Sylvia Brickman was 88 years old when she decided to have a breast reduction.
Her children were against it, but Brickman, a Philadelphia resident, had gone from a 32A to a 38DD after having children. The operation that transformed her into a 36C was one of the best decisions she has ever made.
"I didn't do it for anything other than comfort," Brickman said. "I just didn't like being black and blue from the bras and being so uncomfortable."
Doctors once resisted operating on seniors unless something was broken, blocked or bleeding. General anesthesia and long recuperation periods raised the risk of blood clots and other complications -- outweighing issues of arthritic pain and vanity.
But changes in anesthesia and an overall increase in health in the older population have changed the way doctors see senior patients.
Not only are people living longer, but they want to continue walking, playing golf and dating. That has led to a huge increase in the number of seniors coming out of the operating room with tucked chins, breast lifts and new knees.
"I did a total knee replacement on a 101-year-old man who was a doctor, a pathologist and still working," said Robert Booth, chief of orthopedics at Pennsylvania Hospital in Philadelphia. "And he lived for three more years and got married."
For cosmetic surgery in particular, the numbers of older patients have boomed. In 2000, 244 patients older than 65 got breast implants, according to the American Society of Plastic Surgeons. In 2004, that rose to 2,640. Similarly, 1,406 people chose chin augmentation in 2000, and 3,164 did so in 2004.
That age group accounts for a small percentage of total cosmetic surgery but amounted to 20 percent of all chin augmentations and 29 percent of hair transplants.
Numbers for knee and hip replacements are harder to decipher. The American Academy of Orthopedic Surgeons keeps only total numbers of replacements and revisions -- it does not differentiate between broken hips and those replaced because of osteoarthritis.
But in 1993, there were 16,000 total knee replacements in patients between 80 and 89 -- about 9 percent of all patients. In 2003, there were 45,000 -- about 11 percent of all patients.
"We, as doctors, do a better job of helping people get to an older age, and they come to the operating room in better shape," said Paul Curcillo, vice chairman of surgery at Drexel University College of Medicine in Philadelphia.
"It used to be that if you had an 88-year-old with a bad hip, the cardiologists would keep them out of the operating room, but now they're the ones saying that the best thing for them is often to keep walking."
Improvements in anesthesia have opened the doors to older patients. Once a hip replacement required general anesthesia, which comes with greater health risks, particularly for those already with medical problems. But now a regional anesthetic, such as an epidural, can be used with fewer complications, Curcillo said.
John Moore, a plastic surgeon at Philadelphia's Thomas Jefferson University Hospital, said as much as 70 percent of surgery was done with intravenous sedation and a regional or local anesthetic.
In the last five years, he said, he has seen a marked increase in the number of patients in their 60s, 70s and 80s. Though elective surgery is paid for by patients, Medicare covers orthopedic surgery and some breast lifts.
"There's been a real change in what our society perceives as elderly," said Moore, who said the most commonly requested surgeries were eyelid surgery and a face or a neck lift. "You can be 80 and be vibrant and active and outgoing."
Vibrant and active is exactly how Rose M. Rosenberger describes herself at age 77. She fox-trots, she polkas, she likes a little salsa with her merengue.
But in May 2004, her right hip started hurting. She started taking Aleve and then moved to a prescription. Nothing worked. It hurt to get out of bed.
She went to see Dr. Richard Rothman, founder of the Rothman Institute, an orthopedic surgical practice in Philadelphia. It turned out she had no cartilage left in the right hip.
"I had many concerns, mostly about my osteoporosis -- I could see the bones crumbling when they started drilling," Rosenberger said. "He told me that he'd had worse cases."
She had her hip done in May. Six weeks later, she was back on the dance floor.
Rothman said he did as many as 40 hip replacements a year in people older than 80, and 10 for people older than 90.
"The pain doesn't let them sleep," he said. "Sometimes they have to use a walker or a wheelchair. This allows them to be free of pain, and they can take care of themselves and be more independent."
For Brickman, the surgery gave her "a few days of discomfort" at first but a much-improved body image. Last month, she celebrated her 90th birthday in a pretty flowered dress with a bolero jacket -- she doesn't like how her arms look.
"I know my age, so I always cover up in some fashion," she says. "I don't go around flaunting the wrinkles."