Size acceptance, body positivity, and fat activism are now part of the cultural lexicon, yet according to data from the American Society of Plastic Surgeons (ASPS), nearly a quarter million more cosmetic procedures were performed in 2018 than in 2017.
And this isn’t a new trend. The number of people getting cosmetic procedures has risen steadily over the past five years.
How can you #loveyourself yet still pursue a cosmetic treatment to smooth, shrink, or tuck a facet of your appearance? According to experts, it’s easier— physically, financially, and emotionally — than you may think.
According to the ASPS, 1.8 million cosmetic surgical procedures were done last year. The top 5:
- breast augmentation (up 4% from 2017)
- liposuction (up 5%)
- nose reshaping (down 2%)
- eyelid surgery (down 1%)
- tummy tuck (about the same)
Body-sculpting procedures such as buttock augmentations, which improve the contour, size, or shape of your butt, and thigh lifts, which reduce excess skin and fat of your upper legs, also saw an increase.
15.9 million minimally-invasive procedures were also performed in 2018. Of them, the most popular procedures were:
- Botox (up 3% from 2017)
- fillers (up 2%)
- chemical peels (up 1%)
- laser hair removal (down 1%)
- microdermabrasion (down 4%)
It’s a diverse list, but most of these likely share one thing in common.
“Most patients seek [cosmetic] procedures to feel like the best version of themselves,” said Dr. Lara Devgan, MPH, FACS, chief medical officer at RealSelf, a site where people learn about cosmetic treatments, share experiences, and connect with providers. “There’s a magical paradox I’m helping people achieve: looking the same but better.”
Why cosmetic procedures are on the upswing
Doctors who perform cosmetic procedures point to a number of reasons why people preach “Don’t let anyone judge your appearance!” online yet still shell out money to change their own.
1. More screen time
Dr. Dennis Schimpf, FACS, author of “Finding Beauty: Think, See and Feel Beautiful” and founder of Sweetgrass Plastic Surgery in Charleston, South Carolina, thinks cell phones, selfies, and social media platforms have greatly driven the desire for plastic surgery.
“If you think back even 10 years ago, let alone 25, rarely would you see yourself in pictures,” said Schimpf. “Maybe a birthday or wedding, usually some type of special event. Now, with mobile devices and platforms, we’re literally seeing hundreds, if not thousands, of pictures of ourselves documenting things we don’t like about our appearance, as well as the aging process.”
In other words, we’re all under constant scrutiny — by ourselves.
2. More acceptance
When Alan Matarasso, MD, FACS, first built his private practice in New York City over 25 years ago, “I literally put in a back door because people didn’t want to walk in the front.” Matarasso is also president of ASPS and a clinical professor of surgery at Hofstra University.
“Now, with the rise of social media, people are in the recovery room, posting about what they went through and sending pictures to friends that show the bandage on their nose,” he said.
“People are much more comfortable owning their self-care rituals — including those that involve needles and knives,” agreed Devgan.
Since 2015, the total number of reviews on RealSelf has more than doubled. Community users often post before and after photos and share candid details about the treatment they chose to have.
“I also have patients come into my office and request to be on my Instagram feed, which is something we never would have seen 5 years ago,” Devgan said.
She credits millennials for owning self-improvement. They “feel that they don’t have to apologize for their decisions, whatever they may be, and this attitude is making Gen Xers and baby boomers feel that they don’t have to either,” Devgan said.
3. More affordability
At some point in the not-so-distant past, cosmetic plastic surgery was only for the uber-wealthy.
Today, Schimpf’s most common patient is usually “a working professional, often double-income family or a stay-at-home mom who now, after having children, would like to regain the physical appearance she once had,” he said.
In other words, not the stereotypical housewife in Beverly Hills who “had her face done.”
Cosmetic procedures, both surgical and nonsurgical, “have also become more affordable,” said Schimpf.
Plenty of financing options exist, from medical credit cards and personal loans to payment plans offered by doctor’s offices. Health insurance typically only covers cosmetic procedures due to a medical reason — such as breast reconstruction after a mastectomy.
4. More technological advances
Technical procedures used during cosmetic procedures continue to become safer and more reliable, said Matarasso. So are the instruments and products doctors now have at their disposal.
Nonsurgical treatments are an especially rapidly evolving arena. “Lasers didn’t exist 10 years ago,” noted Matarasso.
And Botox used to be the only line-smoothing neurotoxin on the market. Now, three others exist, and a fourth option, Jeuveau, was recently approved by the Food and Drug Administration and is poised to roll out this spring.
5. More health benefits
So maybe getting your lips plumped won’t have benefits beyond increasing your self-esteem. But “in certain circumstances, some cosmetic treatments can benefit your health,” said Matarasso.
Botox, for instance, has been shown to help with conditions such as chronic migraines, excessive sweating, Bell’s palsy, and perhaps even major depressionTrusted Source.
Women who choose a breast reduction often get relief from disc or back problems. And plastic surgery allows people who’ve gone through weight loss surgery to shed extra skin that can cause severe rashes and infections.
“While we may not be curing cancer,” Matarasso said, “the impact and psychological benefit [of some cosmetic treatments] can be profound.”
6. More self-confidence
According to a 2019 survey by RealSelf/Harris Poll, the top cited motivations among those who’ve had or are thinking about a cosmetic treatment are “to improve self-esteem/confidence” and “to look as good as I feel.”
That’s consistent across both surgical and nonsurgical procedures — and those reasons haven’t changed since RealSelf launched a decade ago.
“Despite all of the changes in the technical aspects of aesthetic surgery, human desires and motivations remain the same,” said Devgan. “We all want to present our best selves to the world — the ways we do that depend on who we are.”
Advice for the cosmetically inclined
If you’re thinking about pursuing a cosmetic treatment for yourself, make sure to:
Ask yourself “Why?”
“And be honest,” advised Schimpf. “It has to be for you and the goal has to be to make you feel better about yourself. Having a procedure to impress someone else or make someone else happy will never make you happy.”
Find a reputable doctor you trust
Yes, you could go to a random dentist and have Botox done with a Groupon, but why not carefully research doctors first? Seek care from a skilled board-certified plastic surgeon who will prioritize your care.
“You want to go to someone who can say ‘This is best for you,’ not ‘This is best for me,’” said Matarasso. “Plastic surgeons are trained as much as heart surgeons.”
Besides cosmetic procedures, many also perform complex procedures like breast cancer reconstruction and pediatric birth defects.
Be specific about what you want to be different
Don’t assume any surgeon knows what you mean by “better skin” or “smaller breasts.”
“By understanding what you’re seeing and hoping to improve, the surgeon can hopefully match a procedure that’s safe, as well as one that meets your desired goals,” Schimpf said.
Be realistic
Doctors “aspire to an improvement over baseline, not a shortfall from perfection,” said Devgan. “Plastic surgery is medicine, not magic.”
And if you #loveyourself, you should be totally fine with that.
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