ST. PETERSBURG — Barbara Paonessa works out three times a week, takes piano lessons and volunteers at St. Anthony's Hospital gift shop.
She feels great. But a while back, friends were telling her she looked tired. And she didn't like the way her chin was starting to droop.
So, in her late 60s, the Gulfport resident had an eye lift, and about five years ago, she had surgery to tighten up her chin.
"It gives you a nice feeling when you're looking as good as you can look," said Paonessa, 75.
Some plastic surgeons say their practices are teeming with patients like Paonessa, men and women 65 and over who want to look as young as they can for as long as they can.
"People are living longer. In many cases, they're living healthier, and they don't perceive themselves as being old or older," said Paonessa's doctor, St. Petersburg plastic and reconstructive surgeon Lawrence B. Savitsky.
But as people get older, they may have more health problems and take more medications. Those factors can make any surgery more risky.
"In this and all age groups it's imperative that a patient understands that cosmetic surgery is not a quick fix," said Sheldon J. Sevinor, a plastic and reconstructive surgeon who has offices in Boston and Miami. "This is serious surgery. They must understand the potential risks and complications."
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Last year, about 7 percent of cosmetic procedures were performed on people 65 and older, according to the American Society for Aesthetic Plastic Surgery. The biggest group is 35- to 50-year-olds.
But cosmetic surgery after 65 has increased almost sixfold since 1997, to more than 675,000 last year. Facelifts and cosmetic eye lifts are the most popular procedures in this age group, and those are dwarfed by less invasive (and less expensive) injectable cosmetic treatments, such as Botox.
The procedures remain popular despite the fact that Medicare and other insurance generally cover only those deemed medically necessary, such as breast reconstruction after a mastectomy.
Savitsky, who has been practicing 33 years, said his senior client base grew from referrals from dermatologists and other doctors. Now, about 50 percent of his cosmetic surgery patients are 65 and older. Patients may come in to remove skin cancer and end up asking him about eye lifts or facelifts, he said.
Sevinor, in practice for 34 years, said his reputation for working on seniors blossomed about a decade ago, after he appeared on Good Morning America with his first 80-year-old patient. Among her procedures: a facelift, eye lift, breast augmentation and a chemical peel.
Sevinor performs all surgeries in the hospital and, like Savitsky, insists on complete medical histories and blood work. He also requires preadmission testing, such as electrocardiograms and chest X-rays.
Dr. David J. Smith Jr., director of the division of plastic and reconstructive surgery at USF Health, said a patient's overall health is more important than age when considering surgery.
"You've got to treat each patient differently and sort through the individual issues each patient might have," said Smith.
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One of Sevinor's patients wanted to reward herself after three bouts with cancer and 15 years taking care of her mother, who had Alzheimer's disease.
When Vera Scanlan looked in the mirror, she saw sagging jowls and frown lines. But she didn't feel like she was 70.
"I have invested in other people in time and love and caring," said Scanlan, who lives in Massachusetts. "Now," she said she decided, "I'm going to put that time and love and caring into me."
In June, she went to Sevinor for a chemical peel and lower face and neck lifts.
"He took off about 25 years," said Scanlan, whose husband is 19 years her junior.
"I never understand these people who say 'I'm going to age gracefully,' " Scanlan said. "What the hell for?"
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Not all seniors who have plastic surgery are as pleased.
A Weeki Wachee woman said she suffered infection and disfigurement after a 2008 breast lift, according to a circuit court suit filed in July.
Janet Hohman, 77, declined to comment, but her suit alleges that Dr. Carl Randall Harrell, of the Fountain of Youth Institute in Palm Harbor, failed to properly assess her health before surgery, and didn't diagnose and treat her postsurgical infection.
Harrell denied all of those allegations in his legal response. Neither Harrell nor his lawyer returned calls for comment.
In most cases, Sevinor said, he would likely refuse a patient who came to him for breast surgery in their 70s or 80s. These tend to be major procedures and the "benefits have to far outweigh the risks," he said.
In that age group, he's only done one such surgery: on the 80-year-old featured on GMA.
Not that he'd rule it out entirely, said Sevinor. "It's that no one (else) has asked."
Lorri Helfand can be reached at firstname.lastname@example.org or (727) 445-4155.