list is not based on a large statistical study, but rather on the many people I have talked to over the past twenty years, on the road, on radio and in my psychotherapy office. Tell me what your experience is, if you feel differently or if I’ve left out some that are worth mentioning.

#1. Botox – It probably comes as no surprise that Botox tops this list. We know that millions of women (and an increasing number of men) regularly use Botox, but recently more are openly pleased with the results. Some say Botox will become as routine as coloring hair is today if it continues to be safe and satisfying. Injected into frown lines, forehead creases and crow’s feet, Botox temporarily paralyzes the muscles that lead to wrinkles. Reactions like “my skin looks smoother” or “I look refreshed” are commonly heard within a week after the procedure. Many feel it is a quick and relatively painless solution to halting the deepening lines that come with age. Some say they hope Botox will eliminate wrinkles completely; a possibility that makes it appealing even to 20 and 30 year olds. The minor complaints are about the expense and time needed for upkeep (every 3-6 months), but most say it is worth the effort. My biggest issue with it: the slippery slope it creates when one procedure leads to another, its overuse which can result in static facial expressions and that younger people are now regularly using Botox without a clear understanding of its long term impact.

#2. Cosmetic procedures to treat under eye dark circles, bags, sags and puffiness – I was surprised by how uniformly satisfied men and women were after having surgery to treat dark or puffy circles under their eyes. Most said the shadows under their eyes made them look older and more tired than they really were. Many tried conservative remedies first, like sleep, better nutrition, treatment for sinus conditions or cover-up cosmetics. Treatments like skin lightening, injectable fillers and intense pulse light lasers brought more satisfying results for under eye dark circles. Surgical eyelifts are used for bags and sags that come with age and involve inserting an electronic probe to melt fat located under the eye. Almost all those I spoke to said, “It was the best thing I ever did.” Since some of these treatments can provide over 20 years of satisfaction, few people complained about the cost or discomfort. The only negative I heard was that they had wished they had done it sooner.

#3. Liposuction – In general this term describes a surgical technique that removes excess fat from deposits located between the skin and muscle. Most consistent positive results are reported when liposuction is performed on small and specific areas of the body that are resistant to change through diet and exercise, in contrast to attempts to remove large amounts of fat from various parts of the body. When performed to contour the upper thighs (saddle bags), belly fat (love handles) or to remove added weight after pregnancy, this procedure often leads to great satisfaction.  The complaints I heard were mostly about the cost and about the unanticipated pain. Apparently, some surgeons underplay the discomfort of this procedure. Several people said that if they could do it over again, they would have asked for more fat removal or liposuction on other areas of their body. Most were very glad they had it done. The results are satisfying especially for those who are otherwise in good physical shape.

# 4. Permanent Eyeliner –This was one that surprised me most. I hadn’t known much about this cosmetic option. Even while modeling, it hadn’t been popular. But many women in their 40’s, 50’s and 60’s swear by the pleasure of having permanent liner so that they no longer have to bother putting it on, especially as their eyesight deteriorates. Some women said they wish they had gotten a darker shade of color that shows up more clearly. Most complain only about the pain (it is basically like getting a tattoo). Almost all said they were glad they did it. The negative? Like any tattoo, it is truly permanent. And unlike other more popular cosmetic procedures, it is not easy to find someone experienced and well qualified to perform permanent eyeliner with the care it requires.

#5. Breast reduction – I expected to hear more interest in breast implants or augmentation than breast reduction, but the opposite was true. It turns out that breast reduction surgery was generally experienced with greater satisfaction. Although some women I spoke to clearly enjoy their implants and breast lifts (especially post nursing mothers), there were many more complaints about them. And the need for corrective surgery seemed more prevalent. Women with breast reductions talked about feeling great relief after years of struggling with breasts that interfered with routine activities. Not only did the reduction in size help them exercise, sleep and find comfortable clothes, but it also helped them become less self-consciousness about their bodies.

Obviously these procedures are most satisfying when done in moderation and when safely performed by certified practitioners. And, it goes without saying that this list just brushes the surface of a complicated issue that has deeper implications for contemporary culture. And to be sure, these are not the cosmetic choices I personally would encourage most women to pursue before exploring other options and working on themselves first.

But the basic message I want to convey here is that ‘work’ that works seems to result from clear information, open conversation and careful decision-making. Jane Fonda said she has no regrets about her recent cosmetic alterations. But she also makes it clear that it was the work she had done on the inside that allows her to enjoy what she now sees on the outside. I hear the same from others I talk to; cosmetic work can lead to looking as good as you feel, if you feel good and make thoughtful choices that are uniquely suited to you.