Isze Cohen was 17 when she got a nose job. Growing up Jewish in Los Angeles, where Botox and filler are as run-of-the-mill as sunny weather and smog, she always expected to go under the knife. “It’s just the way that I was raised – my mom was always like, ‘It’s not if, it’s when.’ It’s very normalized in the Jewish community to get a nose job.”
As a teen, Cohen reasoned that getting a nose job was a practical solution for a time-sucking annoyance: shrinking her nose on Facetune, a mobile retouching app, every time she wanted to post a selfie. “I was like, ‘I don't want to Facetune my nose anymore. I'm just going to get my nose done.’ That seems valid, but why am I Facetuning my nose in the first place?” Cohen reflects over the phone. It’s a daunting question, one that touches on the uncomfortable truth that our notions of aesthetic beauty – ski-slope noses, smooth hair, slim waists and shapely butts – are rooted in racism and misogyny.
Now 23, Cohen belongs to a cohort of 11-to-26-year-olds collectively known as Gen Z – a generation that tends to think of itself as, for lack of a better word, woke. These young contemporaries turn out in droves to vote on issues they care about, from abortion access to climate change (50 percent of people aged 18 to 29 voted in the 2020 presidential election, an 11-point increase from 2016). More liberal than their parents, they leverage their spending power to support brands whose values align with their own. The most racially and ethnically diverse generation in history, they’re invested in confronting issues such as systemic racism, gender bias, and the growing wealth gap. They demand equity at work – and they’re not afraid to question older generations abiding by the status quo. They’re also getting Botox and filler at higher rates than before.
In February, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) released the findings of its 2022 plastic surgery survey. 75 percent of the surgeons polled reported an increase in the number of patients under 30 requesting plastic surgery or injectables for cosmetic reasons. [Editor’s note: Medically necessary procedures such as gender-affirming surgery did not factor into the survey, nor will this article discuss them.]
If Gen Z’s values seem at odds with its rising participation in these cosmetic procedures, that’s because they are. Buckling to beauty standards that place a premium on classically European features (such as small noses and fair skin) buys into the very rhetoric that young people readily decry. But appearance, particularly that of women, has never existed in a silo. Understanding why Cohen and her peers are turning to plastic surgery and injectables – and how they feel about it – reveals just how deep our conceptions of beauty cut.
While research has yet to pinpoint the definitive driver behind the growing number of young people seeking cosmetic alterations, Dana Berkowitz, an associate professor of Sociology and Gender Studies at Louisiana State University and the author of Botox Nation: Changing the Face of America, theorizes that a few cultural phenomena are at play. In 2022, she conducted a series of interviews with a group of 25 women, aged 20 to 25, who use Botox and filler. She gleaned three overarching factors leading these young patients to inject: first, the normalization of procedures like Botox and filler; second, increasing accessibility to these procedures via MedSpas and other providers; third, the pressure to broadcast perfection online.
Dr. Jennifer Levine, a board-certified plastic surgeon based in New York, agrees that social media is contributing to a growing interest in plastic surgery and injectables among young patients. “Young people feel less of a stigma than older age groups,” she says. “[Cosmetic procedures are] all over TikTok and social media and [seem] very accessible. [Young people] take a lot of photos, so looking better in photos is important to them.”
Berkowitz also acknowledges the unglamorous, unjust truth that women are rewarded for participating in beauty culture, whether it’s cosmetic injectables, plastic surgery, or extreme dieting. A woman’s appearance functions as aesthetic capital – beauty is currency, which translates to social and professional success. Amid an uncertain economy and skyrocketing costs of living, it’s hardly surprising that young people are going to extreme lengths to get ahead.
Victoria Paris, an influencer who once documented her changing appearance on an Instagram Stories highlight titled “body mod,” began getting Botox at 21 years old as part of a brand deal that entailed posting about a clinic in exchange for free injections. Some of her posts went viral, benefitting both her and the clinic. “They were juicing me up for free 'cause it was getting them views and increasing their customers,” she tells Highsnobiety.
