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One of the most striking images in Terry Gilliam's 1985 dystopian sci-fi masterpiece Brazil is of Ida (Katherine Helmond) nonchalantly chatting with her son while undergoing the latest ministrations of her plastic surgeon, who pulls, warps and stretches the prosthetic skin on the actress's face like plasticine. "I'll make you 20 years younger," he enthuses. "They won't know you when I've finished with you!" Ida is obsessed with the latest trends and cosmetics and candid about her surgical interventions, but also utterly oblivious to how extreme the effect is. Science fiction – emphasis on the fiction – has long served as an interesting lens on our preoccupations and, in Brazil's case, it's a gruesomely fascinating one on the psychology around vanity and cosmetic enhancement. Thirty years later, we now have a different commentary, again thanks to sci-fi – the romantic drama The Age of Adaline, in theatres April 24, in which a young woman (Blake Lively) suddenly becomes immortal and ceases to visibly age, her looks frozen at 29.

The movie's premise is improbable, not because of the impossible logic, or even the idea that Adaline is a reluctant ingenue Highlander who considers her eternal youth a curse. Instead, the most challenging suspension of disbelief the film posits is that if anyone noticed that this woman-of-a-certain-age's looks are stuck on permanent pause, that they would dare remark on it at all. (Only one person in the film speaks up, and Adaline laughs her off, attributing the fresh face to a new cream from Paris made from the royal jelly of the queen bee – then promptly moves away and changes her identity.) That plot twist rings true, because while cosmetic intervention abounds in North America, it's not something we often dare discuss. There's pressure and manipulation from all sides to look young, yet it's a giant game of pretend when older people actually do.

In reading the obituaries of Dr. Fredric Brandt, the cosmetic dermatologist who died in early April, the ongoing taboo-acknowledging was noticeable: industry contacts, friends and a few famous clients like Kelly Ripa and Ellen Barkin happily stepped forward to eulogize him, but many more very famous, rumoured celebrity client friends were conspicuously silent. It's this sort of vacuum of hypocritical silence that has created a nasty call-out culture that only worsens the problem.

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Elsewhere, like South Korea, there's even more pressure to look young, but it's coupled with much less stigma. Inspired by the stars of K-pop (the country's trend-driven electronic-dance-music genre), women visit the so-called Beauty Belt, the cosmetic surgery neighbourhood in the showy, upmarket Gangnam district of Seoul. Doctors are touted as "beauty designers" and the Korea Tourism Organization markets their cosmetic-procedure expertise to international clients. K-Pop stars and civilians alike are honest about the eyelid interventions and facial contouring (shaving bones) they seek.

With apologies to the Japanese whisky commercial Bill Murray filmed in 2003 in Lost in Translation, a new product tag line could be "for wrinkle-relaxing times, make it Suntory time." Since Suntory's in the booze and not the beauty biz, the Japanese brand has produced an alternative supplement product called Precious, a new collagen-infused beer marketed at age-defying women. Aside from beer goggles, the only way a pint is going to help is if someone throws it in your face – though presumably, their follow-up will be collagin cocktails.

That frank and open, if optimistic, faith in a product that sounds borrowed from science fiction brought to mind something Linda Rodin joked about with me last year during an interview. "One day you'll be able to go into [American drugstore chain] Duane Reed and buy a can like Elnett [hairspray] but it will be facelift and you'll spray it on like a spray-on tan and you'll look 20," the stylist and natural skin-care brand founder, 67, said. Rodin also freely admitted that she had tried facial fillers and Fraxel laser treatments, but decided that route wasn't for her, though she doesn't judge those who do dabble – she's merely adamant about not being fraudulent either way. "I'd rather tell the truth, even if it's the worst, rather than get caught in a lie," she said. The pressure to be secretive about cosmetic intervention is as much a symptom of a culture gone wrong as the pressure to look preternaturally young is. Whether it's an extreme makeover or discreet tweaks, that reality is still staring us in the face.

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