As I get older, I’m surprised by how viscerally I react to my own reflection. My face distracts me on Zoom calls. I angle the camera just so to sharpen my jawline and soften the “marionette” effect. I understand that aging is not a personal failing, and yet, a familiar feeling arises anyway: shame.
It’s a feeling I know well. I wrote a book about how shame — especially around women’s bodies and behavior — is internalized, and as a coach, I see how even those of us who recognize the absurdity of these standards are still affected by them.
Women my age (I’m 46) who visibly try — who dye their hair, get injectables, wear makeup, or invest time and money into their appearance — are often dismissed as vain, high-maintenance, or insecure. Meanwhile, those who don’t can be seen as having “let themselves go.”
Even women who exercise to stay fit, filter their photos, or follow elaborate skincare routines tend to draw a line just below their own behavior and judge anyone who crosses it.
Botox has started to feel as normal an investment as a regular gel manicure
Botox is often lumped in with plastic surgery, especially by people who are skeptical of cosmetic procedures or unfamiliar with the distinctions. If you, like me, came of age in the 1980s — before medspas were commonplace — you may still think of these treatments as something only wealthy women do.
I’m by no means wealthy, but when the four-step skincare routine I’d adopted in my late 30s stopped delivering, I looked into injectables. They weren’t as expensive as I’d feared, or as dangerous as some people made them sound.
Still nervous, I went to my dermatologist for the first time instead of a med spa and ended up paying far more than I needed to.
Riding home on the subway, I felt self-conscious
I had the telltale “bee sting” dots across my forehead. Within hours, they faded, and within days, my skin had smoothed — my face looking like a more rested, slightly younger version of itself.
Since 2021, I’ve gone every six to eight months or so — slightly less often than recommended, but as often as I can afford. I treat my forehead, crow’s feet, and the “elevens”— those vertical lines between the eyebrows that deepen when you frown.
All in, I spend around $800-$1,000 a year. It’s worth every penny.
I’ve never had a bad experience, and I always love the results
Most recently, I went to VIO Medspa in Dobbs Ferry, New York, a local outpost of a larger medspa chain. Walking in, I was oddly reassured it was staffed by “normal”-looking women. Not that there’s anything wrong with the “plastic surgery look,” I reminded myself.
Still, it helped to imagine no one was judging me for what I wasn’t getting done — the uneven texture, sagging skin, and other imperfections Botox couldn’t fix.
While I waited, I spoke with a licensed aesthetician about different procedures. She talked about how she came to open the medspa as her kids got older, a second act built around helping women feel more comfortable in their skin. We talked candidly about Westchester real estate, taking kids on college visits, and the slow practice of letting go of control. The space felt easy and unguarded, like the female equivalent of going to the barbershop.
The procedure itself took a minute or two. I didn’t feel any pain, just a series of small pinches. The results appeared about two weeks later. I plan to go back.
Do I need it? No, I don’t think anyone needs anything done.
I also think it’s everyone’s right to do what they want.
When I’ve had Botox, I spend less time scrutinizing myself on camera. I can jump into a meeting without adjusting the angle, the lighting, or my posture. I’m more present with my clients because I’m less preoccupied with how I look. I’ve thought about a facelift, but Botox is doing the job for now.
No one in my social circle gets Botox, and my husband says he doesn’t see a difference. I don’t expect that my clients can put a finger on it either, but I’m confident they appreciate it when I show up with a more polished appearance.
We can pretend appearance doesn’t matter, but it does
Appearance-based shame remains powerful, even among people who reject beauty standards. Across the political spectrum, people mock and police others’ looks — especially those they dislike or see as powerful.
What passes as critique is often a form of self-protection: shaming someone else’s appearance can momentarily soothe our own anxiety about aging, visibility, and physical change, even as it deepens the harmful link between beauty and virtue. Over time, this culture of shame takes a real toll on mental health, especially for women.
I long for a world where we resist harshly judging people for how they look, where we can disagree without turning someone’s face into evidence, and where aging isn’t treated as a moral failure.
In the meantime, I put my best face forward in the world as it is.
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