Sarah is a successful physician in New York City, a fact that, theoretically at least, has very little to do with how she looks. She would, presumably, be a successful physician in New York City without Botox. But every four or five months, Sarah, who is 43 (and who, like the other patients in this story, will be referred to with a pseudonym), spends $500 erasing her crow’s feet. “That’s probably somewhere between $1,750 and $2,000 a year, just on Botox,” she says. This is an indulgence, obviously, but also an investment. And, Sarah says, the returns are pretty good.

“I think it pays for itself when people are googling me and they want to know if they want to come see me,” she says. “They look at my website, they see my picture, and people unconsciously select for people who they think lo

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