In Our Prime

by Patricia Cohen

  The consultant Paco Underhill describes shopping as “a method of becoming a newer, perhaps even slightly improved person. The products you buy turn you into that other, idealized version of yourself: That dress makes you beautiful, this lipstick makes you kissable, that lamp turns your house into an elegant showplace.”

  In moderation, the power of consumption to enrich daily comfort and sensibility is one of the great luxuries capitalism provides. Yet there is a danger in infusing products with too much meaning. In his classic 1979 critique The Culture of Narcissism, Christopher Lasch perceptively argued that consumers want “to find a meaning in life,” and advertising “upholds consumption as the answer to the age-old discontents of loneliness, sickness, weariness, lack of sexual satisfaction.” Sixties radicals expressed a rebellious individualism by buying mass-produced goods, and in the nineties “Bourgeois Bohemians” flaunted a commitment to environmental sustainability—“conspicuous conservation”—by buying expensive products with ecofriendly labels.

  The middle-aged version combines happiness with virtue. This connection is one that surfaced when college graduates talked to MIDUS researchers about social responsibility, mentioning that taking care of themselves was a prerequisite for taking care of others. Taking responsibility for personal health should be vigorously encouraged, but the Midlife Industrial Complex transforms this impulse into anxiety about aging. Responding to the pressure to mask signs of middle age and look more youthful is cast as a civic obligation, as when Rubenstein scolded women for being lazy if they did not utilize the market’s bounty to make themselves beautiful.

  Consumption as activism has obvious appeal. For one, it infuses our daily transactions with meaning, elevating them above the narcissistic function that Lasch excoriated. It also satisfies a fundamental need: the very act of buying can give people a sense of control, not only because financial resources are a tangible buffer against bad fortune but because it can create the illusion of potency. Even if the wrinkle cream doesn’t work or the drooping stomach remains under the camouflage of clothing, at least you have the satisfaction of knowing you took action instead of sitting passively, listening to the clock tick. As MIDUS studies demonstrated, a feeling of control is both a source of satisfaction and a spur to improve your health.

  Middle age is hardly the first vehicle that marketers have used to turn happiness, respect, youth, and self-confidence into commodities. But the number and power of the generation who currently occupy this tier have given midlife’s consuming desire a new prominence and influence. Products and procedures that once lay outside the glossy ring of everyday consumption have been pulled inside. Many surgeons and clients consider plastic surgery a kin of any other luxury commodity available to aspiring Americans. One Beverly Hills plastic surgeon recounted, “One of my patients said: ‘I financed my car. Why shouldn’t I finance my face?’ . . . Plastic surgery is another high-ticket item you put on credit and pay for later.” Among their clients are working-class people who would not have considered such expensive treatments without the lure of easy loans. (“Don’t wait to enjoy the benefits of plastic surgery,” one website urged. “You can qualify for a loan in as little as 30 seconds.”) After the financial crisis tightened credit, some surgeons offered layaway plans.

  Reality makeover shows normalize the idea of plastic surgery and other extreme cosmetic treatments in the pursuit of a youthful appearance. The overwhelming majority of American women, seventy percent, say they would never consider plastic surgery. That figure seems surprising given the operation’s ubiquity on-screen. Four out of five patients who went under the knife said they had been “directly influenced to have a procedure by the plastic surgery reality-television shows they watch.” Although viewers see the bandaged, pained expressions of patients, the brief summary of their recovery (followed by further alterations effected through makeup and clothes) minimizes the surgical risks. A perfectly sculpted middle age, no matter the physical, financial, and emotional price, is promoted as a universal dream.

  Plastic surgery, an expensive luxury, bounced back during the recession, according to the American Society for Aesthetic Plastic Surgery. The number of operations grew to 1.6 million in 2010, a hike of nearly nine percent in one year. Newer nonsurgical treatments, including Botox and facial fillers, are far more popular, although they were more affected by the economic downturn. The number of these procedures dropped by nearly nine percent to 9.5 million in 2010. (Although the percentage of male customers has been growing, men still accounted for fewer than one in ten procedures.) Altogether, Americans, most of them middle-aged, spent nearly $10.7 billion on cosmetic procedures.

