It took roughly 50 years for Lara* to discover she could have it all. Sure, she had a great family, a fulfilling job as a writer—those things definitely count. But in the past 10 or so years, the 55-year-old has also given herself a head-to-toe transformation via routine Botox and IPL facials, dental veneers, a breast reduction, and Ozempic. “I know they say you have to choose between your face and your waist, but can’t I get a little done on each area?” she jokes. Her husband, also in his 50s, is entirely against these procedures: “He’s like, ‘I thought we were going to get old together.’ And I’m like, ‘I would love to get old with you at the same pace as you. But you didn’t have two kids, and you didn’t gain 40 pounds during the pandemic—or was it the peri-menopause?—and then lose 40 pounds with Ozempic,’” she says.
Eavesdrop on any 40- and 50-something women in a restaurant or the bleachers of a boring high school soccer game, and it can all feel very Are You There God? It’s Me, Menopause. Just think about how many Gen Xers grew up on Judy Blume’s 1970 book. That seminal ovular novel primed a generation of girls—like so many stimulated follicles—to talk frankly and humorously about their periods. Then their birth control. Then their adventures in infertility and pregnancy and breastfeeding and, for some, the subsequent mommy makeover: a nip and a tuck to their stretched-to-the-limit boobs, tummy, and vagina. Hot-flash-forward to menopause, and your friends have no shame or shyness in declaring things like “My last period resembled rusty water” or “I can’t remember a goddamn thing” or “My eyelids are like soggy sandwich bags. Mama needs a bleph.” (That’s short for blepharoplasty. Yes, we’re on a nickname basis with plastic surgery procedures, too.)
Appearance-wise, the ages from 40 to 50 are “the window of frustration,” says Melinda Anna Farina, founder of Beauty Brokers, which serves as a matchmaker between patients and plastic surgeons (you can find her on Instagram @beautybrokerofficial). “Aging is aging is aging. Whether you’re in menopause or perimenopause, there is certainly a sense that we are all on a decline after 40.” As Mary Claire Haver, MD, an ob-gyn in the Houston area and author of The New Menopause, puts it, “You’re going along on your merry way, and then all of a sudden—and it is not gradual—you wake up, and you’re like, ‘I’m not sleeping anymore. And where is this inner tube around my waist coming from? And why are my boobs sagging?’” Blame it on estrogen’s rush for the exit: “It’s a really powerful antiinflammatory hormone, and it’s wonderful at keeping cells healthy and functioning,” Haver says. “When it is taken away, we lose resilience to aging. We lose resilience to environmental factors and poor choices. That one glass of wine? You won’t sleep tonight.”
Of course, hormone replacement therapy can address a lot of this misery. But what about the whole “my face and body are betraying me” thing? The whole “my life is half over, my kids are grown, who am I, and what do I really want” thing? For many, it’s cosmetic and surgical interventions: permission to hold the line (often the waistline) or turn back the clock a bit (think daylight saving, not Back to the Future). When menopausal patients see Troy, Michigan, plastic surgeon Anthony Youn, MD, “they are realistic and want to take five or 10 years off their appearance,” says the author of the new book Younger for Life. “They are not looking for overly drastic changes.”
Women between the ages of 40 & 50 (prime perimenopausal years) are the leading demographic for cosmetic procedures.
Drastic, no. But dramatic? Maybe. Take Lee*, a real estate agent in New York. A few years ago, when she was in her mid-40s, she felt her appearance was out of sync with how she felt. “I would look at myself and be like, What is going on here? I have two kids and did natural childbirth and nursed each of them for two years.” In that time, her breasts went from a 36D to an H or a J. “I had a new party trick where I could hold a book under the flap of my boobs,” she says, laughing. “I would go to sleep and wake up with a boob in my armpit. I didn’t need implants. I had enough there—I just wanted it where it used to be.”
