When you’re under 40, the whole “aging” thing seems remote. Sure, you’ve noticed it happens to other people. Old people. But it’s never going to happen to you.

Then, sometime after you hit your 40s, the Yikes, do I look that old? moment strikes you.

It goes like this: A friend e-mails you a photo she took of you at a party. You click on it to enlarge and peer closer.

What’s going on with my neck?

Click again. Enlarge.

What’s with all that hanging skin? Where did that come from? I look like my grandmother, for heaven’s sake, and I’m only 45!

Alas, aging happens. Sometime in our 40s, the skin on our faces and necks begins to loosen, causing crow's feet around the eyes, jawline jowling, folds (or "marionette lines") at the corner of the mouth and vertical folds and a double chin. When and how much of this happens depends on genetics, sun exposure and personal habits.

A photo can be an unpleasant wake-up call for those who have perfected the art of mirror-squinting. Denial, after all, has its uses.

“I’ve had patients say they had no idea they had a saggy jawline or droopy eyelids until they saw a photo of themselves,” says John R. Leikensohn, M.D., F.A.C.S., a board-certified plastic surgeon with the Plastic Surgery Center in Sarasota and Bradenton. “Suddenly they see their mother’s jowls or their father’s bags under their eyes. It’s a natural process; everyone ages. Some people don’t mind the changes—and some do. The ones who mind usually end up consulting with a plastic surgeon.”

According to statistics culled by the American Society of Plastic Surgeons (ASPS), there are a lot of Americans out there who do mind. More than 10 million cosmetic procedures were performed last year, including such non-invasive treatments as Botox and Restylane injections, chemical peels and laser skin resurfacing. (Surgical procedures represented 18 percent of the total; non-surgical procedures were 82 percent of the total.) And, according to a related survey, while less than 10 percent of adults in the United States have experienced cosmetic surgery, almost twice as many hope to do so in the future.

That’s a lot of people wanting to turn back the clock.

Plastic surgery is hardly new. The advent of contemporary reconstructive plastic surgery dates back to the early 20th century. During World War I, physicians were called upon to fix the shattered faces and bodies of soldiers. Techniques were honed during subsequent military conflicts. But it wasn’t until the 1960s, when silicone emerged as a way to treat skin flaws, that the American public began to view plastic surgery as an elective option for cosmetic enhancement. By the late 1970s, most of today’s surgical techniques had already been invented.

In fact, true innovations are fairly uncommon in cosmetic surgery these days, says Dr. David L. Mobley, a board-certified plastic surgeon with Sarasota Plastic Surgery Center. “We’re always hearing about the newest miracle procedure, but meaningful innovations are rare,” he says. “The surgical procedures that have been used during the past 30 years have stood the test of time.”

Where the industry has blossomed, he says, is in the arena of non-invasive procedures. Wrinkle fillers such as Botox, Restylane and other hyaluronic acid treatments are hot tools in the anti-aging arsenal and have “completely expanded the ways in which we can revitalize skin.” Laser resurfacing and chemical peels have also changed the face of cosmetic enhancement. Most plastic surgeons now recommend a mix of traditional surgery and non-invasive procedures.

Today, beauty spas, medical clinics and plastic surgery centers offer hundreds of ways to achieve a newer, more refreshed and revitalized version of you. From Botox to Frazel laser treatments to butt implants (yes, butt implants), the options are endless. But how do you make the right choice? Do you go with a surgical and more permanent procedure—or something less invasive? Is liposuction really necessary—or will exercise exorcise those fat demons?

And when should you even start thinking about cosmetic surgery? When’s the best time to begin to keep the aging process at bay?

When signs of aging start to, well, get under your skin is Dr. Mobley’s simple answer.

“It may be the right time when you have age-related changes that bother you and that makeup or a good night’s sleep no longer help,” he says. “Making the decision to undergo cosmetic surgery should come from within, not from outside pressure. It certainly shouldn’t be motivated by a desire to look perfect.”

The first step is to find a reputable, board-certified plastic surgeon. He or she can tell you if you can get away with non-invasive procedures such as laser treatments and wrinkle fillers, or if surgical alteration will better suit your needs.

Susan Goldfarb, the executive director of an area learning center and a long-time yoga teacher, says that in her 40s she pooh-poohed the notion of plastic surgery. “Why not just grow older gracefully, letting the beauty from within shine through the well-earned wrinkles?” she thought.

Yeah, right.

When she hit her 50s, Goldfarb says, all that changed. She would look in the mirror and feel dispirited. “My reflection didn’t show the healthy, high-spirited me,” she explains. “My upper eyelids had extra skin that made them look less open, and my lower lids were puffy, giving me an overall tired look. My jowls were starting to sag a little and I had developed a deep line between my eyes. I looked like I was frowning, sad or mad at somebody. People told me I looked tired all the time.”