Now 23, Paris eventually stopped receiving Botox (“They fucked up my face,” she says) and began experimenting with other treatments like lip tattoos, lip flips, and chin liposuction. When asked what, exactly, pushed her to pursue these cosmetic alterations, she doesn’t beat around the bush: “It was never out of insecurity. It was more so out of pressure.”
“Playing into this beauty standard does nothing but excel your career. Because I'm recording so much, I was like, ‘I'm going to do the work that feels right for me.' the stuff that makes me feel fresh-faced if I get on camera at 6 AM or 6 PM.”
The beauty industry makes it easy for customers to fall under its spell, veiling surgery and injectables in vaguely political buzzwords such as “self-care” and “empowerment.” In 2017, Harper’s Bazaar spoke to several young women who characterized their decision to go under the knife as feminist – they had the agency to change their own appearance! It’s a belief that fit nicely into the sort of pop feminism saturating the cultural landscape at the time. Think: the Netflix adaptation of Sophia Amoruso’s #Girlboss; The Wing, Audrey Gelman’s women-only coworking space; Wall Street’s “Fearless Girl” statue, sponsored by investment management firm State Street Global Advisors – salable notions of “girl power” that did little to meaningfully confront the cultural institutions that oppress women.
Six years later, young women are beginning to poke holes in this Girlboss-ian brand of feminism. “You can get cosmetic surgery and feel amazing from it – your insecurities are a little bit better – but I don't think that's the root of the problem,” says Ling Tubbs, a 20-year-old student and part-time content creator. “Capitalism exploits these insecurities. Maybe you got your lips done, but now you need to focus on all these other areas of your body that society is telling you to alter.”
Paris puts it bluntly: “I don't think getting work done is inherently feminist because we live in a misogynistic, capitalist society.”
Jessica DeFino, a reporter whose work takes an unflinchingly critical look at the beauty industry, characterizes the decision to undergo a cosmetic procedure as a “coerced choice,” one coaxed by a culture in which women are rewarded for manipulating their appearance to meet an impossible standard of beauty. “This idea that anything a woman does is inherently feminist because she's choosing to do it is obviously very problematic,” she says. “It doesn't look at the underlying cultural and socioeconomic factors that influence our choices, or the wider impact of our choices.” That’s where plastic-surgery-as-empowerment-speak falls short: It fails to recognize that cosmetic surgery and injectables help perpetuate a beauty culture that harms everyone – particularly women of color.
Growing up, Sophi St. Louis felt she should change her appearance to better fit a Western beauty ideal. “I thought, ‘Maybe if I do change myself, more people will like me. I'll be more appealing to the standard,’” the 21-year-old content creator reflects. Now, she notices that cosmetic trends reproduce the very features she once wished she could alter. “When I was younger, I used to get bullied for my lips,” she says. “Now, everyone is getting lip fillers.”
“Everybody's just trying to make it in this world and it feels like they'll do whatever is necessary,” Cohen says. “If having cornrows is in, they're all gonna get them, regardless of who it's damaging.” While much of Gen Z would recoil at the prospect of a white woman wearing cornrows, the same demographic plumps their lips and lifts their eyes, “tweakments” that appropriate racialized facial features. When it comes to beauty, patients of all ages engage in a game of pick-and-choose. Some Anglo-Saxon features are accentuated, others eschewed; slim noses and large eyes are embraced while thin lips are rejected in favor of fuller mouths, a characteristic celebrated on white women yet mocked and degraded in relation to Blackness.
DeFino, 33, is acutely aware of how our “beauty behaviors,” as she calls them, affect both the individual and the collective. In 2022, she penned a viral exposé on her experience working for the Kardashian-Jenner apps, a series of now-defunct platforms that relied on selling an unrealistic beauty ideal to its millions of users. In the essay, DeFino wrote: “The normalization of cosmetic surgery, illusory makeup, and altered photos raises the baseline standard of beauty for all – a form of aesthetic inflation, if you will. It makes it harder for women and girls to opt out of spending their time, money, and energy on aesthetic labor without facing financial and social consequences.”
It’s this realization that helped push DeFino to divest from the beauty behaviors many accept as realities of day-to-day life. She eschews skincare products, wears minimal makeup only on special occasions, and draws a hard line at cosmetic procedures. “I don't want to be getting these procedures to make myself feel better. Meanwhile, my face becomes part of the increasing pressure on my peers, people younger than me, people around me, and people within my personal sphere of influence to engage in these behaviors and perpetuate these beauty standards.”
