NEW YORK CITY (Natasha Singer, NYTimes) March 1, 2007 — Back when she was in her early 40s and her skin was still smooth and unlined, Susan Burke used to joke that she was going to have a face-lift the minute she turned 45. The deadline came and went.

But now that Ms. Burke has turned 50, she is feeling pressure to do something about the changes she sees in the mirror. Wrinkles have started to appear. Grocery store clerks have started calling her “ma’am.” And many of her friends have already made the leap to the range of procedures promoted to make them look younger than their years. “The eyelift, that’s very popular,” said Ms. Burke, a registered nurse from Point Pleasant, N.J. “The Botox, everybody is getting it. And the fillers.”

Her concerns are the wrinkles between her eyebrows and the creases that run from the corners of her nose to her mouth, she said. “It would make me happy to be able to turn those things back a little bit.”

She is not alone. Though the number of Americans who regularly have cosmetic facial injections is estimated to be only about one million, the mere availability of the procedures has heightened the pressure on women over 30 to consider a level of intervention that until recently was embraced only by the famous or the rich.

“Women have always been under pressure to look good, but that has increased recently because we have become so used to seeing perfect, unwrinkled faces,” Ms. Burke said. “Now when you see someone who looks like a raisin or a prune, it seems so unusual that you are almost repulsed.”

Are wrinkles to become a thing of the past for the self-selected few, like crooked teeth after the advent of modern orthodontics? At the very least, wrinkles are being repositioned as the new gray hair — another means to judge attractiveness, romantic viability, professional competitiveness and social status.

In interviews, many women, some as young as their early 30s, said they are feeling caught between nature and an anti-aging climate. Many are involved in an internal debate — a negotiation, of sorts — about how much they are willing to intervene.

“It makes people ask themselves whether age is a matter to be treated like white teeth or a manicure,” said Nancy Etcoff, a clinical instructor in psychology at Harvard Medical School who has studied human perceptions of attractiveness. “For some people, the pressure to keep back a few years of time has turned upkeep into a third career, after work and family.”

As recently as a decade ago, the obliteration of wrinkles required full face-lifts or deep laser resurfacing. To partake of these expensive treatments required disposable income and recovery time; patients retreated with their wounds, to reemerge weeks later with smoother skin or a tighter jaw.

But now newer, less invasive treatments — including Botox injections to temporarily paralyze muscles beneath frown lines, Restylane injections to fill out facial creases and updated lasers to eliminate surface layers of skin — are easily available and relatively safe, albeit still too expensive for most people of middle-class means.

These cosmetic technologies are also changing the way pop culture perceives the aging face. Once a biological fact of life like kneecaps or navels, wrinkles now appear to be optional for those who can afford to smooth them.

By now the disdain for them is ingrained in the culture. This month even the magazine of the AARP, a group dedicated to fighting ageism, published a cover line exhorting readers to “Look Younger Now: Erase Ten Years (Or More)” — effectively canonizing the notion that a face that telegraphs its age is out of date.

One reason for the pressure is increasing life spans. As Americans live longer, middle age has shifted to 60 from 40, with 40 recast as a youthful stage. That leaves some women grappling with the idea of what 60 looks like.

Nora Ephron taps that nerve in her book, “I Feel Bad About My Neck,” a chronicle of her efforts to keep age at bay. In a phone interview, Ms. Ephron described aging as an endless negotiation with the mirror.

“There is so much that we do now that you can barely keep track,” said Ms. Ephron, 65, who has sold 750,000 hardcover copies of her book. “Just redoing your teeth can keep you going for six months with the delusion that you have managed to stop time — or liposuction or Restylane, or whatever you are using for filler.”

Some women have decided that less is more. And the numbers seem to bear that out. While about $12.4 billion was spent on cosmetic medical treatments in America in 2005, about $49 billion was spent on cosmetics and toiletries.

For Cathy MacFarlane, 52, of Wilmington, Del., the line was drawn at her hair. Color, no. Fashionable cut for her silver mane, yes.

“People are trying to look airbrushed in daily life, and that is not healthy,” said Ms. MacFarlane, who directs corporate relations for a bank.

