The other day a patient of mine asked what I thought about her daughter's desire to get Botox. She told me that they had been to the dermatologist for a routine appointment when a projector screen in the waiting room began showing pictures of various anti-aging procedures. "The video kept looping over and over, with before and after pictures, so you couldn't help but watch it," she said, as if explaining her interest in such matters. That's when she realized her daughter was watching too. Her daughter is 16-years-old.
In light of the recent deaths of two young women undergoing cosmetic procedures -- one a 23 year old receiving her sixth breast implant, the other a 35 year old getting liposuction, along with the recent research showing evidence of potential muscle atrophy with repeated use of botox, it wasn't difficult to answer my patient's question. "Starting Botox at age 16 was not a good idea." In fact, I suggested that interest in anti-aging procedures by girls her age was worth a deeper discussion about what lay behind the request. Self-esteem issues? Concerns about her body? Fear of aging?
My patient's question stayed with me long after she left my office, and I began to think of the challenges facing young girls -- and guys -- today. Why was this teen -- or for that matter any teen -- thinking about facial lines and wrinkles? How early does this all start? And I wondered what exactly these young people were trying to ward off? Were fine lines and slight sags indications of imperfections that needed fixing? Or did these changes foreshadow the inevitable vulnerability that comes with age? Although we know how preoccupied midlife women are with visible changes they see -- and the extremes to which they will go to defy them -- we may not be aware how far this fear has trickled down. More importantly, do we have to wait for another death resulting from optional plastic surgery or witness the unsightly effects from overuse of cosmetic procedures like Botox to know we are a culture in trouble?
What we do know is that young girls (and boys) today live in a society obsessed with youth and beauty. They can't escape the messages that bombard them in the media about the importance of looking younger, thinner, stronger, enhanced and better. There are the reality shows that promote all sorts of transformations; "Extreme Makeover," "The Biggest Loser," "The Swan," and, one of the most offensive, "Bridalplasty." In that show, which I wrote about here, young brides competed for the surgical procedure of their choice and were presented to their grooms on their wedding day. The message was clear; even on one's wedding day, perfection, not love, was the goal. And of course during these shows (surprisingly a favorite of the under 30 demographic) non-stop ads offer their own version of anti-aging solutions. Commercials featuring beautiful, and of course, young looking actresses, endorse makeup, gels, creams, and yes, Botox and Juvederm, products that promise to revitalize, revolutionize and transform. And while the girls hear a little bit of this or that will take years from their faces, the boys hear how years can be added to their sex lives. Have you counted the number of Erectile Dysfunction ads that are aired during one single quarter of one football game? By the fourth quarter, guys must feel exhausted imagining the long lasting, ever-ready potency that will be demanded of them as they age.
If we then turn to the Internet, where the fastest rise in marketing is taking place, (and where young kids spend half their lives), we find there are even more anti-aging messages invading our youth's psyche. Online advertisers allow viewers to remove lines from wrinkled faces by using magic wands and create images of perfection by virtually altering body parts with the touch of a button. How can teens distinguish what is real and what isn't, what is possible or not? With that in mind, what about the amount of online pornography our teens have access to -- in spite of our attempts to disallow it? Whether we recognize it or not, they are exposed to and growing up around digitally (or surgically) enhanced everything, everywhere. Add to that the kind of film clips that my patient saw in places you don't even expect -- and what are we telling our kids?
These are not merely observations. While the number of cosmetic procedures remains highest among midlife women, the steepest increases can be found among women much younger. A quarter of a million teens have undergone cosmetic surgery in 2010 in the US alone (these include procedures to reshape, reconstruct and enhance). According to a recent article in The New York Times, about teen usage of anti-aging injectables, approximately 12,000 between the ages of 13-19 received Botox and Dysport (two brand names for the botulinum toxin) some receiving multiple doses. "Teen Toxing," as it is sometimes called, has increased 2 percent over the past year and 100 percent in the past 15 years. While this rise may be astounding, it is small in comparison to the 509 perncet increase in Botox use by all ages over that same period. It doesn't take a psychologist to recognize that my patient's question and these statistics reflect a larger problem that has to be addressed.
