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.