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Over the years, Alice Patterson has endured every health problem imaginable—“I’ve lived a reckless life,” she chuckles meaningfully. Now in her seventies, the longtime disabilities advocate has trouble with her hearing, her vision, her legs, and her heart. She is soft and round (exercise has long been out of the question), with smiling blue eyes and pale pink skin that has begun to take on the papery fragility that comes with age. Even so, the preternaturally upbeat Patterson is in constant motion, bouncing around in her chair, waving her hands, laughing with her entire body. A devout Christian, she is a poster child for learning to embrace whatever God throws your way. Except … Leaning forward suddenly, Patterson sweeps the flyaway blonde bangs from her forehead and asks excitedly: “Now do you see?”

The proffered forehead is striking because of what you do not see: wrinkles. A few weeks ago, Patterson—who asked for a pseudonym to avoid embarrassing her employer—joined the swelling ranks of Americans who have received botox treatments, the wildly popular cosmetic procedure in which a doctor injects a diluted strain of the botulism toxin into a patient’s face, paralyzing the nerves and muscles that cause frown lines. (Last year alone, doctors botoxed an estimated 1.6 million Americans.) Now, while from the eyebrows down Patterson shows the telltale creases of age, her forehead is smoother than that of a woman 40 years her junior. Patterson is so thrilled with her results that “next, I want to get rid of these,” she bubbles, running index fingers down the lines on either side of her nose and mouth. This, she admits, will be a much bigger commitment. While the botox took only minutes and was relatively inexpensive (a round of shots runs about $500 in the nation’s capital), de-lining her lower face will require surgery and cost Patterson closer to $7,000. Her advocacy job doesn’t pay much, but Patterson plans to head back to the surgeon’s office “as soon as I can save enough pennies.” She will also have to confess her plans to her co-workers—they haven’t remarked on her botoxification, but a full-blown face-lift will be harder to hide—at least one of whom she is certain will be “appalled.”

And after all the pain, expense, recovery time, and potential embarrassment, this sunny senior expects to look in the mirror and see ... an old woman. “I’m no spring chicken,” Patterson acknowledges in a soft, breathy voice. “I don’t want to look young. I just want to look pleasant.” And she wants to look that way, explains Patterson, for her work. A crusader for, and public face of, the disabled community, she feels it’s important not to look “decrepit” or “harassed.” Looking “calm” and “in control,” Patterson reasons, helps her put audiences at ease and conveys a more positive image of people with disabilities. “When I’m smiling, I look pleasant”—she cracks a huge grin to illustrate—“but when I’m serious, these lines tend to make one look a little crabby. And that doesn’t fit with my message.”

WHEN EX-CNN legal analyst Greta Van Susteren went under the knife in January, acquiring a dramatically more glam look for her debut on FOX NEWS, much of the American public (and all of official Washington) sniggered. Jokes flew about how “FOX-y” and downright unrecognizable the new Greta is. Newspapers across the globe offered up snarky takes on Van Susteren’s new look. “GRETA, BUT WHY?” was the headline of a San Francisco Chronicle editorial that scolded: “We would have thought—ok, hoped—that the 47-year-old Van Susteren would have had the substantive credentials and healthily wholesome looks to resist the temptation of an eye tuck and forehead squeeze.” A headline in the South China Morning Post was just as disapproving: “JAWS DROP AND HOPES SAG AS SOBER PUNDIT GOES UNDER SURGEON’S KNIFE.” Perhaps most harshly, an op-ed in USA Today (headlined “WHY TURN BRILLIANT LAWYER INTO BARBIE WITH BRAINS?”) branded Van Susteren “a reminder of the minimalization of American women by American culture.”

Plastic surgery has become one of those things—like reading the tabloids and watching The Home Shopping Network—that Americans like doing and love ridiculing others for doing. Depending on whose numbers you believe, more than seven million of us went under the knife last year. But in a Roper Starch survey conducted for the AARP, 65 percent of respondents described the “typical” cosmetic-surgery seeker as either “rich or upper class,” “insecure or unhappy with themselves,” or “vain or materialistic.” Doctors have even developed a bag of tricks to help patients hide the ugly truth. To explain the swelling associated with an eye job, D.C. plastic surgeon Stephen Wall—the man behind Alice Patterson’s forehead—tells patients to say they’ve had an allergic reaction. He advises those who wear glasses to buy new frames after surgery. “People might comment that something is different,” says Wall, “but they’ll usually accept that it’s the glasses.”