  Companies that manufacture these pharmaceutical products, not to mention over-the-counter cosmetics, invest millions of dollars to convince people that wrinkles and sagging skin, like nearsightedness or a chipped tooth, should be treated or repaired as a matter of course. High-end sports clubs have cosmetic dermatologists on staff to suggest laser facials and injections to clients. “You do your hair, right?” a doctor at a day spa asks. “Why wouldn’t you do your face?”

  Botulinum toxin type A, more commonly known by its brand names Botox and Dysport, is a neurotoxin that eliminates lines by temporarily interrupting the connection between the nerves and muscles. It is the number one minimally invasive cosmetic procedure in the country. The widespread use among actors over 35 has directors bemoaning the eerie absence of facial expressiveness. More troubling is a 2011 study that found Botox reduces a person’s ability to empathize with others because it erases the ability to mimic facial expressions.

  For Allergan, the manufacturer of the biggest seller, Botox, middle age has proved to be an enormous marketing opportunity. Originally created to treat strabismus, a condition in which the eyes are not properly aligned, Botox was first used in the mid-1990s to paralyze facial muscles, even before the FDA formally approved it for cosmetic use in 2002. Since then, purchases of the injectable have leaped up year after year with total net sales expected to pass $1.5 billion in 2011. More than a name, the brand has become a signifier for a lifestyle and an attitude. Allergan was eager to repeat its success with a product it introduced in 2008, Juvéderm, an injectable hyaluronic acid used to fill in or plump out lines and wrinkles. Its ad campaign serves as a case study of how a company goes about redefining the look of middle age.

  Consumerize It

  “Forty is the sweet spot,” says Caroline Van Hove, Allergan’s director of marketing. That’s when women and, to a lesser extent, men become interested in what Van Hove calls “middle age” cosmetic treatments.

  Dressed in a lapis blue blouse and black pants, Van Hove is thin, with blond hair and eyelashes as thick and long as spider legs. They are, she reveals with a conspiratorial smile, the result of using Latisse, the company’s new eyelash lengthener. “Juvéderm was a challenge to the marketing team in the U.S.,” Van Hove explained. While Botox had completely dominated the market for more than a decade, Juvéderm was a newcomer. A competitor, Restylane, was already well established as a popular alternative to more radical surgical procedures. Other firms were similarly trying to wriggle their way into the American market. Allergan not only had to get Juvéderm noticed, it had to differentiate it from other skin plumpers.

  “The beauty of this is that it is still medicine, but you can consumerize it,” Van Hove said of Juvéderm. In other words, sell it like a bar of soap.

  Allergan launched Juvéderm with a sponsorship of the U.S. Tennis Association. Many fans are affluent women in or nearing middle age. Allergan signed Lindsay Davenport, a singles champion, and Tracy Austin, the former top tennis player in the world, to be the faces of Juvéderm.

  The Decades of Smooth campaign, created by Grey Advertising, portrayed Allergan as a well-meaning mentor. “The project’s goal,” copywriters wrote, “is to educate women and men about the best skin care routines for the various decades of life, taking into account lifestyle choices, environmental factors, and individual approac
hes to aging.” The tennis players were described as partners in a “health education campaign.” “What I like about the campaign is that it’s just educating people that there are choices out there,” Austin declared during the rollout in 2008.

  Juvéderm wove information about the product into what appeared to be a public health message, except in this account signs of natural aging were a cause for alarm: “Continued exposure to the environment, coupled with repeated facial expressions such as frowning, squinting, and smiling may make wrinkles and lines apparent even when your face is relaxed.” In other words, laughing and smiling are damaging to one’s appearance because they create wrinkles; they are characterized as agents of physical deterioration rather than as emblems of a life well lived.

  Instead of directly urging people to use Juvéderm, the ad phrased its message as a form of medical advice: “Your doctor may recommend Juvéderm dermal filler to treat the ‘parentheses’ lines between the nose and mouth and other wrinkles and folds on the face where volume has been lost over time.” These cosmetic treatments are precisely the ones from which doctors make the most money. At an annual meeting of the American Academy of Dermatology, one speaker pronounced 14 as the age when “a girl’s lips reach their peak of fullness.” After that, “it’s an uphill battle.” (At this rate, only newborns will have desirable skin, and mothers will be advised to slather on antiaging cream along with baby lotion.) No wonder women in their 20s are anxious about whether they should start eliminating the first signs of aging.