Clara Perlmutter, better known as @tinyjewishgirl on Instagram and TikTok, worries that her nose job might influence her followers. “I'm scared that people are going to see that I have a nose job and want what I have. I'm honest about it, but I also try to get people to think critically about what they're doing to themselves,” the 24-year-old says. “That's better than just giving people the illusion that I'm a magically, seemingly perfect reflection of whatever beauty standards.”
At 15, Perlmutter, fed up with being made fun of for her large nose, successfully petitioned her parents for surgery. While recovering from the procedure, she suffered a psychotic episode after withdrawing from the painkillers that her plastic surgeon prescribed. It was a harrowing experience that turned her off from pursuing additional cosmetic procedures – but Perlmutter has another, more practical reason for shunning future surgeries. “My insecurities were not fixed by my nose job,” she states, explaining that she’s still not entirely happy with her appearance. “The side [of my nose that] I like, it looks soft and rounder. And the side that I don't look like, it looks sharper.”
Still, the influencer acknowledges that altering her appearance has benefitted her career. “I've had an easy path, being considered very conventionally attractive [and] doing what I do – doing the social media content and having my appearance be my livelihood,” she admits. “When I'm open with people about the fact that I've had a nose job, am I perpetuating that you need a nose job to be successful – getting beauty deals, getting fashion deals, all of that? It weighs on me. It does.”
Paris feels similarly. “It doesn’t make me happy when I see people getting the same procedures I do. When I got my chin lipo, it was one of the darkest points in my life. I was extremely depressed. My binge eating disorder was out of control. I'm glad I got it done, but I know it didn't come out of a great place.”
She has since deleted some of her social media content detailing the process of chin liposuction, as well as her “body mod” Instagram Stories highlight, a former shrine to the invasive and non-invasive cosmetic treatments she’s undergone, including lip tattoos, eyebrow tinting, and eyelash extensions. Unlike DeFino and Perlmutter, Paris doesn’t write off future procedures. “I would love to say, ‘No, I love the way I look and I want to stay exactly the way I am and no more,’ but that could very well not be the case. The internet is a dark place. I could want to do more shit.”
“It's a very fraught thing to try to navigate the world as a woman without participating in any sort of standardized beauty practices,” DeFino says. “Beauty standards are the physical manifestations of systems of oppression – basically any beauty standard can be traced back to a larger system of oppression, like racism, white supremacy, ageism, ableism, sizeism, sexism.” Cosmetic work puts a shiny band-aid on these ills: Botox is a salve for ageism, liposuction a balm for fatphobia. Opting for the band-aid is understandable – after all, we as individuals have very little control over the systemic issues that DeFino cites.
That doesn’t mean we’re obligated to roll over and take it. “We need to be more outraged that the beauty industry is proposing individual solutions to systemic problems,” DeFino says. “The beauty industry is saying ‘Fix yourself, change yourself so you're better able to live in this oppressive world.’ We should not be looking at that and thinking, ‘Oh, great idea. I'm going to do it.’ We should be looking at that and saying, ‘This system is really fucked up. How come nobody is proposing systemic solutions?’”
In many states, it’s legal for employers to discriminate against people based on physical attributes such as weight and hair texture – just one example of the ways in which institutions coerce us into conforming to aesthetic standards. To begin to dismantle beauty standards, protection against these forms of appearance-based discrimination must be codified.
It won’t happen overnight, but we’re getting there. In 2019, California signed the C.R.O.W.N. Act, a law that prohibits discrimination based on hair style and hair texture. This spring, New York City is expected to approve a bill banning weight discrimination in hiring and housing.
It’s also worth casting a critical eye on cosmeceutical giants such as Allergan, the maker of Botox and Juvéderm. It’s no secret that big pharma is courting young, impressionable consumers – in 2019, Allergan rolled out “Own Your Look,” a Botox marketing campaign that pivoted focus from its core consumer (women 40 and up) to a younger demographic (20 to 30-year-olds). To Berkowitz, these marketing tactics are deeply unethical.
