This story is based on an interview with Heather Emerson, 42, of Austin , the founder of an international staffing agency. It has been edited for length and clarity.

How did I feel about the way I looked? It depended on the day. There were definitely times when I felt very pretty.

On other occasions, I would look in the mirror, pull up the skin on my face and neck, and see how I might look after a facelift. I thought my features looked heavy, and the negative thoughts were taking up a lot of brain space.

My husband, Faiez, and I were planning our annual goals in January 2025. I said I wanted surgery toward the end of the year, when I expected…