Mary Lou Lueders never thought she would have cosmetic surgery. A widow whose social life revolves around her five children, Lueders also loves to go to the gym and work in her yard. She's too busy to brood about the march of time.
"I just thought I would grow old gracefully," said the 74-year-old Tampa resident.
But about a year and a half ago, her daughter pointed out that her upper eyelids had become so droopy, they were impairing her field of vision. Since it was a matter of function, not just looks, Lueders agreed to consider surgery.
She made an appointment with Tampa plastic surgeon Adam Scheiner, who said upper eyelid surgery would definitely improve her vision. He also told her that adding a laser procedure to remove the puffy malar mounds, also known as festoons, under her eyes would improve her overall appearance.
The eyelid procedure, considered medically necessary, would be covered by Medicare; eliminating the festoons, considered cosmetic, would cost about $2,000.
At her daughter's urging, Lueders decided to go for it. She's glad she did.
"People told me I looked 10, 20 years younger," said Lueders, who was surprised at the positive reaction. "Now I understand why women do this sort of thing. It makes them feel better and look better."
That's not news to her doctor, who is among the numerous experts who has seen an increase in seniors requesting cosmetic plastic surgery.
"I had a patient in her 90s come in for eyelid surgery," said Scheiner, who specializes in eyelid and facial plastic surgery at the Tampa Eye Clinic. "The face communicates so much. The natural course of aging may make us look sleepy, tired or sick all the time. That's not fair to those people who feel great but their face sends a different message."
Trend likely to grow
Last year there were 84,685 surgical procedures among patients age 65 and older, according to the American Society for Aesthetic Plastic Surgery. They included 26,635 facelifts; 24,783 cosmetic eyelid operations; 6,469 liposuctions; 5,874 breast reductions; 3,875 forehead lifts; 3,339 breast lifts; and 2,414 breast augmentations.
Except for a brief turndown during the recession, those numbers have been rising for years now, and experts say the trend seems likely to accelerate as baby boomers begin to pass age 65.
Seniors in good physical health can be considered for most cosmetic surgeries. Advancing age is rarely a disqualifying factor. Those with multiple medical problems involving the lungs or heart may be discouraged from extensive surgery or may be steered toward less invasive procedures.
"It all depends on the type of anesthesia that will be needed. Longer surgeries with general anesthesia are of a little more concern than if we're using local anesthesia," Scheiner said.
More often it's unrealistic expectations or budget that precludes a patient.
"Someone may come in and just want Botox for a deep line on their face. But I know that's not going to make a big difference in their appearance. That's an unrealistic expectation,'' he said.
Or they may want to treat just one area, because that's all their budget will allow. "I know if we do that one thing and the rest isn't balanced, I will dissuade people until they can come back and we can do it all, so it looks natural and balanced,'' Scheiner said.
"I have to pay attention to neighboring areas. That's so critical.''
Reasons vs. risks
Any operation poses risks, but surprisingly few studies have focused on older patients and cosmetic enhancements. One report, published in the journal Plastic and Reconstructive Surgery in June, found that the hazards in people over age 65 are no greater than in the younger population.
Researchers from the Cleveland Clinic reviewed the medical records of 216 facelift patients over the course of three years. The researchers found no significant difference in the instances of minor or major complications between one group of patients whose average age was 70 and another group whose average age was 57.6.
There are as many reasons for getting plastic surgery as there are older patients, experts say. Some people are living longer and remaining healthier, and they want their physiques to align with their psyches. Some are preening for potential mates and want their feathers to look their freshest. Some are still working or looking for jobs and want to be seen as more youthful contenders.
And some are simply sick of slackened jowls, jiggly underarms and saggy eyelids. Gilbert Meyer, a retired film producer in Boynton Beach, who gave his age only as "over 75," saw Jacob Steiger, a facial plastic surgeon in Boca Raton, for an eye and neck lift last year. He spent $8,000.
"I was looking at myself in the mirror and didn't like what I was starting to see and did something about it," Meyer said. "Why not look as good as you can when you can?"
Some critics question whether the benefits are worth the risks, which may be underestimated.
"You know there are biases because of the underreporting of negative findings," said James Hughes, executive director of the Institute for Ethics and Emerging Technologies, a nonprofit research group in Hartford, Conn. "The doctors have more or less financial incentives to do these procedures, and that often leads them to understate alternative kinds of treatments or medical advice."
Harriet A. Washington, author of two books about medical ethics issues, asks how older patients can give informed consent to plastic surgery when so little is known of its risks to them, especially to those with chronic conditions like diabetes, osteoporosis and heart disease.
"It's one of those things that has crept up on us, and I think, as usual, we've embraced the technology before we've really embraced the ethical questions and dimensions," she said.
Assuming a patient is healthy, meets all of the presurgical criteria and understands that there are risks, why is it that people often are squeamish about seniors going under the knife?
Nancy Etcoff, an assistant clinical professor at Harvard Medical School who studies biology and social beliefs about beauty, believes the double-takes arise from our culture's mixed feelings about old people actively on the prowl.
"Part of our stereotype of old people is that they are social, warm and likeable, but powerless and sexless," she said. "Here we are in the age of Viagra, which is very well accepted, but suddenly the idea of older people, mostly women, wanting to be sexually attractive at that age makes us uncomfortable. If an older woman wants to regain eyelids or wants a breast that she doesn't have to tuck into a waistband, then why not?"
Times staff writer Irene Maher contributed to this report, which includes information from the New York Times.