The Glow Up

Are We Done Shaming People for Having "Work Done" Yet?

As beauty standards change over time, so, too, do the ways we view our bodies and others'. In recent decades, each beauty shift has had a ripple effect within the world of plastic surgery as well, creating trends like lifted eyes, smoothed foreheads or filled lips, tweaks that have become all the more common and accessible, often requiring needles not knives to achieve.

As these cosmetic procedures continue to skyrocket, the industry is expected to be worth 43.9 billion dollars by 2025, according to one study. Yet despite the growing familiarity with cosmetic procedures, the stigma surrounding them — and those who choose to get them — hasn't shifted. In other words: Tons of people are getting work done, and no one's talking about it in a positive way (if they're talking about it at all). Tabloids and "gotcha" social media posts seem to go after celebrities with supposed before-and-after photos, attempting to out someone for having had work done, implicitly shaming them along with anyone else who'd choose to undergo the same. And what for?

The reality is, everyone's life experience is unique, and how we feel about ourselves and how we look is important. The motivation to have cosmetic treatments or even undergo surgery can run way deeper than the stigma would have us believe but it can also be quite simple: Some people just want to. Lots of people, actually.

InStyle conducted a research study into women's attitudes toward transformative beauty, and found no sign of this trend slowing down. People like the way they look and feel after having a procedure. They are interested in getting more. (In our survey of 2,100 women ages 18 to 74, 96% of users who've had prior procedures and 92% of prospective users shared that they're open to procedures in the future, 68% feel like they need it, and 38% would consider a cosmetic surgery after doing a non-surgical beauty treatment.) Sometimes the only barrier is money (80% of users say they see this as a luxury) — and sometimes it's shame.

While larger cities in the United States — NYC, LA, and Miami — are generally more accepting of new cultural norms, an anti-procedure stigma is alive and well throughout the country. And many still hold the idea that cosmetic treatments are vain, superficial, or only for people with low self-esteem.

"I talk to my girlfriends about getting treatments," a 46-year-old InStyle reader shared in our proprietary study, which surveyed women across the United States about their attitudes on in-office cosmetic treatments. "My mom is old school and would judge me, so I don't talk about it with her."

This type of reaction is all too common — and experts say it leads many to be dishonest about the work they've had done, which perpetuates the ongoing circle of stigma.

"I think that there are still pockets of situations where people want to attribute what they've achieved physically to not having undergone the knife," explains renowned New York City plastic surgeon, Dr. Alan Matarasso, who is also the former president of the American Society of Plastic Surgeons.

He suggests that the problem is twofold, starting with the denial of any outside help from those who have had it. "It seems as though there's almost a badge for some people who say that they look this good on their own," Dr. Matarasso says. The real whammy, he believes, is the sneaky second part, which he considers to be "an implied condescension toward those who aren't 'natural.'"

It feels good to look good.

Judging the 'natural' as 'better' is why it's perhaps more difficult for people to consider the significant impact cosmetic procedures can have on a person's quality of life, says New York City plastic surgeon Dr. Adam Kolker. "The whole idea of aesthetic surgery being superficial, it's just not," he says. "People tend to be very judgmental, but it's so much more important to focus on the individual and their self-perception."

In study after study, he says results show "a dramatic increase in self-perception, self-confidence, and sexual wellbeing." And that's behind the recommendations surgeons make to their patients who come in curious about a poke or prod.

"Plastic surgeons don't make any decisions about what we do without evidence," Dr. Kolker adds, referencing industry research, including patient reported outcomes and quality of life, to examine all aspects of their post-surgical health, from physical to psychological to sexual. "These procedures are proven to have a very, very deep impact on the individual's life," he adds.

Even in InStyle's qualitative research findings, participants shared that they were "motivated by the desire for self-improvement" as well as the anti-aging benefits of non-invasive cosmetic procedures, like Botox or fillers. Of those who had undergone cosmetic procedures, 90% reported feeling more positive post-treatment.

"I think the stigma may be a vestige of our history," explains Dr. Matarasso. "When you go back to the '60s, '70s, '80s, plastic surgery was done in secret — even the surgeons wouldn't admit they performed it. It was literally hidden from public operation rooms."

Today, both plastic surgeons and dermatologists are open about the types of treatments and procedures they perform in-office. And our study found that among the women surveyed, in addition to Botox, 96% of users and 92% of prospects were most interested in facial treatments like Juvéderm, Kybella, and chemical peels, as well as body treatments like IPL laser, laser hair removal, and CoolSculpt — even if they choose not to be open about it (only 32% said they would discuss treatments with anyone who asks). But, still, those who have had treatments resoundingly have no regrets.

Lisa, a 46-year-old InStyle reader from Delaware shared in our report that, for her, laser hair removal was life-changing. "I am very happy. I had laser hair removal, and once [the] hair was removed my clothing changed, my confidence changed, I started wearing makeup," she said. "[I] don't hesitate to put on a bathing suit cause I am always ready to go!"

Wilma, a 51-year-old fellow InStyle reader agrees when it comes to the self-esteem boost from in-office treatments. "It was very positive," she said. "I felt complimented all the time. My outside finally looked as fit as I felt inside."

