Why Gen Z is so open about getting plastic surgery

Swiping through TikTok can take one on any number of similar cosmetic journeys, guided by chirpy, young content creators who emerge ever so slightly more tucked, augmented or symmetrical. Halley Kate, who co-hosts the “Hot Girl Talks” podcast with Smith and Carly Weinstein, made about a dozen TikToks documenting her chin liposuction earlier this year. TikTok star Alix Earle celebrated the anniversary of her breast augmentation — her “boobaversary,” as she called it — with more than 5 million followers by making a video in which she outlined the details of her procedure, which she said she paid for from earnings and childhood savings.

“I did 275 cc, moderate profile,” she said, describing the size of her implants as she applied makeup. “Not going to lie, I wish I did a little bit more.”

Plastic surgery’s initial purpose was primarily to reconstruct rather than enhance. During World War I, doctors developed methods for fixing ruined noses and shattered jaws, and after the war, they used them for elective cosmetic procedures. In 1962, Timmie Jean Lindsey, a Texas housewife, became the first person to get silicone breast implants. By the 1990s, aging baby boomers with plenty of discretionary income decided they wanted to freshen up their looks. Liposuction procedures increased tenfold that decade, by some estimates.

But despite its steady growth in popularity, cosmetic surgery has often been discussed by those who undergo it in the hushed, cryptic tones usually reserved for national intelligence agencies. For every celebrity like Dolly Parton, who once famously declared, “If something is bagging, sagging or dragging, I’ll tuck it, suck it or pluck it,” there were a dozen others who outright denied having work done.

In 2011, movie star Megan Fox responded to rumors that she’d had Botox by posting a Facebook album titled, “Things You Can’t Do With Your Face When You Have Botox,” with pictures of her frowning and looking surprised. In 2016, the actor Olivia Munn wrote on Instagram that her recent facial transformation was the result of eating Japanese potatoes and getting better eyebrow grooming. After this year’s Grammy Awards, Madonna denounced widespread speculation about her face as “ageism and misogyny.” And the Kardashian-Jenners — bellwethers of cultural beauty standards — are notoriously cagey about what enhancements they may or may not have undergone, while their fans pick apart paparazzi shots for the telltale signs of a surgeon’s scalpel.

Gen Z, by contrast, shouts about their procedures from the digital rooftops.

“I ask every surgical patient and injection patient if I can put their pictures online,” said Theda Kontis, a facial plastic surgeon in Baltimore and the president of the American Academy of Facial Plastic and Reconstructive Surgery. “Older patients are sort of wishy-washy about it. Younger people are like, ‘Sure, when is it going to be posted?’ And if I don’t post it, they post it.” Obviousness is the goal now, she explained. “They want people to say, ‘Wow, you got your lips done.’”

Americans young and old emerged from the depths of the pandemic like dissatisfied Narcissuses, determined to fix whatever perceived flaws they had noticed in the terrible depths of their Zoom windows. In 2022, the American Society of Plastic Surgeons surveyed its members and found that 76 percent of surgeons said that they had experienced at least a slight increase in demand compared with before the pandemic. Patients’ top reasons for getting plastic surgery, that same report said, included wanting to “feel refreshed/look younger after aging from pandemic stress” and noticing “things they want to improve during video calls.”

People younger than 30 are still a minority of plastic surgery patients, but doctors who spoke with The Washington Post reported a noticeable increase in that demographic. For the most part, Kontis said, Gen Z patients are interested in “prejuvination” measures: injectables such as Botox and soft-tissue fillers that will prevent the natural ravages of aging.

What really sets the members of this generation apart, surgeons agree, is not just that they are coming in earlier for treatments but also that they are coming in knowing exactly what treatments they want.

“My older patients will come in and say: ‘I want to look better. I don’t like this. I’m not sure what I need,’” Kontis said. “The younger patients come in and say: ‘I want fillers in my cheeks, and I want Botox here, because I don’t want to get crow’s feet.’ They know exactly what they want, and they know what it does.”

Countless TikTok and Instagram accounts chronicle procedures or pick apart celebrities’ evolving looks. An Instagram account run by Houston-based dietitian Dana Omari Harrell (@igfamousbydana) has more than 260,000 followers and posts before-and-after photos of celebrities, guessing what work they may have had done. Scrolling through the account can give the sense of being a character in “The Matrix” who has realized that everything around them is a simulation.

Smith, the TikToker, says she pored over hashtags for “breast augmentation” and “breast augmentation removal,” so she could prepare herself for what to expect if she needed to have her implants removed. She came to a conclusion: “I could get struck by lightning tomorrow, and at the end of the day, I know boobs are going to make me feel better.”