Goldfarb spent the next two years and thousands of dollars experimenting with non-surgical options, including an acupuncture facelift, Botox and Restylane treatments, and anti-aging creams. In the end, she says, she wanted a more permanent solution.

She did her research and found two highly recommended board-certified plastic surgeons. “I didn’t feel comfortable going to someone who wasn’t an expert in his field,” she says. “After all, I’ve only got one face.” After these consultations, Goldfarb decided to go ahead with upper and lower eyelid surgery and a lower facelift, commonly referred to as a “mini-lift.”

She says she chose her surgeon, Dr. Leikensohn, for two reasons. First, she had seen “his triumphs” on a few of her friends. Second, his before-and-after photos “didn’t look stretched and unnatural. I wanted a subtle outcome, not the wind-tunnel effect.”

Leikensoh says that he avoids working with anyone who has unrealistic expectations.

“My patients do look younger after surgery,” he says, “but we’re not talking 20 years younger. At most, people turn back the clock back 10 years. Our goal is to emphasize the natural contours of your face and body.”

Dr. Mobley seconds this. “It shouldn’t look like a face lift,” he says. “We strive to achieve a natural look—to reveal your natural bone structure and give you back the features that have been worn down by the aging process. After treatment, our patients look like themselves, only more fresh and youthful. They look better, not different.”

In other words, if you think you’re going to look like your high school yearbook picture—or like Jennifer Aniston—forget it. If you’re 55, you’re never going to look 35 again. And any reputable doctor worth his salt is not going to recommend surgery for people who are addicted to the process itself.

Dr. Leikensohn is all about the reality principle. You’re thinking about going under the knife, after all. This is not the time for denial—or obsession.

“I always advise my patients to weigh both the risks and the benefits,” he says. “Surgery is not without its risks.”

So, is plastic surgery right for you?

Ask yourself if the aging process is eating into your self-image enough to justify it. Make sure that your goals and expectations are realistic. Check that you’re doing this to boost your self-esteem and not to please someone else or dissolve depression or emotional turmoil. (Although, according to a recent ASPS study, the effect of cosmetic surgery has shown to be a factor in weaning patients off antidepressant medications.) If the insults of time are incidental and you’re still in your 30s or 40s, consider non-invasive treatments to hold you over for a few years.

Money, of course, is another factor. A traditional face lift averages between $5,000 and $10,000. A series of Botox injections costs around $200 to $400 per prick, with the results lasting last three to four months. Hyaluronic acid wrinkle filler treatments such as Restylane cost up to $600 per treatment area, with results lasting up to seven months.

Two years after her surgery, Goldfarb says she is still thrilled with the benefits and the results.

“I put my money into preserving my looks because I look like someone who still belongs in the workforce and not out to pasture. All I wanted to do was buy back a few years and look less dragged down by gravity and age. I got that. I guess you can say I came out of my middle-aged closet ready to tackle the world. I still look like a middle-aged woman—but a healthy and vital one!”

For more information about cosmetic surgery trends and choosing a doctor, see our Web-only stories at www.sarasotamagazine.com.

ZUMBA!
The name itself makes you want to do it—whatever it is.

Zumba is, according to Sarasota’s Zumba guru, Amelia Said, “a creative mix of cardiovascular exercise and freestyle dance timed to Latin, Middle Eastern, African, and rock ’n’ roll music.” The steps are derived from traditional Latin dance, including the merengue, salsa, mambo, rumba, flamenco and calypso.

Zumba is a Colombian word that means to move fast and have fun—and that’s exactly what her students do, explains Said, who teaches Zumba classes at the Berlin branch of the Sarasota YMCA. “The routine itself is easy to follow,” she says. Her students range from kids as young as five years old up to people in their 80s.

Zumba was created by Alberto Perez, a Colombian fitness trainer, who “walked into his aerobics class one day without his music,” says Said. Perez’s only option was to grab whatever tapes he had in his car, which happened to be a mix of his favorite dance music. Soon, the class found itself swaying to funky new rhythms, and they liked it so much they asked for more.

Perez worked on structuring Zumba into a teachable fitness regime. In 1999, he was approached by some entrepreneurs who said they’d help him Zumbacize the world of fitness. Apparently it worked, because there are now more than 2,000 Zumba instructors worldwide.

Said, who is also a kickboxing instructor and personal trainer, assures the less swift of foot among us that we don’t have to know how to dance to Zumba.

“Just flow with the rhythms—and get ready to party!” she says.

Sarasota YMCA, Berlin Branch, 1075 S. Euclid Ave., Sarasota; (941) 955-8194; or (941) 266-8511.