Lee’s surgeon, Kaveh Alizadeh, MD, gave her a NaturaBra lift, which he describes as taking advantage of your own tissue: “We make it rounder and fuller, but not bigger. You get better cleavage; you don’t need to wear a bra.” (The overall trend is for smaller, notes Farina, the patient-surgeon matchmaker, and that’s especially true for middle-aged women. “As we age, our abdomens become boxier, and big boobs on top of that can look very matronly.”) At the same time, Lee got a tummy tuck, because as much as she worked out, “there’s no exercise for getting rid of skin.” The surgery left her with perky boobs and six-pack abs that jibed with her mental image of herself…until she turned around and saw her back.
She jokes that her torso had a mullet—neat in the front, and a little shaggier out back. So a year later, she got her lower back and hips contoured, which requires less cutting through or tightening of muscle than a tummy tuck but still results in “that snatched-waist look,” Alizadeh says. Lee knows she has not seen the last of Alizadeh—she’s planning on an eventual facelift. “I think as you get older, you’re so much more comfortable in your own skin,” she says. “So why not also enjoy the skin? Why wait until you’re 70? I prefer to tweak as I go.”
The most popular surgery among the 55 and up crowd is a blepharoplasty, or eyelid surgery.
Lynn Saladino, a clinical psychologist in New York City, attributes the current wave of menopause makeovers to the countervailing messages about women and aging right now: “There’s this idea that you have to love yourself from the inside,” she says. “But it’s remarkable what we’ve gotten used to on social media, where a normal-looking, healthy woman of a certain age can be called a hag.” In other words, Saladino totally gets it. “It’s true you have to love yourself from the inside,” she says. “But our confidence also comes from the outside—it’s impossible to take other people’s reactions to us off the table.” Aging can be especially hard, she adds, for attractive women who are used to getting “the jobs, the attention, the table at the restaurant, the romantic partner.” Understandably, they want to hold on to that. And if surgery is involved, so be it, she says, “if it allows you the confidence to walk into a room, make new friends, engage in your life and work.”
In that regard, Margaret* is crushing it. She’s 53 but tells people she’s 43, “and no one questions it.” She doesn’t consider herself menopausal, either, though she can no longer have children. She is also a stepgrandmother and, as an actress, spends a fair amount of time looking at herself on a monitor. “That’s hard as I get older,” she says. It’s also motivation for getting treatments and surgery.
When her eyelids started to droop, she got a blepharoplasty. When her waist went a little straight and blocky—that common topographical shift of menopause—she cut back on carbs and lost weight. “But I was still square,” she says, so she got a little liposuction to re-taper her waist, and a noninvasive Renuvion J-Plasma treatment, which uses helium plasma and radio frequency to tighten the saggy skin. “When there’s a decrease in estrogen with menopause, you see laxity in the skin,” explains Sachin Shridharani, MD, Margaret’s plastic surgeon, who considers the noninvasive treatment the gold standard for contouring loose skin without cutting it out. “You are basically shrinkwrapping it,” he says.
Margaret also got J-Plasma on her neck, and had fat from her abdomen spun and injected into the upper portion of her breasts. Still, she is clear that she isn’t trying to pass for someone half her age. “I am not this sexy young thing, and I don’t want that,” she says. “I’ve always enjoyed being attractive. I like the power that comes with beauty.”
“It’s remarkable what we’ve gotten used to on social media, where a normal-looking, healthy woman of a certain age can be called a ‘hag.’
And that’s a power worth protecting. Lee, for one, is highly motivated to safeguard her investments—and not just with religious SPF and big sun hats. “I take care of myself in a different way,” she says. “When my friends want to do something like go rollerskating for their 50th birthdays, I don’t skate. I watch. I don’t want to break any of this,” she says, laughing. “I want to have longevity. I want to be active. I don’t want to be sidelined. I don’t want to break my arm rollerskating the way one of my friends did.” But of course not. That would be a rookie mistake. And something an old woman would do.■