American society's feminine ideal has consistently emphasized youth as beauty and getting old as ugly. Feeling unattractive produces several intrapsychic conflicts leading to depression and anxiety. Summary of the literature on beauty and aging, beauty and culture, and theories of physical beauty will be presented. With a clinical example of a female patient, the writer investigates the conscious and unconscious fantasies, conflicts, and sense of self inside and outside that impelled a physically beautiful female patient to bring her own body closer to her perception of idealized beauty with the aid of plastic surgery.