As the baby-boom generation reaches its 40s and beyond, plastic surgeons stand ready, offering a variety of procedures to rejuvenate aging faces. In 1998 alone, more than 434,000 Americans, primarily women, underwent facial cosmetic surgery.

But while cosmetic surgery may make you look 10 or 20 years younger, the procedures are not cheap, are not generally covered by medical insurance, and are not appropriate for everyone. Most importantly, cosmetic plastic surgery is major surgery that carries a variety of health risks and offers no guarantee of success.

What's Happening to My Skin? Natural Skin Aging

Over time, the epidermis, or outer layer of skin, gradually thins out and loses a portion of its melanin-producing cells. Melanin is a pigment that provides a measure of natural protection from UV radiation. An abundance of melanin is why people of color tend to develop wrinkles much later in life compared with light-skinned people. In some older people, melanin clumps to form brown age spots.

In this close-up diagram of the skin, you can see the epidermis (outer skin layer), the dermis (inner skin layer), and a few structures found in the skin, such as a hair.

Meanwhile, the dermis, or the skin's fibrous inner layer, thins out over time, losing its ability to resist gravity and snap back after being stretched. The fat layer beneath the cheeks also thins out during the natural aging process, while other pockets of fat may form in the jowls and beneath the chin.

Types of Facial Cosmetic Plastic Surgery

Cosmetic surgery can only turn back the clock, not stop it. For example, after surgery you will continue to sustain skin damage from sun exposure unless you take the steps necessary to protect yourself.

Following are some of the most popular cosmetic facial surgeries. Some people have two or three different procedures in one operation. Continue scrolling down or click on the links below, to find out more about these procedures:

Facelifts
Forehead Lifts
Eyelid Surgery
Laser Peels
Chemical Peels
Injectable Fillers

Or, if you wish, skip ahead to these sections in this article:

Finding a Safe Place for Surgery
Risks of Cosmetic Surgery
Are you a Candidate for Surgery?

Facelifts

Facelifts are most often sought by women in their late 40s or 50s. There are at least six different types of facelifts, each of which has variations to suit particular needs. Some facelifts are only skin-deep; others tighten skin and underlying fibrous-fatty tissue, as well.

The overall goal of the traditional facelift is to remove excess skin and fat from the neck and lower half of the face (to remove jowls and double chins) and to tighten the remaining tissue. If you have "turkey-gobbler" neck, the vertical bands in the neck can also be removed. Nasolabial folds--those deep creases of skin some people have between their cheeks and lips--can be lessened by the newer "central facelift." The central facelift also raises the fallen fat pads in the cheeks to accentuate the cheekbones.

Facelifts remove big sags, not fine lines and small wrinkles. Crow. s feet and lines around the lips are not affected, nor are the eyes, brow, or forehead. Also, facelifts do not improve skin quality or texture.

Forehead Lifts

Forehead (brow) lifts are designed to smooth out furrows, slightly raise drooping eyebrows, remove "hooding" over the eyelids, and minimize any scowl lines between the eyebrows. This procedure has no effect from the lower eyelids down.

The forehead lift can be done through an open incision from ear to ear along the scalp line, through several small incisions just inside the hairline, or both. An open incision allows the surgeon to cut away excess skin, a problem that many older patients have. Forehead lifts are sometimes combined with eyelid surgery.

Eyelid Surgery

Blepharoplasty, or the eyelid-lift, tightens and restores contour to droopy eyelids and eliminates or reduces "bags" under the eyes. In certain cases, the surgery can also minimize or erase dark circles under the eyes. After successful surgery, the eyes look bigger and brighter. Blepharoplasty is one of the few cosmetic procedures that insurance sometimes covers, if it can be documented that droopy eyelids are hindering the patient's peripheral vision. The procedure does not correct crow's feet.

The upper eyelid lift is performed through an elliptical incision in the crease of the upper eyelid. Lower eyelid blepharoplasty can be done through an incision just below the lower lashes or through an incision hidden inside the lower eyelid.

