She started with a nose job in her 20s. In her 40s she had a face lift. Now she's back again.
A Dallas woman -- we'll call her "Martine" to protect her privacy -- has spent three decades trying to perfect her face.
"I noticed that I was sagging again ... sagging through the neckline," she said. "People constantly asked me why I was frowning when I was not frowning."
The solution? A second facelift.
"It surprised me that it came so suddenly," she said. "When I had my first one, in 2000, I was told it would last five to eight years, but I somehow thought it would last much longer. And it did not."
Martine is part of a very real trend: the plastic surgery "re-do." Dr. Sam Hamra will perform Martine's second facelift. Today, more than half of his surgeries are repeats, he said. He has seen so many patients disappointed with their first lifts that he wrote a book about it, called "The Facelift Letdown."
Martine said she was happy with the results of her first facelift.
"Yes, however I would term it a creampuff job," she said. "He was a fine surgeon, and he makes you look really great for just a few years. Whereas Dr. Hamra's effects are long-term, and lasting."
Hamra listed the common complaints he hears from women.
"Most of it is, it didn't last long, or I don't look as pretty as I wanted to," Hamra said. "Or my eyes are sort of funny-looking. My neck didn't hold up. ... One has to remember, this is not chiseled in marble. The faces continue to age. So whatever technique, mine or others, is going to age."
The recession has cut into the business of elective plastic surgery. Not so with re-dos.
Dr. Grant Stevens said re-do surgeries have kept his practice outside Los Angeles busy during the downturn.
"There's a whole sub-specialty now, it appears, within the practice of revisions," he said. "What we've seen is an increase in the non-surgical procedures and an increase in revisions. There's been a small decrease in primaries, or first-time surgeries. We looked over our statistics the other day and found that 35 percent of my surgeries that I've done in the last few months have been revision surgeries."
On a recent visit, Stevens was prepping a patient, "L.B." -- again, not her real name -- for a re-do breast implant.
"It didn't deflate right away, just little by little, but you do feel like a small kind of pop or something," said L.B. "I was watching TV and I was like 'Hmmm... looks different.'"
Stevens said the change could happen suddenly.
"It's not subtle," Stevens said. "The woman wakes up, gets out of the shower and says, 'Where'd my breast go?' So she calls typically and runs in. It's not a medical problem. It's clearly a psycho-social problem and an emotional one."
L.B. said getting the fix felt urgent for her.
"For me, yeah, psychologically, get it done," L.B. said. "Because it does affect you, you know, because you have one boob. ... If I had the money, I could have gone there the next day, that option was available. But I did have to work and find the money, and now I have it."
Stevens described the surgery plan.
"We're going to make the pocket a little bit bigger for the larger implant," he said. "It's a little bit lower, a little bit bigger and she's a D cup."
Martine said she didn't hesitate to sign up for a second facelift.