A Boom in plastic surgery for them during the golden years

But one thing needed improvement, she decided: her figure. At his age, "she said," your breasts go in one direction and your brain goes into another. " So on July 22, Ms. Kolstad, a widow living in Orange County, California, underwent a three-hour breast lift with implants, which costs about 8 000 $.

"Physically, I am in good health, and just feel like, why not take advantage of it?" said Ms. Kolstad. "My mother lived for a long time and I will only take it for granted that it will happen to me. And I want my children to be proud of how I look. "

Ms. Kolstad is one of several septuagenarians and octogenarians, also cut the nonagenarians as golden years with the help of a plastic surgeon. Under were American society for aesthetic plastic surgery, 2010 84,685 surgery among patients age 65 and older. Those with 26,635 face-lifts, 24,783 cosmetic eyelid activities. 6,469 liposuctions, 5,874 breast reduction. 3,878 forehead lifts, 3,339 breast lifts and 2,414 breast industrial cooperation.

Except for a brief turndown during the recession, these figures had risen over the years, and experts say the trend looks likely to accelerate when the baby boomer generation starts to pass the age of 65. But growth has also raised concerns about safety and propriety reasons perform invasive elective surgery in elderly patients, who can in case of accidental physical and psychological consequences.

There are so many reasons to get plastic surgery that older patients, say experts. Some people are living longer and remaining healthier, and they want their physiques adjust after their psyches. Some are trimming for potential drivers ' mates and want their fans to see their freshest. Some are still working or seeking jobs and want to be seen as more youthful Challenger.

And some are simply sick slackened chaps, jiggly underarms and saggy eye brows. Gilbert Meyer, a retired film producer in Boynton Beach, Fla., which gave his age as only "over 75", saw Dr. Jacob Steiger, facial plastic surgeon in Boca Raton, Fla., for an eye and neck lift last year. He spent $ 8,000.

-I was looking at myself in the mirror and don't like what I see and did something about it, "said Mr. Meyer. "Why not look as good as you can when you can?"

Mary Graham, a 77-year-old restaurant owner in Thomasville, GA., was given a facelift and breast implants earlier this year. "The only time I go to the doctor for plastic surgery, she says.

Ms. Graham is planning to open another restaurant in Tallahassee, Fla., in the fall. "I work seven days a week," said she. "I wanted to look as young as me."

Her plastic surgeon, Dr. Daniel Man of Boca Raton, Fla., who said that he looks more and more patients over 70 years of age, said, "these people are healthy and want to be an active part in society."

Any measure involves risks, but surprisingly few studies have focused on elderly patients and cosmetic improvements. A report published in the journal of plastic and reconstructive surgery in June, found that the risk of persons over 65 years does not exceed the younger population.

Researchers from the Cleveland Clinic reviewed the medical records 216 facelift patients over the course of three years. The researchers found no significant differences in instances of minor or major complications between a group of patients whose average age was 70 and another group whose average age was 57.6.

"We say it is not the chronologic age which is so important, but it is certainly physiological," said Dr. James e. Zins, senior author study and Chair of the Department of plastic surgery at the Cleveland Clinic.

All patients in his study were screened for health problems such as lung cancer and heart disease, diabetes and high blood pressure, and the use of medication, anticoagulants, that could have complicated business. But not all elderly patients may be screened so thoroughly, so his result is not necessarily the risks are minimal in an older population.

"There is a theoretical age complications are more likely?" He mused. "It means that patients 70 and 75 years and older can safely undergo a facelift with complication is the same as young patients? We do not have enough numbers to answer that question. "

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Plastik kirurgs conversation draws a Mile-High crowd

I try usually arrive the night before when I have to lecture at meetings. It gives me a chance to unwind. Recently, I came to Las Vegas at 5 a.m. for a talk that started at 7. If I had done a procedure, it would be something that I could, or would have done so.

Most of my trips mean actually, medical meetings, lecturing and teaching. It is important to keep up with things and to train other doctors. So no I am opposed to take time away from practice.

I do also some pro bono travels to developing countries, mostly to correct photo malformations. That is incredibly rewarding. Sometimes, I'll also squeeze in a vacation, but now I am the proud father of 3-year-old twin daughters, so these vacations are few.

Last fall I flew to Milan to teach Rhinoplasty at an international course. There were more than 700 participants from almost 60 countries. This was a great event, and I spent the entire flight tweaking and retweaking my PowerPoint presentation, watch on for what seemed to be millions of times all the time I was on the plane.

I sat next to this attractive woman. I was close enough to tell that she had had excellent plastic surgery. She noticed what I did and we began to talk. Soon I was knee-deep in a discussion about plastic surgery and youthfulness in General. Flight attendants and surrounding passengers asked to see my pictures, which included some before and after shots and some surgery, which mesmerized many of the passengers, but many of them also grossed.

When flew home from a pro bono trip to Honduras, had I my surgical instruments such as scalpels or surgical scissors in my luggage. It is not like this stuff can go into a "carry-on.

Agent of customs in Miami, opened the set of instruments and questioned me as if I was some kind of serial killer. It was really bad and although I tried to explain why I travel with scalpel and other equipment, he was not listening. Before I knew it, I was surrounded by security and their main supervisor.

I turned on my laptop, which was already out, and showed them pictures of children I had operated on. All felt bad about giving me trouble, and I was actually an escort to my gate. I am sure that will never happen again.

I sometimes feel uncomfortable telling people I am "facial plastic surgeon" on a trip as this can make some people uncomfortable and others feel the need to break down the field.

I had one other passengers tell if they "believe" in plastic surgery. I really wasn't sure what meant, and I don't go into a speech about how surgery can improve lives and how many of us are doing humanitarian work to assist victims of domestic violence or those with birth defects.

But most people are really curious. And I have no problem not answering questions, especially if I can help educate people. I get always the question: what would you do for me? I am always honest.

There is always a responsibility to answer the call for integrated medical help. I would like to help and am updated on C.P.R. and advanced cardiac life support certification.

I did once a flight attendant whose blood sugar was low. But by sheer luck, primary care doctor or an emergency medicine physician has been among the passengers on other flights when crews were asked if there is a doctor on board.

It was great, because I really better equipped, so that in case someone needs an acute nose job at 35,000 feet.

By Steven Pearlman, who said that Joan Raymond. E-mail: joan.raymond@nytimes.com

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