Plastic surgery’s rise and rise: ‘No one believes it’s kale and lemon water keeping you wrinkle-free’

When Dr Herluf Lund, a plastic surgeon in the United States, started performing aesthetic enhancements 30 years ago, the vast majority of his patients wanted their surgeries kept a secret. Particularly when it came to breast implants, Lund's clients were worried that they would be perceived as having "some kind of devious motivation," he says. Back then his patients wanted discretion and confidentiality above all.

“It’s been a rather 180-degree transformation from when I started my career,” says Lund, who just ended his term as the president of the Aesthetic Society in the US. Now, his patients “expect we’re going to take pictures, and they want to post them,” he says.

Americans spent $9.3 billion, or about €7.6 billion, on all aesthetic procedures in 2020, up from $8.2 billion in 2019, according to the Aesthetic Society. On TikTok, #plasticsurgery has more than 6.8 billion views, and popular social-media pages, such as @celebplastic, @celebrityplastics and @celebbeforeafter on Instagram, are devoted solely to before-and-after images of celebrities (though they don’t tend to have proof that these celebrities have had aesthetic work; they run on speculation).

I have one wild and precious life, and apparently I want to spend 5% to 10% of it thinking about cheek filler

Dr Lara Devgan, a plastic surgeon in New York who has more than 500,000 followers on Instagram and 33,000 followers on TikTok, says that social sharing, particularly among celebrities and influencers, "has reduced stigma about plastic surgery and medical aesthetics". Especially after this strange year, "transparency and authenticity have become social currency – nobody believes it's kale and lemon water keeping you wrinkle-free", she says.

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Devgan uses her social media as an extension of her medical practice, primarily to educate viewers and manage their expectations about what is possible, she says. She posts videos of her procedures, such as an upper eyelid blepharoplasty, and explains what recovery might look like for different kinds of work.

And viewers find these images mesmerising. "I have one wild and precious life, and apparently I want to spend 5-10 per cent of it thinking about cheek filler," says Sarah Evans, who is based in Washington, DC, and is a regular viewer of the @celebface Instagram account. Evans enjoys seeing the amount of work that goes into making famous people look they way they do, and also finds that "it's reassuring to know people don't wake up looking like that".

Though social media has been a large part of reducing the stigma of aesthetic work, several experts interviewed for this article cite Keeping Up with the Kardashians as ushering in a new transparency around injections and fillers in the United States. Kim Kardashian West was depicted getting Botox on an episode in 2010.

Part of the new display of aesthetic enhancements is about status: you're saying you can keep up with the Kardashians when you get fillers like them

“Undergoing a procedure is almost a costar in the show,” says David B Sarwer, associate dean for research in the college for public health at Temple University, in Pennsylvania, who has researched the psychological aspect of cosmetic surgery.

This transparency extends to other reality stars, Sarwer says. Women on the Real Housewives shows have been depicted getting everything from lip filler to vaginal-rejuvenation surgery.

Part of the new display of aesthetic enhancements is about status: you're saying you can keep up with the Kardashians when you get fillers like them, Sarwer says. Lund says that "everyone wants an incredibly sharp jawline and a very chiselled neck" now, and one of the celebrities whose jaw and chin is most admired by his patients is Evan Rachel Wood, from Westworld, a show in which she portrays a sentient android.

But part of it is also that the definition of "self-care" has been stretched so far that it now might include getting injections into your face every six months so you don't look "tired," says Maggie Reid, an assistant professor of journalism at the University of Toronto Scarborough and host of the Generation Botox podcast.

Reid does not believe that the new transparency about plastic surgery has actually made the standards of beauty any less oppressive. “We know celebrities have trainers, special diets and cosmetic interventions to look the way they do, but that’s not the issue here. It’s this ever-escalating beauty ideal that no one can achieve without work, and plastic surgery is more and more a part of that normalised beauty routine,” she says.

Lorry Hill, a YouTube creator, believes we're still not getting a full accounting of the body and facial modifications from many people in the public eye – the Kardashians included. On Hill's YouTube channel, which has more than 200,000 subscribers, she dissects in detail the procedures she personally believes that various celebrities have undergone, along with a meticulously tallied price tag at the end. She makes it clear that she is not a plastic surgeon or expert, just an enthusiast. Her videos are not fact-checked by a surgeon or doctor either. In her YouTube bio, she notes: "Please visit a plastic surgeon for medical advice."

That doesn’t stop people from watching obsessively, however. Hill, who is 43 and lives in Las Vegas, says that she makes these videos to show how much work goes into a celebrity’s picture-perfect image.

“We’re sitting here comparing our natural selves – in most cases it’s younger people doing the comparing – to a celebrity’s surgical images, and they don’t know a person has plastic surgery at all,” she says. Hill walks the walk, too. She has made more than one video about her own facelift and the month it took to recover, as well as the nose jobs she has had.

I can look in the mirror and think I look horrible, or I can look in the mirror and think it's a supercool face. We all create our own reality

Hill says that while she is happy and confident about her own surgeries, she has become less pro-plastic surgery since she started her channel, two years ago; she’s more “middle of the road”, and worries about how these perfect images of beauty may be contributing to low self-esteem.

A review of several studies found solid evidence that social media use is associated with negative self-image, and a study of more than 200 women between the ages of 18 and 25 found increased Instagram use is associated with greater self-objectification and appearance comparison to celebrities. However, research on more diverse samples and other social media platforms is needed.

With her new book, Face: One Square Foot of Skin, Justine Bateman, a film-maker and former actor , is trying to push back against the notion that women's faces are "broken and need to be fixed". On the cover of her book is an unretouched photograph of her, with marks that are from a plastic surgeon's pen; the book is a meditation on women's faces, and the cultural pressure to be "ashamed and apologetic that their faces had aged naturally".

Bateman says that she has chosen to reject that pressure. “I can look in the mirror and think I look horrible, or I can look in the mirror and think it’s a supercool face. We all create our own reality, and that’s my reality, and no one can do anything about it,” she says.

Devgan had a more positive interpretation of those aspirational filtered selfies. She says that while some of her patients used to bring in pictures of celebrities they wanted to emulate, now they bring in aesthetically enhanced pictures of their own faces. “That’s part of the transparency and authenticity: people want to look like the best version of themselves.”

But after a year of isolation, and life mediated by screens more than by in-person interactions, is it possible that our reality has been fractured so deeply that we don’t even know what real faces look like any more?

“We’re engaging in this virtual world almost exclusively, so the image is becoming more important than real life,” Reid says. “We can never attain the look of a filtered selfie: you’re never going to look like an anime character with no pores. We absolutely need to understand that.” – New York Times