I am struck by how many of my patients tell me that work pressures are part of their decision to have surgery. They say that while there is no official age policy where they work, there is an "unofficial" one. If this were not the case, why is it that early retirement is offered or encouraged for employees over 55? A local major telecommunications employer just settled a multimillion dollar suit brought by its older employees, including patients of mine whose concerns were obviously justified.

Typically these patients are about 55 years old and feel they are on the cusp of being "over the hill" and this is not some frivolous concern. They may feel that they could lose their job to a younger employee. Often it is not necessarily being older that is the problem, it is looking older. While it is shameful to treat older, experienced employees this way, it is also a reality. Patients tell me there is no fighting it. It is a sad commentary on our values but a bias that is unlikely to change.

My own mother told me that if she had not had a facelift at age 58 (yes, I did it), she would not have been able to stay on and eventually retire at a time of her own choosing, which was 67. Cosmetic surgery not only has personal importance; it can help keep people in their jobs.