I always hate on Prudie, but this one (first one on the page) really REALLY gets to me. I'll break it down. First the question, and then the response (with my delightful commentary).

I used to be a very beautiful woman with a fit body and pretty features, but since I had a child 11 years ago I have become a hideous troll. My stomach was destroyed by my pregnancy. What was once a flat tummy turned into a full-blown panniculus. At age 45, I'm overweight, I inherited a giant bullfrog neck and jowls from my grandmother, and my nose is growing into a perfect replica of my mother's giant schnoz. I absolutely can't stand to look in the mirror. I have a great husband, beautiful child, great friends, and I love my job. I am still fairly young, in good health, and I have so much to be thankful for. I'm happy with my life, but I'm miserable with my troll-like appearance. A couple of years ago I worked very hard and lost 40 pounds through moderate exercise and religiously counting calories. But I was miserably hungry most of the time and my body shape was just a smaller version of the disgusting new apple-shaped me. Within a few months of coming off the diet I gained all of the weight back. I've tried new hairstyles, dressing better, scarves, makeup, etc. I know I'll never be 120 pounds and gorgeous again, but how can I accept the unsightly creature I've become? I feel so bad for my husband—he married a princess, but now he's stuck with a giant toad.

—Aging Ungracefully

I think we can all relate to this woman. Whether I think her obsession is warranted or not doesn't really matter - I hope I never feel this way. We've all felt inadequate at times, many of us feeling ugly and struggling to lose weight. So one might expect Prudie relates, too. Yet, as usual, she brings some bullshit.

Dear Aging,

I will accept you have a belly you don't like and jowls that drive you crazy, but I don't believe you're the monstrosity you're making yourself out to be. First of all, you give no indication that your husband has complained about or is even aware of your supposed transformation from princess to toad.

Emphasis mine. So she doesn't have a right to feel the way she does, because her husband does not validate her suspicions that she is ugly. If her husband doesn't bring up her unattractiveness, how can she know it's real? Furthermore, if she sees herself as unattractive, that's just merely wrong, because her husband - the person who REALLY matters, attractiveness-wise, seems to have no problem with her.

You say he's great, so it sounds more likely he accepts that neither of you look like you did when you first met. From your own description, you indeed have an enviable life, surrounded by loving people, engaged in satisfying work, enjoying good health. So there is an abyss between how you see yourself (and how the people in your life see you), and what appears when you look in the mirror.

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But none of the things she says she has going for her relate to her looks. Prudie, who are you do say, "you have an enviable life so you need to feel attractive, too?" Obviously, if she was actually ugly, no one in her life would treat her with any respect, right? So that's a good indicator that it's all in her head - people are still nice to her.

First, think about the effect of your self-loathing on your child. You want her or him to absorb the lesson that one should be grateful for one's good fortune and not obsess over superficial things.

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Yes. This sounds like a great job for a therapist! Good - motivate her to learn how to stop hating herself. Help her learn to value herself as she ages, and to accept this inevitability.

But it's undeniably true that how we feel about how we look matters. You've gone the hairdo, scarf, and makeup route and it just makes you feel like a spiffed-up ogre. That's debilitating, and though by inclination I'm not a plastic surgery advocate (as the bags under my eyes will attest), I think in your case some alteration on the outside might cause a big shift in how you feel inside.

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I am not opposed to plastic surgery AT ALL - but why are we not talking about therapy, also?She may very well be suffering from body dysmorphia, if your theory that she's not as ugly as she thinks because people are still nice to her holds true.

A tummy tuck is major surgery, but you are majorly unhappy. I've had friends who felt the way you did about their belly and neck, had them fixed, and were delighted with the results. If you consider plastic surgery, make sure you do your due diligence and find an experienced and reputable surgeon; you don't want to end up on Botched.

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This would all be well and good if you hadn't said "and though by inclination I'm not a plastic surgery advocate (as the bags under my eyes will attest)," above, making sure we all know you're still giving her an appropriate amount of side eye. Never let her feel fully comfortable with any decisions or self-improvement efforts. Also, because she is probably an idiot, remind her not to skimp on the surgery because she probably doesn't realize it could go horribly wrong.

If you go under the knife, make a serious vow that you will limit the number of improvements. I'm sad about the death of Joan Rivers, but down the road you don't want your friends and family, when they look at you, to think they're seeing her double.

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And that's the end; don't look like Joan Rivers. Let's recap:

"You're probably not that ugly, because your husband doesn't think so. While I normally think plastic surgery is a terrible idea and look down on those who get it, I'll recommend it for you since you are clearly hopeless. But don't have too much or else everyone will think you're ugly."

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ETA: A few people brought up the (totally valid) point that the LW opened the discussion of her husband's opinion in her last sentence. I want to revise my post to include that it, then, wasn't an off-limits topic for Prudie to mention. I still feel that she dismisses the woman's own opinion of herself by failing to ever really mention that her own view matters.