IT WAS the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way- in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only. The Tale of Two Cities. Charles Dickens

This introductory passage speaks to the heart of the matter: we exist in perpetual change and conflict. Resources are also becoming limited. We struggle on where to spend that precious additional hour, at the gym, watching children’s sporting events, at work, or merely relaxing. The choices can be bewildering, however for some offerings, the decision making process may be simplified. Considering the importance attributed to youth and beauty, it’s little wonder that Americans have an insatiable appetite for foods, procedures and experiences which promise to promote competitiveness and contentment.

The demographic profile of cosmetic procedure consumers can be defined by their historical cohort and their purchasing decisions. Millenials: (Born 198197) are stalwart Botox & light facial resurfacing consumers but predictably, price conscious. Primary breast augmentation and liposuction are common. Gen “X”: (Born 19651980) are aesthetically savvy with minimally invasive injectable therapies (fillers, neuromuscular toxins). They seek additional solutions for problem areas such as facial aging (jowls, brow descent Ultherapy) and unwanted bulges (Zeltiq or Kythera). Surgical procedures sought include eyelid lifts, mommy makeovers, breast revisions and lifts.

Rather than lumping together all people who have been defined as old, some gerontologists have recognized the diversity of old age by defining subgroups. One study distinguishes the young old, Baby Boomers (Born 19461964), the middle old, Silent Generation (Born 19281945), and the very old, Greatest Generation (80+). They are inspirational, having enjoyed success in life with many amusing vignettes to share while still striving for more adventures. “Boomer’s” attitudes have been shaped by their tenure in an era in which there is an unprecedented historically high acceptance of cosmetic alteration. “Jack” is a rugged 75yearold who shoots, hunts and is a regular “fan” of injectables. On a recent appointment, he confided that he looks forward to his treatments, because these are something he wants to do, rather than needs to do. Provided both patient and physician communicate well, optimize medical conditions, and maintain realistic expectations, great outcomes can result.

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