Laser Peels

This skin-rejuvenating procedure is performed with an ultra-pulse laser, also known as a pulsed carbon-dioxide (CO2) laser beam. The ultra-pulse laser delivers light in bursts so brief in duration that the uppermost layers of skin vaporize without getting hot enough to char. The procedure also tightens underlying collagen tissue, but this effect may be temporary. The new skin that grows back following the laser peel has fewer fine lines and wrinkles. Acne and chickenpox scars are faded, and irregular pigmentation and dry patches are usually reduced or eliminated. Most patients wind up with smoother, more radiant skin.

Laser peels do not correct sagging skin, double chins, or large creases, such as nasolabial folds. Results are better on light-skinned individuals. The peel can be performed on the entire face or regionally. If you are having a laser peel around your eyes and have lax lower eyelids, you may need an eyelid-tightening operation called a canthopexy prior to your peel. Otherwise, you may end up with a "basset-hound" look.

Chemical Peels

Also known as chemosurgery, chemical peels aim to reduce or erase fine lines, wrinkles, and brown spots while improving skin tone--symptoms of aging or "weathered skin" that are not helped by a facelift.

Most chemical peels are done with one of three agents: phenol, trichloracetic acid (TCA), or alpha-hydroxy acid. To varying depths, all three chemically "burn" away the top layers of skin. The procedure spawns the growth of new skin that is usually smoother, more uniform, and younger looking. You can have your whole face chemically peeled, or just one region. Chemical peels are sometimes combined with dermabrasion (mechanical removal of skin) to correct stubborn lines around the mouth.

Injectable Fillers

Fillers are grafts of your own fat, cow or human collagen, or other substances that are injected or implanted just under the skin. The goal is to plump up significant lines, wrinkles, creases, and depressions, such as scars. The procedure is sometimes used to create fuller lips. Results last for several months to several years, depending on which filling agent is used.

Finding a Safe Place for Surgery

As many as 80% of cosmetic surgical procedures are performed in doctor's offices. The advantage is that office surgery costs less than hospital-based surgery. The disadvantage is that offices are subject to less governmental regulation compared to hospitals and freestanding surgicenters.

Before agreeing to undergo cosmetic surgery in a doctor's office, look for the following:

• The doctor should be on staff at a hospital and have privileges there to perform the same operation that will be done on you.

• The office's surgical suite should be accredited by either the American Association of Accreditation of Ambulatory Surgery Facilities (AAAASF) or the Accreditation Association for Ambulatory Health Care (AAAHC). For a list of accredited outpatient facilities used by members of the American Society of Plastic and Reconstructive Surgeons, call (800) 635-0635.

• The operating suite should have state-of-the-art equipment, including a resuscitation machine.

• An anesthesiologist or nurse-anesthetist should be on hand throughout your surgery, if general anesthesia is used.

Risks of Cosmetic Surgery

While most cosmetic procedures can be performed on an outpatient basis, recovery periods generally range from several days to several weeks. Pain during the initial recovery period can usually be controlled with medication. Complications, ranging from bad surgical outcomes, to disfiguring scars, to postoperative infections, to bleeding, to skin deterioration, or even death, may occur but are rare after procedures performed by qualified and experienced surgeons.

It is still vital, however, to ask your surgeon about all the risk factors and complication rates associated with your procedure. Some doctors will put you in touch with other patients who have had the same surgery. If your surgeon is not forthcoming in answering all your questions in plain English, or the surgeon claims that he or she has "never" had a complication, find another surgeon.

Are You A Candidate for Cosmetic Plastic Surgery?

The key to happiness after cosmetic surgery is to have realistic expectations before surgery. You are likely to be disappointed if you have cosmetic surgery for any of the following reasons:

• Your husband or boyfriend wants you to have it.
• You are going through a divorce or another major life change right now.
• You expect the surgery will enable you to attract a mate or land a better job.
• You are clinically depressed or have another mental health problem.
• You expect cosmetic surgery to completely transform your life.
• You are a perfectionist.
• You want to look like your 18-year-old daughter.
• You imagine the results of your surgery will stay with you for the rest of your life.

The best, if not the only valid reason to undergo cosmetic surgery is your own genuine desire to rejuvenate your appearance or to correct wrinkles, irregular skin texture, or another defect that truly bothers you. What other people think should be beside the point.