A consideration of the psychological issues related to cosmetic treatments, from surgical face lifts to non-invasive procedures such as BOTOX®, forces us to look at ourselves in a deeper way. It makes us confront our vanity and look at who we are and who we want to be. In addition, since cosmetic treatments are often used to stave off the effects of aging, their usage is intimately connected to our sense of our bodies, our sexuality, and even to our mortality. But how can we understand the differences between vanity and wanting to look our best? What does it mean to grow old gracefully? To pathologize the search for beauty and any effort to make one look younger, healthier, or just be more physically attractive seems contrary to a physician’s clinical and personal experience. However, to see the use of BOTOX® and other cosmetic treatments as divorced from psychological meaning is also problematic and avoids the complex and subtle nuances of how we think about ourselves and how we look at our patients. Ultimately, the individual decision to change one’s looks is complex and multidetermined. It is influenced by our culture, our sense of our selves, and the ubiquitous wishes, fears, and conflicts that are in all of us.