Corlethia Denise Johnson, 50, a legal secretary from Laurel, Md., colors her hair burgundy but looks askance at injections. “All of these things like the Botox, I hear about them, but I feel when you start, you have to continue,” she said. “It’s best not to start.”

Some — and this number, plastic surgery statistics show, includes men — see appearance as a matter of economics.

“If you want to sell a million-dollar house, you have to look good,” said Tracey McCallum, a real estate broker in Bowie, Md., who is only 33 but has already had Botox injections, as well as chemical peels and laser treatments. “You have to look good, and you have to have confidence that you look good.”

Ms. McCallum, who was interviewed during her visit to the Washington Institute of Dermatologic Laser Surgery, said she had not until recently given any thought to cosmetic treatments. “But as we age,” she said, “we kind of see things in a different light.”

Donna Emnett, a junior high school teacher in St. Louis, said age brings a heightened perception of flaws. Now 56, she is starting to notice looser facial skin and a double chin, she said. After her book club read “I Feel Bad About My Neck,” the members discussed tummy tucks, eyelifts and injections.

“We are from the Midwest, so we are kind of fearful of needles because we don’t want to walk around with weird puffy lips or stiff foreheads,” Ms. Emnett said. “But we decided that an eyelift might be O.K.”

Other women have gone from negotiation to embrace. Kim Pace, 49, an interior decorator in Odenton, Md., began having laser procedures a few years ago to treat acne scars and sun-damaged skin. Then she added Botox for her wrinkles, along with Restylane and Juvéderm injections for her lips, she said.

“My lips used to give away my age,” she said, “but now they don’t any more.”

She said she is merely heeding society’s cues. “I don’t think we are getting more vain,” she said, “I think we have changed our view about how women should look.”

Statistics bear this out. While face-lifts were down to about 150,000 procedures in 2005 from about 157,000 in 2004, cosmetic Botox treatments increased to about 3.3 million from about 2.8 million. In actuality, that means only about one million Americans regularly undergo facial injections, said Jonah Shacknai, the chief executive of Medicis Pharmaceutical Corporation, which distributes Restylane.

But enough people seem to know someone — or several people — who have undergone cosmetic treatment that they find themselves considering it, too.

“We joke among my friends, ‘let’s all go have surgery together,’ ” said Terry Thielen, 58, who works for the municipality of Upper Brookville, N.Y., “because you hear about people having surgery and you think, well, maybe I should do it, too.”

Ms. Thielen said she does not plan to have anything done. But she does feel mixed emotions about aging, thanks to what she described as a bombardment of media images of younger models and stores that stock clothing designed to fit younger people.

“It makes you look in the mirror, pull your skin up and wonder what it would be like to have your 20-year-old face back,” Ms. Thielen said. “I wish our society would make us feel better about getting older instead of glamorizing youth, which is a very short period of life.”

There are some signs of a countermovement.

Dove, for example, has just introduced a line called Pro-Age aimed at women “in their later years.” The products promise to nourish, replenish or renew aging skin and hair. Instead of models, the ad campaign uses real women in their 50s and 60s who happily expose every wrinkle, crease and freckle.

“We are not saying turn back the hands of time, or stop aging, or look 10 years younger,” said Kathy O’Brien, the marketing director at Dove. “We are saying embrace the age that you are and make the best of it.”

That is very similar to the message that Bobbi Brown, the makeup artist, sends in her new book, “Living Beauty.” Ms. Brown, who has her own cosmetics line, admits to feeling concern over her own appearance as she turns 50. But she said drastic changes are for “women on TV.” She herself has had less invasive treatments like Botox injections (twice), laser procedures to remove brown spots and tooth whitening.

“My advice to real women is, you are not on TV or on the red carpet, so let go of some of the pressure,” Ms. Brown said.

She is not suggesting, however, that women do nothing. Rather, they can choose to use concealers, moisturizers, hair color or tooth whitening, she said.

“I want women to know that they have a choice about aging,” Ms. Brown said. “There is the Hollywood way, or my way. I am not saying look younger. I am saying look good for your age.”