Smith started getting preventive Botox at 19 and got a nose job at 23. Although she never had any reservations about cosmetic procedures — because her mother, grandmother and aunt have all had work done — she has noticed a change in how her peers discuss plastic surgery.

“When I would bring it up when I was younger that I wanted a nose job, it was like, ‘Oh, you don’t need it.’ And now it’s transformed to, ‘If that’s what’s going to make you feel better, I fully support you,’” Smith said. “It’s just a more supportive conversation, not questioning whether someone needs something or not.”

This acceptance of the value of cosmetic work is not limited to zoomers. When I brought up this story — over dinners and coffees, at parties — hands flew to necks, foreheads and eyes. Fingers pinched at sags, wrinkles and droops. Their owners — people in their late 20s to their 50s, mostly women, but some men, too — made clear-eyed assertions about all the things they planned to change as they got older or when they had more money and time to spare.

At no point in these conversations did anyone suggest that we were fine the way we were, or that aging was a privilege instead of a humiliating process of degradation that is to be resisted at all costs. These were, as Smith puts it, “supportive” conversations: We were supporting each other’s aesthetic aspirations. Supporting our bodily autonomy. Supporting our right to use our time and money to bend reality to our will.

And yet, for all our enthusiasm about cosmetic procedures, Americans still seem confused about how to discuss their relative philosophical merits: It’s empowering to do what you want with your body, but it’s not empowering to feel the need to conform to conventional beauty standards; no one owes anyone information about their body and medical history, but don’t lie about what you’ve had done; and you should love yourself just as you are, unless you don’t, then you should change it.

Gen Z is perhaps even more tangled up in this discourse than any other generation. In addition to growing up during what Lara Devgan, a plastic surgeon in New York, described as a “mainstreaming of plastic surgery,” 20-somethings also grew up during a mainstreaming of body positivity. While Dove commercials and curvier Barbie dolls urged them to love their bodies, Instagram filters and reality TV urged them to consider how they might be more beautiful if they looked completely different. They were told to accept themselves just as they are, then shown all the ways in which they should change.

“We’re in a culture that’s promoting body acceptance, and we’re also still in a culture that is very much committed to hierarchizing women and their value based on how they look,” said Virgie Tovar, an author, lecturer and expert on weight-based discrimination and body positivity.

Transparency, then, serves as a loophole of sorts: a way to comply with cultural beauty standards while at the same time undermining them. By showing one’s followers just how much work goes into looking conventionally hot, influencers get to show that they understand how unrealistic these standards are, while still benefiting from their adherence to them. (Sure, maybe I entered into a Faustian bargain, but I did so of my own accord, and look at what a hassle it is to work with demons, anyway. Please follow my page to learn more.)

Tovar argued that there is a hierarchy of values at play. “Transparency is an excellent value,” she said, “but if we take a step back and say the next part of the hierarchy is that we still believe in a beauty standard that is based on a White supremacist, thin ideal, then that’s not a really good value.” Practicing transparency without reckoning with that next, more complicated step, Tovar said, “is leading perhaps to the normalization of something like an unnecessary surgery.”

“I do believe it’s not feminist to get plastic surgery, but I don’t think it’s un-feminist to get plastic surgery. It’s just neutral,” said Eli Rallo, 24, a content creator, author and podcast host who has been open about her own cosmetic procedures with her 717,000 TikTok followers. (Women are not the only ones getting elective cosmetic procedures, of course. Male TikTok stars such as Sebastian Bails have also broadcast the work they’ve had done. But overall, the number of male cosmetic surgery patients is still significantly lower. According to the last available statistics from the American Society of Plastic Surgeons, in 2020, male patients represented 8 percent of total cosmetic procedures in the United States.)

This openness and vulnerability was part of the draw of TikTok, Rallo argued.

“I think people were getting sick and tired of the Instagram influencer as we know her,” Rallo said. “The most beautiful, the most wealthy, the most aspirational: We’re looking at these people; they’re not even real.” TikTok, she said, was a medium where “people could just be themselves.” However, she acknowledged that “the TikTok algorithm still does really prioritize prettiness.”

Rallo grew up in New Jersey and got a breast reduction when she was 18, because she couldn’t find prom dresses that fit her F/G-cup chest. The procedure was covered by insurance, but because of how her breasts continued to develop and heal, she had to have a revision. She had another reduction in 2022, and is down to a C/D-cup. She would go even smaller if she could, but said: “This is probably the safest for my internal organs.”

Worrying about the well-being of her organs makes Rallo a fairly conscientious member of her peer group. Devgan said that, in her practice, she has noticed that Gen-Z patients tend to be “terrifyingly risk-friendly”: both frightfully open to undergoing major surgery, and a little naive about what surgery actually entails.

