Hiba Hakki reclines on an exam table as a physician picks up a syringe with his latex-gloved hand and points it at her face. He inserts the needle into the flesh around her eyes. She cringes slightly. This is a Botox injection, just one of the cosmetic procedures Hakki undergoes for the sake of beauty.

“There is a slight burning sensation,” said Hakki, who is 58. “But it’s like anything else that we women do for our appearance that we dread. The needles are very fine so it’s not too bad.”

Hakki is devoted to maintaining a polished appearance, which doesn’t include “crow’s feet,” frown lines, enlarged pores, sagging breasts, discolored teeth or even chipped nail polish. She is not alone in her desire to look her best. A recent survey by the American Society of Aesthetic Plastic Surgery (ASAPS) shows that more than half of all Americans, regardless of income, approve of cosmetic plastic surgery, and spent nearly $10 billion on cosmetic procedures last year. ASAPS says that Botox (Botulinum Toxin Type A) injections top the list of the most popular non-surgical cosmetic procedures, followed by hyaluronic acid, laser hair removal, microdermabrasion, and IPL (intense pulsed light) laser treatment.

“There is a societal pressure to look young and beautiful,” said Arlington resident Linda Gulyn, Ph.D., a Marymount University psychologist who teaches about the natural process of aging from a social-psychological perspective. “Some people have a tougher time growing older than others, and they look for ways to slow down the natural change.”

Candice Early, a spokesperson for the Arlington and Reston offices of plastic surgeon and McLean resident Dr. Wendy Gottlieb, M.D., says that laser hair removal is one of the treatments most commonly requested by patients in her practice. “The laser focuses on the hair bulb under the skin and kills it so that it will not grow back,” said Early. “I did it on my underarms seven years ago and I still don’t have underarm hair.”

Hakki, whose husband is plastic surgeon Dr. Ayman Hakki, M.D., admits that the procedure is not pain-free. “If you can imagine snapping rubber bands on your skin, that is what it feels like,” she said. “Laser hair removal is not a one time treatment. Multiple treatments are needed for it to be effective. You need a lot of money and a lot of time.”

For those seeking to rid their face of wrinkles, age spots and acne scars, microdermabrasion is an option. During the procedure, an esthetician uses a hand-held device that emits crystals onto the skin’s surface and polishes it. “It peels off the top layers of skin to reveal new skin cells,” said Early. “It temporarily damages skin and takes about a week to heal. At first, it looks like really bad sunburn on your face.”

During an IPL laser treatment, an esthetician uses a hand-held device to administer the bright-light treatment. “It’s like laser resurfacing for the face,” said Early. “It tightens and rejuvenates the skin, but you need several treatments. It helps with age spots and makes the face firmer and more youthful.”

Fillers like Restylane and Hylaform are sought-after weapons for those seeking fuller lips or wrinkle-free skin. Hyaluronic acid, the key ingredient in these fillers, is produced naturally in the body, but decreases as one gets older.

“I’ve had fillers distributed all over my face. If you use just a little bit, others will never know it was done,” said Hakki. “I have used fillers to plump my lips, but I have to be careful not to get too much because I don’t want to look like Donald Duck.”

Using cosmetic procedures in moderation is the key, say experts, to maintaining a natural look. “The overuse of Botox, for example, can make a person look like a lion,” said Early. “We can spot people who are addicted to cosmetic procedures and we turn those people away. If we look at you and feel that you don’t need a procedure, we won’t give it to you.”

Gulyn adds, “Our society equates youth with beauty, but there is a line between doing things that freshen your appearance and putting yourself at risk. You have to determine whether or not you’re putting yourself at physical risk, disrupting your family or preventing yourself from adapting to the natural changes of aging.”