Abraham Lincoln reportedly said, "After forty, you get the face you deserve."

That judgment may seem harsh and overly deterministic to aging boomers - but then again, these are the same people who are flocking to lunchtime facelifts, plastic surgeons and botox treatment parties to improve body image and facial appearance.

Fueled by new technologies and competitive pricing, "Cosmetic surgery has increased 400 percent within the last several weeks," according to Kelley Miller at the American Academy of Cosmetic Surgery, headquartered in Chicago.

The newest craze in cosmetics, botox, is a diluted botulism toxin, TYPE A. Injected as a mere prick into the face, it immobilizes muscles just under the skin, lessening the appearance of facial wrinkles around the eyes and forehead.

"What woman wouldn't want to smooth these wrinkles?" asks Mitra, an attractive hair stylist at White Flint Mall in Rockville, looking in the mirror behind her stylist's chair.

"It's not as expensive as a facelift," she says. "Three-hundred dollars for crows feet; $700 for those wrinkles as well as frown lines and forehead wrinkles, too.

"But I won't chance it," she continues, referring to the possibility of side effects, such as drooping eyelids or involuntarily raised eyebrows, which sometime accompany the injections. "And you have to re-do the treatment about every three months," she adds.

And yet new cosmetic technologies are creating a rising social phenomenon and lucrative marketing opportunity that doctors now refer to as "elective surgery." The one vendor that markets botox, Allergan, had sales last year of $350 million, and the company expects a 35 percent increase in sales this year. It is estimated that 7 million people paid for botox treatments in 2001.

The 'corrections'

Botox is not the only innovation in cosmetic treatment. Traditional plastic surgery has been improved by altering underlying muscles as well as the skin itself. Other cosmetic improvements include laser re-surfacing, chemical facial peels, intradermal pigmentation that can camouflage scars and augment lip size, body sculpting through liposuction, advanced techniques in breast implants, and bleaching of sun-damaged skin and age spots.

In contrast to the lunchtime botox treatment, which may run as little as $300, a full, in-hospital, elective cosmetic treatment may cost between $15,000 and $20,000.

Certain population groups are more interested than others in cosmetic treatments. Botox treatments appeal to people in the age range of 30 to 50, estimates Dr. Jim Gilmore, a plastic surgeon in Dallas. People in their forties go for "corrections" such as body sculpting and liposuction, the extraction of fat from body parts, he says.

What Gilmore calls "rejuvenation," - facelifts, buttocks lifting - is preferred by people ages 50 to 55. Nose and ear surgery operations are sought after by those ages 35 to 40. And women between 30 and 35 are most likely to seek breast implants.

While women are the largest consumers of cosmetic treatments, men now account for 20 percent of all cosmetic surgery, says Gilmore. "And men are a growing market for elective surgery."

There is a cultural mania among young men for bodily perfection, according to Jamie Carrington, 22, a graduating senior at Kenyon College haling from Washington, D.C. He says he knows of men who have had procedures to artificially expand their calves and pectoral muscles - a phenomenon Carrington calls "the cosmeticization of masculinity."

Body image attitudes

But whence does the current popularity of botox and other cosmetic techniques stem?

One key to understanding might be to identify emotional attitudes about body parts and then figure the relation of those attitudes to self-esteem.

To this end, Dr. Stephen Franzoi, psychology professor at Marquette University in Milwaukee, has developed a "body esteem scale." He reports that men find self-esteem mainly in "the body in motion," strength in the upper torso and self-perceived virility, whereas women derive esteem from a more static, iconographic image of their bodies - especially involving face, breasts and overall weight.

A growing number of therapists advise patients on body self-esteem. A leading group of such therapists is directed by Dr. Ann Kearney-Cooke of the Cincinnati Psychotherapy Institute and director of the Helping Girls to Become Strong Women project at Columbia University. The group specializes in counseling regarding self-image, shame relating to the body, eating disorders, body image disturbances, breast implants, body concerns of men and plastic surgery.

Self-esteem can be strengthened by cosmetic fixes according to Kearney-Cooke. "Interestingly," she says, "many people want to be changed, but not too much."

They want to retain their original image, and "Very often, the before-and-after images aren't that profoundly different," she says.

The investment in "grooming" apparently creates a shift in attitude about oneself, which helps improve appearance beyond the actual impact of the cosmetic technology. But Kearney-Cooke maintains that techniques such as guided imagery sometimes can do more for patients, at a cheaper price, than does surgery to improve self-esteem and appearance - although surgery should not be ruled out in some cases.

If there are perceived "bad" body parts, there are work-arounds, Kearney-Cooke says.

"Tina Turner, the singer, is not perfect in every part of her body. But she has great legs, and she emphasizes those. And she expresses herself. She puts her story out through song and dance. Expression, your story, makes you feel good, makes you look good," she pointed out.

Social phenomenon

The perception of beauty has its foundations in biology, but it's also subject to fluctuations in societal attitudes.

Kearney-Cooke emphasizes the social dimension of what is considered beauty. She points out that Elizabeth Taylor, who was considered the epitome of feminine beauty in the '60s, was supplanted the following decade by Twiggy, the rail-thin waif of a model. And this notion of "thin is beautiful" has stuck - especially in the minds of women.

She cites Fallon and Osin"s classic 1985 study "Sex Differences and Perceptions of Desirable Body Shape" which showed photos of female models to a group of women and the same photos to a group of men and asked them to rank the models for their beauty. The women statistically went more for the thin models. The men chose heavier, not fat, but more curvaceous women - who had "some meat on their bones."

There are also cultural factors affecting perception of beauty.

For instance, white and Hispanic women are more likely to want bigger breasts. African-American and Asian women typically are not as concerned about breast size, but African-Americans are more sensitive to hair appearance and lighter skin tone. There is a pill that can be taken to lighten skin tone, according to Dr. Diane Colgan, a cosmetic surgeon with a practice in Potomac who says this chemical treatment is gaining popularity.

Certainly there must be a reasonable point somewhere along a continuum between what is good grooming and taking care of oneself, and what can only be described as the foolishness of unnecessary surgery and injecting poisons into the face.

Kearney-Cooke conducted a study in 1999 that showed teen-agers who get cosmetic surgery have low self-esteem and tend to stay longer in unhealthy relationships. One-time adult adopters of cosmetic technology gain higher self-esteem the same study shows. But if these same adults use MULTIPLE treatments without recognizing perceived benefits, they, too, suffer lower self-esteem.

Computer scientists may have something to say about the human face because of their work with robots. At the Artificial Intelligence Lab at the Massachusetts Institute of Technology in Cambridge, researchers have found that a computer cannot develop intelligence without interactive social skills.

Without a mobile face, social skills cannot be developed. And so robots are built with eyebrows, foreheads, mouths, cheeks, chins, eyes. Everything we humans have.

"Non-verbal information is communicated by means of the face. That communication, that information is interactive," says Anne Foerst, Ph.D., professor of computer science and theology at Bonaventure University in Buffalo, N.Y. "Without a face, the computer is stupid," she says.

That gives one pause about botox, a technology that freezes facial muscles, which enable facial mobility - one of the foundations of social intelligence.

Clearly many may benefit from botox treatment and the other new cosmetic technologies. But consider: Abraham Lincoln's face shows its own sort of radiant beauty - and intelligence - despite its furrows and flaws.

Caption: "Expression, your s on a sha Ȁ> ory, makes you feel good, makes you look good."

Dr. Ann Kearney-Cooke, Cincinnati Psychotherapy Institute

(c) 2002 Russ Barnes. All rights reserved.