Enough already. We all know the arguments against plastic surgery: It objectifies women, feeds unrealistic images of beauty, perpetuates cultural obsession with youth, etc. As Wendy Kaminer moralized in The American Prospect last winter, “Cosmetic surgery is often lauded for boosting self-esteem, although it encourages people to hate themselves for being physically imperfect or looking over 45.” But whether plastic surgery improves or undermines self- esteem misses the point: In cold, hard economic terms, being attractive helps you get ahead. In 1993 Daniel Hamermesh, an economics professor at the University of Texas at Austin, and Jeff Biddle, an economics professor at Michigan State, published a paper entitled “Beauty and the Labor Market,” in which they calculated that “plain people” suffered a pay penalty of 5 percent to 10 percent compared with “average people,” while good-looking people enjoyed a 5 percent premium. This bias (surprisingly) impacts men more than women, but unattractive women are dealt a double whammy: They’re not only disadvantaged in their own careers; they are also more likely to marry men with limited earning potential. (Unfairly, ugly men don’t have a problem scoring great mates.) What’s more, over the course of their careers, attractive people sort themselves into the (more lucrative) specialties where good looks pay off. In a 1998 paper subtitled “Lawyers’ Looks and Lucre,” Hamermesh and Biddle found that not only did comely attorneys earn more as their careers progressed, but they tended to gravitate toward the private sector, where attracting clients is key to success. Their homely peers, conversely, headed for lower-paying public- sector jobs.

Our society’s bias toward attractiveness is exacerbated by its cult of youth. In an (admittedly self-serving) survey conducted last year by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), one in four employees expressed concern that their boss viewed them as less capable than younger employees. Boomers in particular are finding it painful as they crash into “the silver ceiling.” Last summer USA Today reported that, between fiscal years 1999 and 2000, age-discrimination complaints filed with the Equal Employment Opportunity Commission jumped from 14,000 to 16,000. Not surprisingly, doctors say they’re increasingly performing botox injections and eye-lifts on hard-charging professionals worried about the young guns charging up the ladder behind them. “In any corporate culture where looking young and aggressive is important, people are using this as a way to keep themselves looking younger,” says Ira Papel, a vice president of the AAFPRS. Real estate agents tend to be particularly concerned about image, he notes, as do high-tech geeks. “With anything having to do with computers,” says Papel, “so many experts are so young that people in their early forties feel older and [like they need to compete] with the up-and-comers.” The industry has been both lauded and criticized for its youth bias. (Just ask Intel, which has faced a half-dozen age-discrimination suits in recent years.)

Given the evidence, the most common defense of plastic surgery—that it boosts self-esteem—seems beside the point, if not downright counterproductive. Yes, plastic surgery may boost the confidence of the person seeking cosmetic surgery (and perhaps lower the confidence of those who don’t and must compare themselves to their surgically enhanced peers). But by framing the argument in psychological terms, advocates implicitly concede that people seeking cosmetic surgery are vain or insecure—i.e., irrationally concerned with how they look. This defense is particularly treacherous when deployed on behalf of women, whom society is already predisposed to consider irrational. In reality, much of the enhanced self-esteem that comes with a nip or tuck may well be a by-product of the very concrete advantages that come from looking more attractive. Which is to say that plastic surgery (if you can afford it) isn’t irrational at all.

To be fair, the people whose self-esteem is lowered by the plastic surgery of others are also being rational: Since attractiveness is relative, if the people around you look better— and thus earn more—you may be judged to look worse and, thus, earn less. But people do all kinds of things that give them an edge, some of which (starvation diets, workout mania, 80-hour workweeks) are at least as socially and physically unhealthy as cosmetic surgery. And in our hypercompetitive, hyperindividualistic society, we more often celebrate this push-yourself-to-get-ahead ethos than condemn it. Some feminists might argue that women should eschew plastic surgery because it undermines our broader fight to be judged on something other than looks. But given that feminists also remind us that women will be judged more on the way they look than will men for generations to come, it’s morally dubious to insist that individual women should ignore their personal advancement (especially given that they are often competing with men) for a distant dream of collective gender equality.

Ironically, the people who may ultimately wipe away plastic surgery’s lingering stigma are men. According to the American Society of Plastic Surgeons, men now account for 14 percent of all cosmetic-surgery procedures. At present, men tend to be far more secretive about their bodywork because they fear being perceived as vain, say doctors. But when men do discuss their touch-ups, they defend them in exactly the terms that women should. “Men always say it’s work- related,” says Papel. In other words, the more guys have plastic surgery, the more society will view it as a rational response to the culture in which we live. Which, for better or worse, it is.

This article originally ran in the March 25, 2002 issue of the magazine.