The president of the National Research Center for Women and Families, Diana Zuckerman said to the L.A. Times, "We've made a decision about what beauty looks like in this country, and everybody -- teens in particular -- wants to fit the mold." The article goes on to say, that although cosmetic surgery on teens is concerning, surgeons argue that these procedures aren't just about improving appearances. They can improve self-esteem too. They say, "Because teens take every imperfection (real or perceived) seriously, physical differences, however minor, can influence what they think of themselves and how they behave."
Which brings me back to my patient and her daughter asking about Botox. How are parents to respond to their teens who beg them to "renew" or "reshape" their faces and bodies using cosmetic procedures? Remember, we are not talking magic wands, but requests that can involve general anesthesia and invasive surgery. What are we to make of teens who have been convinced -- sometimes by their own doctors -- that just the right physical alteration might help them not only look better, but be more confident and popular? When we are asked by our kids to help keep them from being left out, or from possibly being bullied, can we stop ourselves? And, if they have been told that they can potentially avoid signs of aging -- and I mean promises they will never ever have a wrinkle -- if they act now rather than later, do we deprive them of what we may have wished for, but never could have achieved?
But, wait. What if your teen suggests throwing some medication into the mix. Ritalin before SATs? Klonopin for Prom anxiety? Zoloft to ease their romantic troubles? And what if your tween wants in on it too? Will we be leading them down a slippery slope never to climb back up? Wasn't adolescence supposed to be about learning to cope and deal with the kinds of struggles that prepare them for the rest of adulthood? To answer, I say again, a 16-year-old's desire for Botox, or for that matter, any cosmetic procedure must be questioned for many reasons. So should all quick-fixes that override the internal angst these desires may represent. That we are even struggling to answer the questions these teens are asking worries me on many levels. Does it worry you?
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Vivian Diller, Ph.D. is a psychologist in private practice in New York City. She has written articles on beauty, aging, media, models and dancers. She serves as a consultant to companies promoting health, beauty and cosmetic products. "Face It: What Women Really Feel As Their Looks Change" (2010), written with Jill Muir-Sukenick, Ph.D. and edited by Michele Willens, is a psychological guide to help women deal with the emotions brought on by their changing appearances. For more information, please visit www.VivianDiller.com
Follow Vivian Diller, Ph.D. on Twitter: www.twitter.com/DrVDiller
Teen Plastic Surgery - ABC News
Plastic Surgery and Teens on MedicineNet.com
Plastic surgery for teens: A good or bad move? - Parenting ...
Discovery Health "Kids and Cosmetic Surgery: Are Teens Too Young ...
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And there are many non-cosmetic uses for Botox, such as for excess sweating. Many of the teen users may be getting injections for these purposes.
You are very right to point out the medical benefits of some of these proceduresÂ. For example, Botox has been found helpful to treat spasmodic muscle disorders, migraines, anal fissures (excess sweating, as you mention, and more). Juvederm has been used to relieve paralyzed vocal cords. The use of plastic surgery to correct birth defects and disfiguremÂent due to injury can not be dismissed. I appreciate you reminding everyone of this.
Just keep in mind, that this piece was written about use of cosmetic procedures in reaction to fear of aging (especiallÂy among teens) and I hope you see the necessity of bring up that point. Thanks for you comment.
And, it doesn't hurt that we have people in the media, like Bening, Mirren and Streep, to present themselves as role models for what looking beautiful can mean at midlife.
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Most of the older women in my village have never used any sort of cosmetics, and most still have long traditional hair. Old age is accepted here; everyone grows up caring for their elders as well as their own babies. What a concept!
Ironically, it is these bronzed, weathered, and wrinkled faces that are sought by many local and foreign artists and photographers. I've always sensed a much greater inner peace among the Mexican elders than among the many northern retirees who settle here. The superficial and materialistic values of the north will not sustain you into your old age.