During a consultation, Devgan said, she will often do an anatomical analysis and talk patients through a number of options, ranging from least to most invasive. “For example, options for a brow lift could be the use of Botox, or a suture suspension, or surgery,” she said. “And I’m always shocked by how frequently someone in this younger age group will be like, ‘Okay, can we do the surgery right now?’”

Major surgery always involves a significant degree of risk, but nonsurgical interventions can be hazardous, too. Kontis said that she warns young patients who come in asking for a liquid rhinoplasty — the injection of dermal fillers in and around the nose to alter its shape — that the procedure can be dangerous and can potentially result in blindness, the embolization of a blood vessel or the loss of skin on the nose. “They look at me like: ‘Well not if I go to so-and-so injector. It’s not on social media. It’s really safe!’” Kontis said. “I’m sorry, but this is the truth.”

Why would they be worried? Even the most complex, potentially dangerous procedures look easy, breezy and fast when they’re collapsed into a 30-second time-lapse video set to Kay P’s “Never Dat!” — a popular accompaniment to breast augmentation videos. (Lyrics: “She ain’t like her titties, f— it, get her new boobs.”)

In her boobaversary video, Earle said she was surprised at just how surgical breast augmentation turned out to be. “No one tells you that they’re just going to like walk you into this cold, refrigerated room, and there’s like a table, and then next to it is just, like, a tray with like knives and slicers. And you’re sitting there, just like, ‘Oh my God, I’m about to get cut open.’”

One thing influencers want you to know is that they’re not trying to persuade you to get work done. (Except when they are. Reports from NBC News and Insider found that beauty companies, med spas and surgeons frequently offer influencers free procedures in exchange for posts.) But as Earle says in her video: “This is also not me convincing anyone to get a boob job. You should love yourself. But if there is something you want do for yourself, then do it.” And Smith says: “I’m not encouraging anyone to do anything. If I want to get something done, it’s a personal choice, and I’m choosing to share my personal choice.”

Getting work done is your choice and your choice alone, young influencers say. They are doing it for themselves, and nobody else! And sometimes they are also sort of doing it for their followers, because their followers had criticized their looks, and they are talking about it because they knew their followers would harass them if they didn’t cop to what they’d had done.

Besides the breast reduction, Rallo has also posted about getting a lip flip — a noninvasive procedure that makes the upper lip look fuller by injecting Botox into the muscle above it — and some filler in her upper lip. She did it, she said, because she was being bullied by followers because her gums were visible when she smiled. She loves her smile now, she said, but admits: “I feel sad that what pushed me there was the TikTok comments.”

Rallo says she felt comfortable detailing the work she’d had done because she’d seen other creators doing the same. But she said there is a pressure to be transparent, too. When you’re an influencer and your job is sharing the details of your life, followers can come to expect all the details, and they can become resentful if they feel as if you’re holding back. “I was always pretty open about my breast reduction specifically, because I felt like I knew people were going to talk about it, and I wanted to get in front of that.”

The right to demur or withhold personal surgical information, Smith said, is increasingly a privilege reserved for the mega-famous. “When you’re a big celebrity, you can get away with people not knowing things,” she said. “When you’re a certain type of influencer who shares a lot of the personal details of their life, people feel entitled to a certain amount of information.”

Posting about her procedure was basically a professional obligation, Smith said, because “my job is just sharing things on the internet, anyway.” She admitted that she struggles with drawing boundaries between herself and her followers, and that it’s something she discusses with her therapist. (“I do feel guilty when I don’t share certain stuff,” she said.) Still, she believes that this increased forthrightness around cosmetic procedures has overall made things “easier and better.”

“Before it was like: It could be done, it could not be done. You don’t know,” she says. “People confirming that they have had whatever done and being open about it makes it different. There can’t be all this secrecy and guessing.”

Tovar also said there’s potential in this moment to better identify and question the narrow aesthetic norms to which people might feel pressure to adhere: “The potential silver lining here is that if we’re being transparent about the fact that we’re doing [cosmetic procedures], can we go to the next step of transparency of why we’re doing it? And can that open up a conversation that leads to something different?”

In 1991, Canadian feminist philosopher Kathryn Pauly Morgan published a paper titled “Women and the Knife: Cosmetic Surgery and the Colonization of Women’s Bodies.” In it, she wrote that elective cosmetic surgery “is becoming the norm.” She posited that, as a result, women who elect not to go under the knife would “increasingly be stigmatized and seen as deviant.”

A little melodramatic. But I thought of that line when I was on the phone with Kontis. I asked her why Gen Z seems so much more comfortable broadcasting their cosmetic work than other generations. “Because everyone else does,” she said simply. “They want to be like everyone else.” Then, she added: “There’s no natural beauty anymore.” I felt sad when she said that. And, as she spoke, I caught sight of my soft neck in the reflection of my computer screen, and thought about how I’d love to get it tightened up.