  At a press conference for the campaign launch, Austin, then 45, said seeing her face on high-definition TV is what convinced her she needed work. She mentioned her mother’s skin cancer. Although Juvéderm has nothing to do with disease prevention, by linking the two, Austin sent the message that healthy living (applying sunscreen to prevent cancer) is associated with looking younger (using Juvéderm). At another point, Austin referred to how the stigma associated with these treatments has faded, an echo of Clairol’s forties-era ads about hair dye. “I was secretive at first about it, only telling a few friends,” Austin said, “but now I’m proud to talk about it.”

  Thirty-one-year-old Davenport, her dark hair cut in a bob, said she wanted to let women know they have options their mothers did not. She, too, emphasized health. “I am a proponent of healthy aging, which can involve different approaches at various points in your life, especially when it comes to skin care, eating right, and exercise,” she said. In this telling, injectable treatments are unrelated to vanity, but simply a sign of healthy living and taking charge of your life, like going to the gym.

  The themes of responsibility, happiness, and empowerment are combined in the advertising campaign’s narrative. Juvéderm places itself within the familiar frame of self-improvement, helping people to become their best selves. “I’m celebrating the ‘big 4-0’ this year so there’s no better time than now to switch up my routine to help me look and feel like the best version of myself,” Dayna Devon, a former television host, tells visitors to Juvéderm’s website.

  The campaign repeats the same “take responsibility” message that Lysol and other products pitched in the 1920s, albeit with a gentler tone: “Over time the natural volume of youthful skin begins to diminish as wrinkles and folds form. But with Juvéderm injectable gel, you don’t have to just sit back and let it happen!”

  Juvéderm later instituted a frequent flier–like rewards program that allows repeat users to earn points to spend on more Allergan products.

  Feminists have embraced such products not only out of necessity, as in NOW’s justification for fighting the Bo-Tax, but also as a measure of empowerment. “In 1985, I saw a tape of myself where my eyes were puffy,” said Faye Wattleton, president of the nonprofit Center for the Advancement of Women. “I looked very tired and bedraggled and not as youthful as I would like to have been.” Then 41, Wattleton had an eye-lift. Twenty years later, she had a lower face-lift. “I didn’t do it because I was worried I would lose my job,” she said in 2008. “I did it to make a better appearance, a fresher appearance, a more youthful appearance.”

  Wattleton chastised others for judging cosmetic procedures harshly: “Being a person who has had plastic surgery and goes to the gym five days a week to work my muscles up so they don’t look atrophied as a 60-year-old, I don’t disparage people who want to maintain their appearance. But what I don’t want is a society that tells me I have to.” Disdainful comments from respected public figures about “atrophied” skin, however, contribute to the pressure. Wattleton’s comments are evidence of a wider shift in judgment about the way women and men are supposed to look. Even AARP, a group created to fight ageism, urged readers on the cover of its magazine to “Look Younger Now: Erase Ten Years (or More).”

  In the summer of 2011, Indiana instituted a law requiring anyone over 40 to show identification when buying alcohol, motivated by a concern about curbing teenage drinking and the difficulty of trying to estimate someone’s age in this era of agelessness.

  The cultural critic Margaret Morganroth Gullette, who has written extensively about “middle-ageism,” notes in her 2011 book Agewise that since the 1990s, a narrative of decline—“the entire system that worsens the experience of aging-past-youth”—has become more prevalent and powerful. One effect has been to convince people that the middle-aged body “once located within the huge range of normal, has become substandard or even deformed.”

  Confronted with a demand to conform to the market’s image of beauty, middle-aged women have internalized the judgment and transformed the pursuit of beauty into an exercise in self-improvement and autonomy. Marketers encourage that perception. “I love that L’Oréal is a company known for empowering women,” Diane Keaton said in a television ad. Taking steps to look younger by erasing wrinkles is converted into an act of self-expression, an exercise of control.

