Artifice

She is what the French call “une femme d’un certain age” (a woman of indeterminate age). To the casual observer, her physical traits place her somewhere between 60 & 70, which sociologists have established as “young old age”. Like many of my patients, we have “traveled” together for some time now and in so doing have come to know some details of her story. She has been most articulate in expressing her requirements to look the best she can while being fiscally responsible; we try to project and stay in budget. For my part, I am anxious to please and meet her expectations; she is a performance artiste and we exist in a symbiotic relationship.

My patroness has always been infinitely resourceful. At the relatively tender age of 16, she was obliged to leave home. She lived on her wit, beauty and hope for improvement, which she accomplished in great measure. Ever the adventuress, she earned a teaching degree, married and developed her aesthetic sense. I do not pry but occasionally she will recount how a student resisted her lesson plan or a loutish customer in a nail salon shouted her down. I realize that I have risen to an elite level of her inner circle but this shared confidence doesn’t distract me as I inventory the facial aesthetic units to be prioritized, assemble the injectable palette and start on my “human canvas”.

I listen as she vents her disappointment about unmet promises and detect a recurrent theme which accounts for the seemingly insatiable rise of med spa services, namely the fear of being dismissed as being old, uninteresting and ultimately socially isolated. The dual spectres: “agism” and “beauty” are ubiquitous; hardly anyone is immune: male, female, ethnicity, profession. We are imprinted on attractive, youthful images, so it’s hardly surprising that many wish to remain in “suspended animation”. On the occasion of the annual Plastic Surgery meeting in Los Angeles this September, I asked my RN to Botox my brow. Why? Perhaps it was the desire to avoid the scrutiny of peers. So is it artifice or practicality? Judge for yourself.

My vivacious brunette is attractive, energetic and flirtatious. She has divorced but is certain that she will never remarry as the odds are stacked; however, she’s open to romance. Her optimism and hard work in fighting the ravages of age is inspiring. She reiterates her brief that “my face is my fortune” but “I don’t want to be like Joan Rivers and it’s got to flow with the rest of my body”. I applaud her resolve and realistic attitude. Taking care of her has taught me that it’s not a matter of artifice but rather an active choice to appear as if aging is proceeding less precipitously because the end game, “old old age” is simply undesirable. We the purveyors of aesthetic procedures should take a page out of her playbook to continuously innovate, work tirelessly and investigate options thoroughly prior to offering them. Ultimately, it’s such a privilege to have a patient place their trust and face in your hands.