“Very few people stop using Botox once they start. Very few people stop using filler once they start,” she says. “We know that these procedures are addictive. We know that they change what we see as normal and beautiful. We need to be much more critical and upfront about the ethics involved in creating this lifetime consumer of injectables.”
For far too long, the beauty industry has peddled the illusion of control – the prospect of wielding a modicum of power over a system that disempowers women at every turn. As a woman of color, I’ve certainly fallen prey to the false promises of body modification. In my early teens, I obsessively researched nose jobs. I wanted to more closely resemble my white peers, all of whom seemed infinitely more popular and happy than I was. Later, I began counting calories using an iPhone app: If I couldn’t enjoy the privileges of being white, at least I could enjoy the privileges of being thin. In my mid-twenties, I got filler for the first time. If I wanted to succeed in an industry that profits off of appearance, I had to put my best face forward. Looking in the mirror, I may have felt powerful. But unwittingly, I’d relinquished even more agency. Ultimately, I’d spent time, energy, and thousands of dollars adhering to a standard of beauty over which I had no control.
Unsurprisingly, plastic surgeons hesitate to acknowledge the cultural and social consequences of the cosmetic procedures they perform. “I think social media perpetuates unrealistic beauty standards, not cosmetic surgery,” says Dr. Theda Kontis, president of the AAFPRS. Dr. Levine aso rebuffs the notion that her line of work upholds harmful beauty standards. “There are certain mathematical proportions that are found in nature, in space, in architecture that are also repeated in the face,” she says, citing the golden ratio. “Beauty in many ways is biological, not societal.” However, the widely held belief that beauty is biologically based (i.e. certain features are more attractive because they signal health and desirable genetics) might not be as scientifically sound as we think. In a 2015 article for BBC, science writer David Robson discussed findings from several studies suggesting that our conceptions of beauty aren’t the product of evolution, but social conditioning.
Of course, Dr. Kontis and Dr. Levine’s livelihoods rely on glossing over the politics of beauty – it would be financially inadvisable for them to acknowledge that plastic surgery intersects with thorny social issues like racism and misogyny. Expecting patients to suddenly shun surgery and injectables is unrealistic, too. As Jia Tolentino once wrote in her essay Always Be Optimizing: “It's very easy, under conditions of artificial but continually escalating obligation, to find yourself organizing your life around practices you find ridiculous and possibly indefensible. Women have known this intimately for a long time.”
It’s less about saying “yes” or “no” to cosmetic work, and more about recognizing these procedures as products of a deeply flawed culture, one in which appearance informs economic and social success. “We are all victims of unrealistic beauty standards. We perpetuate them because it is really hard to live outside of them,” Perlmutter says. “I know what it’s like to feel alienated because of my appearance and desperately want to fit in.”
At the same time, it’s foolish to regard ourselves as totally powerless pawns dropped into a predatory game. “We want to have the agency to say, ‘Okay, I'm going to change my body.’ Then, it's proposed [that we] resist beauty culture. Suddenly, everybody wants to erase all signs of agency and say, ‘Well, how could I possibly exist in this world if I don't manipulate my body?’” DeFino notes.
Beauty culture renders us both victims and perpetrators, disenfranchised and emboldened. It operates on contradictions – this is what makes it so difficult to parse. Beauty culture tells us to be thin and curvy, fair-skinned and tan. To wear makeup and look natural. To feel confident in and ashamed of our bodies, to love ourselves and to hate ourselves.
It’s up to each of us to figure out our relationship to these impossible standards. Like DeFino, you might realize that you want to divest completely from the cosmeceutical industry. You might also realize that you’re comfortable participating, despite the consequences. Whatever conclusion you come to, you’re likely to run into some contradictions of your own – self-understanding often requires embracing the dialectic, accepting that two opposing truths can co-exist.
Cohen mulls her own opposing truths while reflecting on her nose job. “I definitely wouldn’t say that it was an act of feminism,” she says. “Maybe I’m not a total feminist. I don’t think my values hold me one hundred percent to the ground. Sometimes I don’t recycle – that doesn’t make me an environmentally unconscious person. It just makes me human.”