  Equating female empowerment with purchasing a product was a strategy pioneered by Edward Bernays. His first job for American Tobacco was convincing people that smoking in public was socially acceptable for women. Recalling that suffragettes smoked while marching for enfranchisement, Bernays hired ten fashion models to light up during the 1929 Easter Parade on Fifth Avenue in New York and called the cigarette a “torch of freedom.” A headline in the New York Times the next day read: “Group of Girls Puff at Cigarettes as a Gesture of ‘Freedom.’” Within a year, women were commonly seen smoking outside. Philip Morris successfully repeated Bernays’s tactics in the late 1960s and 1970s, when it employed the slogan “You’ve Come a Long Way, Baby” for a new skinny cigarette designed for women, Virginia Slims. By emphasizing that objections to women smoking once signified sexism, the ads suggested that puffing on a Virginia Slims was an empowering symbol of independence. Never mind the increased risk of cancer, a fact the tobacco industry was doing everything possible to conceal. Light up a skinny cigarette and declare yourself a feminist.

  Today, the challenge facing both men and women in their middle years is to manage self-help’s exuberant possibilities and its tyrannical dictates, to take responsibility for improving physical and mental health without succumbing to the compulsion to deny middle age.

  11

  Middle Age Medicine

  “Search for the Fountain of Youth,” 1898

  Youth is a silly vapid state

  Old age with fears and ills is rife

  This simple boon I beg of FATE—

  A thousand years of Middle Life!

  —Poet and author Carolyn Wells

  Before Alex Comfort became spectacularly famous as “Dr. Sex,” author of The Joy of Sex, he was known for his work on the biology of aging. Throughout the 1950s and 1960s, Comfort wrote about the process of growing older in mollusks, mongoose, and man, and in 1969 predicted that within twenty years average life expectancy would reach 120. What Comfort and other biologists were aiming for was not simply an extension of life but of midlife in particular. No one wants to stretch out old age with all its frailties and
debilities. As the political philosopher Harvey Wheeler pointed out. “The aim, and the promise, is instead to add the additional years to the prime of life. So-called middle age would last for forty or more years.”

  An elongated middle age is now offered by another branch of the Midlife Industrial Complex—the sprawling antiaging and hormone replacement industries. For all the evocations of “youth,” a prolonged midlife certainly seems to be what Ronald Klatz, co-founder of the American Academy of Anti-Aging Medicine, is describing when he says, “We believe that there can be an end to aging,” a way of “achieving optimal health and optimal performance at age 55 . . . and staying that way for another 50, 60, 70, 80 years or perhaps even longer.” We are “ushering in a new reality,” he adds, “in which 75 years old may well be considered middle age.” As adults in their middle years witness in their family and friends the physical and mental frailty that accompanies longer life spans, deep fears of creeping decrepitude strike more acutely, priming them for these sorts of messages.

  Part industry, part movement, part philosophy, antiaging is really middle age medicine, with all its promise and its perils.

  A Modern Fountain of Youth

  Myths about halting or reversing aging have been told by ancient Greeks and contemporary science-fiction writers. The magic has taken the form of restorative springs, alien cocoons, hidden cities, and clones. But the current, institutionalized, IRS-registered industry is of much more recent vintage. Today, antiaging products include everything from mesotherapy’s “medicinal bullets” to untested hormone therapies that purport to slow or reverse the biological process of aging. This modern partnership between commerce and science emerged in the 1990s, when the first wave of boomers hit their mid-40s, and grew into a nearly $90 billion industry in little more than a decade. The American Academy for Anti-Aging Medicine is both a mainstay and an emblem of this wide-ranging and mostly unregulated industry. The official-sounding “academy” goes back to 1992, when a dozen doctors met in Mexico to explore the antiaging effects of human growth hormone (HGH). Two osteopaths, Klatz and Robert Goldman, were its founders. Their partnership has bloomed into a huge global operation with more than twenty-two thousand members and a series of conferences hosted around the world that attract thousands of practitioners even though the trade group is not recognized by the American Medical Association. The continuing education courses in “anti-aging regenerative medicine” and the international conference business that the academy sponsors bring in millions of dollars each year.