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."
'Where'd My Breast Go?'
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.
"There's no price too high for beauty," she said.
Her surgery took nearly five hours. Recovery would take months.
L.B.'s breast implant surgery, in contrast, would take a lot less time. Stevens said one of her original implants had "deflated."
"It sprung a leak and all the saline is out of it, so she's got a flat tire," Stevens said. "We'll fix that now."
It's not just old implants that Stevens finds himself fixing, he said. He also fixes new implants put in by unqualified surgeons.
"A number of people are coming in for revisional surgery following implant deflations like this, but even more are coming in following bad surgeries," Stevens said. "We're seeing a number of people dabbling in this marketplace who are unqualified, both here and outside the country. Medical tourism is contributing to revisional surgery as well as non-board certified plastic surgeons doing this type of surgery."
The day after her surgery, L.B. was recovering well, and happy with the results.
"They're bigger, they're a D now," said Stevens.
"Thanks," LB said.
"No cute, sexy black dress because you're in a grandma bra," advised a nurse.
"I'm not going anywhere," said L.B. "No boyfriend."
"Not yet," the nurse said.
We checked back in with Martine six weeks after her facelift re-do. The recovery process was drawn-out and painful, with significant bruising to her face. But both Martine and her doctor were pleased with her progress: so far, so good.
"Everybody tells me I look 20 to 30 years younger and so I feel great, I get so many compliments every day," said Martine.
Hamra said he expected the results to last.
"As pretty as you look, I wouldn't be happy until six months or almost a year goes by, because the whole theory is that operation is very stable and everything we've created here should stay for a long, long time," Hamra said.
Martine did come away from the surgery with a few scars, but her doctor promised they'd fade.
"Behind the ear I had to use what the previous surgeon used, you can't have any choice there," Hamra said, referring to an incision and the scar that resulted.
Martine said it's a small price to pay for what she now sees in the mirror.
"Just overall I feel like I have a much more youthful look," she said. "My skin is so smooth."
But is she afraid she's going to be right back under the surgeon's knife in 10 years?
"No," she said. "Dr. Hamra has been a fine surgeon with a wonderful reputation for years. I know that it will be long-lasting.