Patients often bring up the issue of vanity and wonder if it is an acceptable reason for wanting a facelift. My response is: "Is it okay to want to repaint your house, get some new clothes or change in an old clunker for a new car? Why would it not be okay to spruce up your facial appearance?"

People in many parts of the world, Brazil, for example, do not find it necessary to justify such vanity. Perhaps it is the American Puritanical heritage that makes us question such self-indulgence. The purist would eschew jewelry and makeup and leave her hair looking like Albert Einstein's, or maybe cover it with a Pilgrim's hat. It strikes me that one's appearance is more important than jewelry, and perhaps jewelry is a poor substitute. Is cosmetic surgery the 21st century extension of jewelry? One of my patients called her cosmetic surgery her "everyday jewelry." At least vanity is not included among the seven cardinal sins.

Having a facelift is really just an extension of one's desire for self-improvement, to look one's best. It can have a profound psychological benefit! Many of my patients are also losing weight, exercising, quitting smoking, eating better, having cosmetic dentistry, whitening their teeth, undergoing LASIK treatment so they don't need to wear glasses and having their varicose veins injected. Timing is often related to a watershed life event – children leaving for college, marital breakup, turning 50, substantial weight loss, change in job, retirement or moving to a new city.

The traditional view is that a facelift is not supposed to be undertaken in response to an external life event and there should be no expectation that a facelift will solve one's problems (when it may have been closer to the truth to say that past techniques may simply not have been up to the job). The over-the-top Nip/Tuck series promoted the dark view of cosmetic surgery as a false prophet of happiness, a desperate and often pathetic diversion for those who fail to confront their internal issues. These old ideas are being reexamined. Life events may well trigger a patient's decision to have cosmetic surgery. The example I see regularly is the woman whose husband left her for a younger woman, some of whom are featured in the Patient Photographs section. This always impresses me – the fact that a youthful appearance alone can trump all the advantages of having a partner with shared life experiences, memories, and children and the tremendous personal and financial upheaval that results from divorce. Obviously, there may be other considerations, but, undeniably, lost youth is the big one. It is a big psychological boost for her to ramp up her appearance. It helps her to make a new start.

In truth, many patients do experience a psychological improvement from cosmetic surgery. It is not unreasonable for them to think that this may have a positive effect on their quality of life. I've been told by many of my patients (including psychologist-patients) that a few hours under the scalpel was more helpful in boosting their self-esteem than hours of psychotherapy.