“Mother” is now an unacceptable body type.
That’s the message sent by billboards depicting a forty-something woman posing with her adolescent daughter. This image is used to advertise the “mommy makeover,” a set of cosmetic procedures targeting a woman’s breasts, tummy, and other body parts that tend to change after childbirth.
The image represents a dereliction of duty. Girls look to their mothers as role models for how they should think about and talk about their changing bodies, and mothers are responsible for building their daughters’ self-esteem. But the message that a daughter receives from her mommy’s makeover is clear: even healthy, natural changes to our bodies should be met with surgical intervention.
The plastic surgery industry promotes the myths that elective cosmetic procedures are harmless choices and that they put people in touch with their real selves. These myths neglect the prevalence of mental health disorders in plastic surgery patients. They also ignore the ways in which everything from screen time to scientific expertise convince people to “get work done.”
Our culture is steeped in language describing a sharp division between our material bodies and immaterial selves. That can make it hard to see what’s wrong with the claims of the plastic surgery industry. But when we understand that our bodies are essential to our personhood, we can also understand the dignity of each of our life stages—and why a mother’s body is something to celebrate rather than make over.
Myth One: Elective Cosmetic Procedures Are Harmless
Both invasive (surgical) and non-invasive (non-surgical) cosmetic procedures are becoming more and more popular. The American Society of Plastic Surgeons (ASPS) reported a 19 percent increase in plastic surgeries from 2019 to 2022. In 2022, there were nearly 1.5 million breast augmentations, buttocks lifts, liposuctions, and other invasive procedures. Meanwhile, non-invasive procedures like Botox and lip fillers were performed around 23.7 million times.
Patients report high satisfaction rates for both plastic surgery and non-invasive procedures, and side effects are rare. Across all surgeries, studies claim serious complication rates of two percent or fewer. With high satisfaction rates and low complication rates, cosmetic procedures appear to create happy, healthy patients.
But high satisfaction rates belie patients’ poor mental health. A meta-analysis of 48 studies found that an estimated 19.2 percent of plastic surgery requests come from people with body dysmorphic disorder (BDD), a condition characterized by obsession over perceived flaws in appearance. For dysmorphic patients, cosmetic procedures can belong to a doom loop: distress over their appearance, surgery, relief, temporary satisfaction, renewed distress, then more surgery. This cycle brings satisfaction rates into question.
JAMA Facial Plastic Surgery reports that “formal screening [for BDD] is not common.” Without a requirement for formal screening, patients who need a mental health intervention are given a surgical one instead. Plastic surgeons treat differences in appearance and normal biological changes as medical problems. When plastic surgeons erase signs that a body has sustained and nourished life, they convince a patient with a mental health disorder that her body, not her self-image, is the problem.
Even patients without diagnosed BDD would benefit more from cognitive behavioral therapy than they would from CoolSculpting. People pursuing cosmetic procedures are a pretty unhappy bunch. But, rather than refer their patients to therapy, surgeons convince them that their wrinkles, aquiline noses, or post-C-section tummies require surgical fixes.
Visit the r/PlasticSurgery forum on Reddit, where moderators tell users that they’re not allowed to dissuade others from plastic surgery, and it’s like reading diagnostic criteria from the DSM-5. The forum chronicles obsessions over tiny imperfections or made-up flaws and shows users caught in the plastic surgery doom loop–behaviors that a therapist might diagnose as BDD. Users discuss chin implants, nipple removal, otoplasty, and forehead reductions as correctives to non-existent problems. Others, dissatisfied with their results, consider additional surgeries.
The Nuffield Council on Bioethics, a London-based think tank, found that plastic surgery patients feel more insecure about their appearance as they age than their non-surgery-seeking counterparts. Additional research from Nuffield shows that people taking anti-anxiety medications and sleep aids are more likely to pursue plastic surgery. In short: plastic surgeons fuel sickness by validating patients’ distorted self-image and then are all too happy to offer a cure.
The iatrogenic nature of an industry that exacerbates mental health issues debunks the first myth—that elective cosmetic procedures are harmless.
Myth Two: Elective Cosmetic Procedures Are Free Choices
To be truly free, a choice must be made without external pressure, with accurate information, and in the right frame of mind. Understanding the degree of freedom present in the choice to get plastic surgery can help us decide when and how to intervene, whether that means dissuading a friend from plastic surgery or pushing for stronger industry-wide regulations.
Patients aren’t truly free in their choice to get cosmetic procedures if they’re pressured into it. It is notoriously difficult to get roles in Hollywood as an aging actress. No one’s holding a gun to an actress’s head, but she may still feel forced to choose between a harmful procedure and losing her livelihood. What’s more, the relationship between appearance and career stability isn’t confined to the entertainment industry, nor is the pressure only on women. Noting the 207 percent increase in men’s cosmetic procedures from 2019 to 2022, the ASPS’s most recent report speculates that the surge is driven by men who are working past the retirement age, who want to “remain competitive in the job market.”
I suspect that people aren’t thrilled to get their faces cut off, stretched, and then sewn back on for the sake of their careers. The actresses and men at the end of their careers are competing for scarce goods (jobs). They see their comparative attractiveness as giving them an edge in casting or the promotion to partner. The problem is that cosmetic procedures’ ubiquity transforms them from a strategy for standing out to a necessity. Normal aging becomes abnormal, so the few holdouts feel ever more pressured into getting work done. Until we normalize natural aging, runaway plastic surgery will worsen, with patients getting increasingly bizarre procedures and at younger ages. (Who would’ve thought that stars in their twenties would remove their buccal fat, a sign of youth, en masse?)
