Mitch McCabe, moviemaker and daughter of a plastic surgeon, is age-obsessed. But then again, who isn’t? McCabe’s mission to discover the origins of our country’s youth obsession, which has led to a $60 billion a year anti-aging industry, took the director on a cross-country trip, where she interviewed more than 200 people. The result is the documentary Youth Knows No Pain.

McCabe has been creating documentaries since college, an art form that allows her to combine her passions for photography and creative writing. But Youth Knows No Pain is her first feature-length documentary. Just days before its August 31st premiere on HBO, MM spoke with McCabe about the making of her latest film and whether her own opinions on aging industry have changed as a result of the film.

Eliza Chute (MM): This is your first feature-length documentary. What was the biggest difference between the process of making this film and the short-format documentaries you’ve made in the past?

Mitch McCabe (MC): The short answer: Money.

Longer answer: With my short films, I always did everything by myself and a crew sometimes helping for a day or some post-production professionals at the end. But with Youth Knows No Pain, I worked with a constant army of great, dedicated people, from a 24-hour family hub of four to eight people in New York, to others spread around the country.

I worked with animators, motions graphics designers, composers, a music supervisor and the headache and heartache of music licensing. I slept in the editing room, working with an editor for seven months (while I co-edited in another room). We had a posse of assistant editing interns prepping, transcribing and cutting footage in another room, some other summer interns churning through Vietnam surgery footage or breast implant shots, etc. and anyone who needed air running to get the whole operation Starbucks to keep us alive. By the end, there were seven producers. Suffice it to say, it was not a small operation. Oh, and did I mention the process of raising money?

MM: Plastic surgery has become a pop culture obsession. In what direction were you looking to go for this film? Did you want it to be journalistic or more of a human interest piece? Did that direction ever change along the way?

MC: The biggest turn the film took was that for a long while we had many different strands of the anti-aging world represented, from growth hormone to cryonics to life extension architecture. But when we tried to work it all into the same film with something as visual as plastic surgery, and as specific as the personal story of my dad being a plastic surgeon, all of those other topics just didn’t make sense against it. So early on in the editing process—and made clearer when we pre-sold it to HBO—we dropped almost all those threads and stuck to the basics that are in the film now.

I knew from the start that the film had to be a film—a story—and not a news piece; it had to set itself apart from the countless articles, shows and news segments on the topic of plastic surgery. Usually the point of those shows is rather one-note, updating you on the newest trend or technique, or a gawking event at what celebrity had gone too far. I wanted to focus on just the anti-aging world—from creams to injectibles to the nip-tucks—and explore what was behind the aging obsession and who the real-life, non-celebrity, non-super-rich Americans were who were buying the cosmeceuticals, Botox, hair transplants and surgeries. So in order to be a story, the film would be all about the casting. We had to find people who had a story to tell; people from all different areas, ages and both genders who fought the clock.

MM: This film is very personal to you, since your father is a plastic surgeon. How much personal information did you end up including and why?

MC: Personal films are always a tricky dance. When it came to the personal information, we went by strict rules as to what to include and exclude. If the material or narration didn’t directly address my dad, youth obsession or the other characters’ stories, it was out. So no talk about boys, tangential thoughts, other family members or anything else about my life.

As far as how much to put in, when we were editing we had a colored index card system on the wall: Yellow cards for the main characters, pink for interviews, green for me. We would squint and make sure that there wasn’t too much green and that it was spread far apart. It was like making a soup—you’d put a little too much in, you’d take a bit out, then it wasn’t enough and so forth. For some reason, 25 percent Mitch became our target.

MM: You interviewed more than 200 people for the project. How did you decide which interviews made it into the film and which did not?
MC: Most of the interviewing was conducted as part of the research process into how people of different ages, demographics and areas felt about aging—which lasted well over a year… Ultimately, the people who sat in the interview chair (or phone) popped out because of their honesty, forthrightness and some kind of chemistry I had with them. In that sense it was a bit like blind dating. Again, the characters who told their stories were essential and were dear to me. We treat old people pretty badly in this country, and aging is almost seen as failure. And the world is particularly harsh on women. So the film needed to be candid and harsh in its honest discussion of why people do these things. As such, we wanted the film’s main characters to only be people who were age-obsessed and taking action against aging in the pursuit of youth.

MM: What regional differences did you find in peoples’ attitudes toward aging and plastic surgery?

MC: Of all the areas I went to, the Deep South seemed to have the most complex attitudes toward aging and plastic surgery, but that could well be because I’m a Northerner and didn’t understand what was going on. While there was a harsher divide in the attitude toward intervention in the South along class lines, there was certainly a much greater acceptance of aging overall, and I attribute that to a deeper spirituality and religious beliefs they discussed, whether it be Shamans I met in Baton Rouge or an Evangelist Muralists in Mississippi. ,

Not surprisingly, the closer you are to any metropolitan area, the greater the acceptance is of plastic surgery, and the more obsessed people might be with looking young. There‘s more competition among women and more services available, among other reasons. So in suburban Minneapolis, Detroit, Austin and all those places, you would always find people who had a Botox and Dr. Perricone regimen. South Dakota? Tougher. Whenever I asked people, ‘Are you scared of aging?’ in South Dakota it was like asking them, ‘Hey, are you scared to walk?’ Florida, California, New York, Texas—they’re all fair game when it comes to plastic surgery. Those are no countries for old men and women, apparently.

MM: In this film, you looked into the origins of youth obsession. After making the film, where do you think it comes from?

MC: It’s complicated, and everyone will tell you something different (“I want to look fresh”, “I don’t want to be invisible”), and often something as simple and opaque as “because I don’t want to look old” or “youth is beauty.” But if you boil it all down to its simplest idea, people don’t want to be reminded that time is running out, and that, as Simon Doonan says, “the Grim Reaper, she’s coming around the corner.” The loss of fat tissue, facial bone mass, wrinkles—it’s all a sign that we’re not here forever. That might be worth some injections so we can go have some fun at the bar!

MM: You said that your opinion about the anti-aging industry changed over the course of working on this film for several years. Do you think your audiences will have a similar reaction?

MC: My opinion about the anti-aging industry did change over the course of making the film; I became more empathetic as I came to know these people and saw how looking a little younger than their driver’s license made them (for the large part) happier. In a world that likes to date young, hire young and out young people in the limelight, how can you blame them for wanting to stay young?

Will it change other people’s attitudes? Not necessarily. I’m sure the film will make anyone more aware of the rise of the industry. If they hadn’t noticed the pamphlets for Botox at their dentist’s office and all the products and ads with rejuvi- and reversal in the names, they might now. Or the guys in the audience might inspect their faces in the mirror for changes, like many of us women do. Some people I’d never suspect have called me for recommendations though! Others have come up to me and complained that they’re now suddenly paranoid about their faces—but then happily write back a week later to say they thought more and more and feel better about aging than the ever did. The film may make some viewers angry that people go through all of this expense, pain and danger to fight the inevitable. That’s understandable, I suppose. I tried to create a world inside the film that was exhaustive and claustrophobic for a good reason. Because worrying about aging is claustraphobic and exhaustive! And yet… I do it.

MM: What are your hopes for this film?

MC: I hope the film sparks a real discussion about our unhealthy obsession with aging and fascination with youth, a fascination that few of us aren’t guilty of on some level. I hope that the film is not perceived as having just stamped my opinion on the topic of plastic surgery. And of course, like any filmmaker, I hope lots of people see it for a long time.