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Amid pressure to keep a youthful edge, more businesswomen are spending their holiday break with their plastic surgeon.

One in four women would consider cosmetic surgery to boost her career.

You probably wouldn’t think twice if one of your company’s rising or higher-ranking denizens didn’t show up for the company’s holiday party this year. Or returned to work looking considerably more refreshed, rejuvenated and energized than you remember seeing her. You (or she) might chalk it up to two weeks of R&R at St. Bart's or 10 days of detox and yoga at Canyon Ranch. But it might be something else entirely. “The winter holidays are my busiest times - they book up in July," says Tony Youn, M.D., a cosmetic surgeon in Detroit. "It's an easy time for executives to take off because co-workers will assume they've been on vacation. When they return two weeks later most of the swelling or bruising will have gone and they’ll just be looking good."

It's a business fact of life. The American Society for Aesthetic Plastic Surgery reports that surgical and nonsurgical cosmetic procedures increased by 44 percent in 2004 to a total of nearly 11.9 million - 90 percent of them on women. And a recent survey by Aziz, a leading British executive communications company, found that one in four women would consider cosmetic surgery to boost her career.

Even though a woman’s achievements, experience, skills and performance are primary factors leading her to professional success, the appearance she projects is key. "It may not be fair, but women are held up to a much higher standard than men are," Youn notes. "Some of the most powerful men in business are 70 years old and pretty dumpy-looking. How often do you see a dumpy-looking 70-year-old woman in an equivalent position?" To put it more bluntly: Most believe a woman who keeps her look up to date is just keeping a smart, competitive edge in today's ever-changing job market.

To wit: The majority of professional women who do opt for surgery - be it face-lifts and eyelid surgery or less invasive cosmetic procedures like fillers, peels or Botox - tend to be generally secure and fulfilled. It’s less about morphing into a "babe" than about projecting the more youthful, energetic professional within. When Greta Van Susteren, one of the most successful and respected reporters on television, went public with her surgery to remove under-eye bags (and, suspect many surgeons, a tad more than that), she brought plastic surgery out of the closet for professional women. Suddenly it was no longer a vanity-driven cliche for aging actresses or Baywatch wannabes. "Greta’s transformation was not about looking transformed or younger as much as about not looking quite so beat up anymore," says New Orleans dermatologist Mary Lupo, M. D., who, at 51, freely admits to having resurfacing laser treatments and injected fillers herself. "There's a diference between looking old and looking tired, worried and uncertain. I think Greta did it for the right reasons. It’s clear she valued herself as a person but opted to do it because she was looking a little drawn and tired."

We tend to feel a certain age within. Many women hit their stride - personal and professional - in their mid-30s or early 40s, when we feel an empowering synergy of youth, success and confidence. At some point after that, however, what we see in the mirror no longer corresponds with the youthful vigor we feel inside. "Many career women feel that signs of aging affect how they're viewed by others, and rejuvenation surgery can help them 'rebalance,'" says Boris Ackerman, M.D., a cosmetic surgeon in Newport Beach, Calif. "When they're no longer at odds with their appearance, they feel happier, more functional and more likely to advance in their career." Ackerman, the vast majority of whose patients are women, has also treated male lawyers, doctors and executives over the years, but notes that they tend to be driven less by professional reasons than by life changes such as marriage or divorce.

"First impressions are everything in business, especially if you're a woman - I don't care what anybody says," states Linda Green, a 38-year-old attorney specializing in employment law who moved from California to Valparaiso, Ind., in the mid-'90s.

Cosmetic surgery was just part of her campaign to gain every edge she could, along with taking courses and a campaign of extensive networking. Two years ago, she had Botox to ease the creases in her forehead and fat injections in her face to fill in some of the hollowness that occurs with age, when subcutaneous fat stores start to thin out.

She took more drastic measures after one particular incident. While she was in the waiting area before one of her cases, an older judge walked by and told her that she looked really tired. "This was a judge I routinely appeared before and this was in the middle of the day - in front of a lot of other judges. That's when I said, 'Hey, I need to do some maintenance here,’" says Green, who represents huge corporations, including Wal-Mart and Walgreens, in employment lawsuits. "What you have to understand is that these companies place their fate in my hands."

GLOSSARY

BOTOX:
A harmless injectable derivative of the botulism toxin; temporaily “paralyzes" muscles that create frown lines, forehead furrows and crow’s feet.

BROW LIFT:
Corrects dropping brows and improves the lines and furrows that can give a sad or tired appearance. Also known as a forehead lift.

EYELID SURGERY:
Usually a small incision to remove under-eye fat that causes “bags."

THREAD LIFT:
A minimally invasive face-lift alternative whereby skin is gently pulled and held in place via tiny incisions and stitches in the scalp.

FILLERS:
Injected substances like collagen (derived from cows). Restylane (hyaluronic acid, naturally present in human skin) to plump up fine lines, or fat, harvested from a patient’s own body, to fill out hollowed areas in the face.

LASER RESURFACING:
Vaporizing the skin’s surface layer using a carbon dioxide laser (instead of a chemical peel or dermabrasion) to smooth out skin, even out skin tone and minimize fine lines.

LIPOSUCTION:
Removal of stubborn pockets of localized fat using suction and a cannula.