We like to believe we have complete control over our looks, and "getting work done" requires admitting that we don't.

When I started training for my first marathon two years ago, I was happy with a lot of the ways my new fitness routine changed my body, but my ever-disappearing chest was one change that I was not prepared for. I became fixated on my decreasing cup size, even though no one but me noticed there was a little less volume each week. When I consulted Dr. Kolker and mentioned offhand that I was a runner, the cause and effect was so obvious that he immediately asked: How much volume did you lose? Still, friends at the time were aghast that I'd consider implants; they said I didn't 'need' it, or they couldn't tell the difference.

I wasn't going after a '90s bombshell look, I simply wanted breasts that looked the way mine had before I started running. And that made me a prime candidate for surgery, Dr. Matarasso explains. "Plastic surgery achieves something that you can't achieve on your own," he says.

Dr. Kolker had acknowledged my "deflated" appearance, and though it was validating that he saw what I saw, the flat-and-sagging look had deflated my self-esteem, too, and for me the fix was a natural-looking implant that felt like me. "I feel that the best plastic surgery is plastic surgery that whispers rather than screams," Dr. Kolker says. For many, the desired result is one that doesn't announce itself at all.

It's really not just about looks.

One of the biggest misconceptions about plastic surgery that contributes directly to the stigma against it is the idea that it is purely cosmetic.

Instead, Dr. Kolker explains that aesthetic and reconstructive procedures make up a Venn diagram, and "the continuity between those two circles is huge. For example, it's not just restoring a certain shape when you talk about post-cancer breast reconstruction; you just want someone to feel comfortable in their own skin."

Dr. Matarasso agrees, adding there are "many arms" within the plastic surgery universe, listing hand surgery, pediatric care, cancer reconstruction, and microsurgery, which entails operating under a microscope to heal a wound. "Aesthetic or cosmetic surgery is just one small aspect of what plastic surgery is."

And yet it makes up the largest social perception of what these doctors do — much like an ob/gyn who performs D&C procedures, sometimes to remove non-viable pregnancies, and sometimes unplanned ones. Stigmatizing an entire class of medical procedure based on a narrow-minded view of one of its uses is outdated, and public opinion increasingly skews toward letting people do with their bodies what they please in both cases. In our research, 87% of people who've had cosmetic procedures and 84% of those who've thought about it believe there's less stigma around non-surgical beauty procedures than there used to be. And only 29% of prospective users believe women who get cosmetic treatments solely do so out of vanity (still: that's nearly a third, which is kind of harsh).

Thomas*, a lawyer in Pittsburgh, recalls the night when he was in dire need of a plastic surgeon, after surviving a random attack by a brick-wielding stranger. "One side of my entire face was sliding down, my orbital, cheek, and jawbones were shattered," he says. "My chance at looking even somewhat like my old self felt as lost as Humpty Dumpy's. I definitely wasn't going to be put back together again."

But he was — with titanium plates and the help of a surgeon specializing in maxillofacial reconstruction, a niche plastic surgery specialty. "At first, I didn't even consider this to be 'plastic surgery' because it wasn't elective — my face needed to be completely rebuilt, and I don't even want to think about what I would look like otherwise," he shares, saying he doubts anyone would even notice what was done, to see him now.

Thomas's experience is a great example of the intersecting Venn diagram spheres, Dr. Kolker says. "This reconstruction procedure not only restored form and function, but also a sense of self."

Lauren*, a New York City-based creative in her early 30s, found herself facing breast cancer this past year, a "crazy, shocking thing" that led to her opting to have a bilateral mastectomy with reconstruction — a very common case for plastic surgery.

"I really just wanted to look like myself after this ordeal," she says of her decision. And she worried about the aftercare. If she had chosen a lumpectomy instead of having her breasts removed, she would have had to undergo mammograms and MRIs every six months indefinitely. "It wasn't even the mammograms, it was the feeling of waiting for potentially bad news, and I thought to myself, I don't want to go through this every six months."

When she woke up in the recovery room, she says the first thing she did was look down her hospital gown. "I saw my nipples," she exclaims. "It was so exciting! Obviously, the cancer not spreading was the biggest relief of all, but the nipples just felt like more good news."

She tells the story of her search for plastic surgeons and how a comment she initially thought was "weird" actually flipped her perspective altogether. "He said something about looking sexy and I thought, sexy? Is he kidding?" she shares. 'In my head, I thought my body would never look remotely the same. I had thrown any idea that my body could be sexy again out the window."

But as the surgeon's comment registered, she felt reassured. "It was like someone speaking to me in a way that was like, 'You're going to look good, it's going to be okay.'"

The experts interviewed for this story all have patients with uplifting outcomes like Lauren's, but they also each have anecdotes about the ones they turn away. "Plastic surgery is not for people who don't like themselves," Dr. Matarasso cautions, noting that any good doctor will be able to assess when a patient's needs go beyond the pale of a cosmetic tweak.

"Cosmetic surgery and plastic surgeons help people feel better about themselves," says Dr. Matarasso, noting no one should feel ashamed for wanting that. "That's just human nature."

This is the Glow Up, an examination of the most popular cosmetic procedures and products today, using survey data straight from readers like you.