Others convince themselves that plastic surgery is a good idea because they’re surrounded by bad information. The volume of content from the industry, as well as its supposed authority and expertise, can prevent patients from meeting the second criterion for freedom: their choices are well-informed.
A web search of elective cosmetic procedures yields plastic surgeons’ blogs, journal articles written by and for plastic surgeons, and news/opinion sites that cover these procedures from the surgeon’s perspective. Along with industry-operated journals and favorable news coverage, university hospitals prop up the claim that elective cosmetic procedures are harmless choices that put people in touch with their real selves. The Ohio State University hospital, for example, tells patients that plastic surgery can make “your looks better reflect how you feel about yourself on the inside.” With the backing of well-respected institutions, plastic surgeons are no longer charlatans exploiting patients’ insecurities. They’re trusted medical experts on par with the cardiologists who share their building. Few, then, will question the experts when they medicalize differences by treating wrinkles or thin lips as “deformities.” These sources generate and validate the desire to get plastic surgery by feigning credibility and dominating the conversation.
A growing number of patients are coming to regret their procedures once they get offline and return to the right frame of mind—the third criterion for evaluating the degree of freedom in a choice.
Social media algorithms are designed to capture attention by presenting the most extreme desires. Freya India, a Gen Z writer specializing in her generation’s mental health, calls this the “algorithmic conveyor belt.” It starts with filtering photos and clicking on makeup tutorials and ends with a constant stream of ads for Botox and videos of influencers sharing their surgeries. “And where have we ended up?” India asks. “With record rates of cosmetic surgeries … and younger clients than ever before. With young women asking plastic surgeons to make them look like Snapchat filters.” Note the similarities between the pursuit of “Instagram face” among young women and rapid-onset gender dysphoria (ROGD). They are both social contagions, pathologies that take hold and spread within a peer group. Before social media, schools were common sites of spreading pathologies from eating disorders to cutting, particularly among girls. Likewise, girls are especially susceptible to the ill effects of social media, from anxiety and depression to the compulsion to get cosmetic procedures. Often, the decision to get plastic surgery resembles a choice made by someone in the throes of addiction, not someone in their right mind.
Most plastic surgery patients seem to fail at least one of the three criteria for evaluating freedom in choice. Career aspirations pressure them into getting cosmetic procedures; bad information convinces them that it’s a good idea; or the algorithmic conveyor belt addicts them to content about plastic surgery before getting them hooked on the real deal.
To give people true freedom of choice, we can each do our best to talk friends and family out of plastic surgery by making them aware of its harms and the likelihood of regret. Because screen time influences the desire for plastic surgery (ASPS says as much in its report), we must keep teens offline through age verification laws. We should also restrict plastic surgery marketing just as we do other addictive products, such as tobacco. Influencers could play a positive role here, too. By showing off their unadulterated #mombods and signs of aging, they can help make loving our natural bodies seem normal and desirable. TikTok and Instagram users need bite-sized information on the goodness of our life stages.
Myth Three: Elective Cosmetic Procedures Put People in Touch with Their Real Selves
Plastic surgery’s final myth is the hardest to debunk, because it relies on a widely accepted—but deeply flawed—vision of what it means to be human.
The phrase “real self” appears everywhere in plastic surgery. A popular site for patients to find or review plastic surgeons and read industry news is called RealSelf. The ASPS report similarly claims that plastic surgery is about “authenticity,” “self-actualization,” and “empowerment.”
Cosmetic procedures reject the body as it is in favor of the body as it should be (or, at least, as patients think it should be). In doing so, plastic surgery subscribes to a gnostic account of the human person. The ancient heresy of gnosticism regarded the material body as inferior to the spiritual world, even evil. To transcend the material world, some gnostic sects practiced asceticism, or the denial of bodily pleasures through fasting or chastity. Today’s gnostics have updated their practices, using “self-actualization” and other lofty terms to elevate a disembodied sense of the human person.
It is essential to challenge this flawed anthropology. As Mary Stanford observes, “Manifesting the person, the body serves as a symbol par excellence. It ‘presents’ a reality—the whole of which is not entirely material—in a visible way.” Likewise, Erika Bachiochi emphasizes the need to reject the dualistic division of body and soul that dominates our culture today, writing: “Our sexed bodies are not mere appendages of our minds… they express who we are as human persons, a reality that cannot be mechanistically (and technologically) willed away, as hard as we may try.” The experiences of our lives—especially, for women, the experiences of our fertility—inevitably shape both our bodies and our souls. No amount of plastic surgery can erase the passage of time.
Human nature involves passing through life stages that are distinct yet equally valuable. The matriarch helps with childcare and strengthens relationships in her family and community. The man close to retirement is a mentor to his younger colleagues. Advocates of cosmetic procedures, by contrast, present reductive ideas of “man” and “woman” that define the sexes by a snapshot in time or a body part. By the logic of plastic surgery, women should be forever 25, chasing after the look of peak fertility, and men should chase after the look of peak testosterone. Something like the mommy makeover tells women that they’re not really women if their breasts hang lower or if they have a few extra fat cells.
Adults must choose which message they want to send. They can uphold the myths of elective cosmetic procedures by rejecting their bodies’ natural, healthy changes, or they can embrace these changes as part of their humanity. My hope is that the mother-daughter image can be reclaimed. It reminds us that adolescents and children are always watching adults, learning from us whether to embrace or reject their imperfect, always changing, beautiful bodies.