The northern women fear no one will love them if they are not "perfect" looking.
Sad.
My 93 year old mother in law is one of the most beautiful women I know. Her children and grandchildren never stop telling her how lovely her white, wavy hair is, how soft and delicate her skin feels and how wonderful her smile is. We have photographs of her all over our house and I bring one to all the talks I give to show as a role model for aging gracefully.
Your points are well taken. Most of us have a natural desire to look attractive at any age, but good health and happiness are the main key. At 61, I'm facing these issues myself, but in a totally different cultural context, which has actually been most enlightening.
Hints to naturally beautiful aging: Healthy natural diet, variety of exercise, yoga (to reverse the effect of gravity to pull upward on your sagging tissues and blood circulation), steam baths for detox and a healthy glow, and clay facials, followed by whatever suits your skin.
Ironically, some cosmetic surgery winds up making the person look only more worse than before: the botched botox, the clash between artificially smooth faces and wrinkled arms and legs, the stretched smiles, etc.
As for me, I am neither a mom or grandmother, not wholly by choice, so I'm walking a cultural tightrope between the solid traditional values of the Mexican close family life which I see around me, and a much more alienated, superficial, and media-driven northern culture from whence I came.
Bottom line - the Mexicans seem much happier at all ages.
Unfortunately, the youth and beauty obsession is hitting men more than you would think, especially at midlife. As many are facing being single after divorce and back in the dating world (up to 50% of marriages end in divorce), as unemployment is high and there is age discrimination at work, men are finding themselves in a similar dilemma as women are --wanting to look younger than they are. You see, we are all living longer lives than ever before in a culture that sees youth as vital and aging as invisible. Men are feeling that attitude toward themselves too, even if this a more recent phenomena. The challenge we all face it getting the next generation to view aging less as a disease and more as a phase of life. The way I see it, is that if we are to change cultural attitudes, men and women have to join together in this challenge.
When she's job hunting, she gets no respect from interviewers who treat her either like she's lied on her resume about her 20+ of experience, or worse - like she's a teenager applying for a job way over her head. After her divorce five years ago, she started going out more...and got hit on by college kids. The kind of substantial, smart men she's interested in want nothing to do with her for fear of being seen as "dirty old men."
The truth is, women don't really want to look young --- they just don't want to look old. Looking young is only fun when you ARE young.
I think that is a great way to talk about this topic. The desire to not "look old" might be better achieved by looking the best we can for our age. We should enjoy our youth while we are young. Enjoy watching those younger than us as they go through their youth. Then move on and learn to enjoy being the best we can be at our own age. It's the natural flow of life.
wondering on this:
per cliche/norm, gals supposedly do all this "for themselves," but i wonder if it is also medical preening done to catch the "right" guy. i see/hear/read what gals do to/for themselves who re-enter the singles market - arm candy for the next moneyed thing in trousers? young singles r out there too, and the focus is on having radar that can seek out & nab men of affluence. the notion of the "right" guy is just as messed up, i think.
wealthy men, who, though trolls themselves, "get" & wear their women just as sure as the women wear their clothes, jewelry -- and now procedures. looks-based upward mobility is a sociological reality - 24/7 media has brought this into every household, and things r looking pretty pimpy.
can all this obsession also be misguided attempts to attract the "right" guy (right = $$$?)?
do we also need to redefine who exactly girls & women should regard as the best catches and that there just might be great guys out there who prefer women who are not physically altered?
we are all just trying to make our mark.
the sum of our deeds? more like how "hot" we are. yikes.
Brilliant! Yes. Thanks for your great contributing comment.
I recently returned to my natural hair color at 43. I no longer have the angel-blond hair my daughter has at 4, and as I saw my grey coming in I actually kind of liked it. I'm looking forward to being an old lady with a gorgeous head of white hair like my grandmother. I will definitely wear flowers in it every day.
Thanks for yet another great article.