Beauty products, cosmetic procedures, and plastic surgery seemingly advance a single goal: to change your appearance. Yet physical alterations are often promoted by celebrities, doctors, and patients as a psychological intervention. “What you are doing is reconstructing or recuperating [a patient’s] self-esteem, which is not superficial,” the world-famous Brazilian plastic surgeon Ivo Pitanguy has said. “It is deeper than skin.”
These days, the belief that “getting work done is self-love” (to paraphrase one Texan plastic surgeon) is everywhere. It’s the subject of numerous scientific papers, many of which have claimed that plastic surgery boosts “enjoyment of life, satisfaction, and self-esteem.” It’s bolstered by pieces in national news outlets that draw a connection between the mental health of teen girls and their physical appearance. (To some surgeons and parents, “the opportunity to transform a teenager with low self-esteem and a crooked nose into someone with self-confidence is often justified,” the New York Times reported in 2009, “because a well-timed operation could prevent destructive behaviors, including eating disorders, bullying and self-mutilation.”) And it’s reinforced in corporate branding and direct-to-consumer advertising: “Everyone deserves to look and feel their best,” claims the website copy of “cosmetics bar” Alchemy 43.
All of these examples serve to position such apparently superficial interventions as one point along a continuum of “wellness”—an improvement to the body that results in a healthier mind and more peaceful spirit. You might suspect that this is not exactly how a nose job would really work for your friend who can’t stop scrolling plastic surgery Instagram … but maybe another part of you thinks that you would be a little happier if only your chin were just a little sharper? (Because that’s exactly what I mean when I talk about the purely cosmetic in this piece: While the boundaries are in fact porous, I do not intend to critique surgery that is reconstructive or gender-affirming, but rather the elective procedures that mold the body to trendy beauty ideals.) Indeed, the question of whether and how cosmetic treatments enhance a person’s well-being remains open—and it’s all the more difficult to answer given that the beauty industry isn’t, of course, actually out to make you feel better.
It’s a peer-reviewed truth that cosmetic procedures can be a confidence boost, at least in some instances. In a 2018 study in the journal Dermatologic Surgery, for example, Joseph Sobanko—an associate professor of dermatology at the Hospital of the University of Pennsylvania—and his colleagues looked at how using injectable fillers to reduce signs of aging affected their patients’ sense of self. The researchers surveyed 75 patients, before and after receiving the fillers. To measure body image satisfaction, people filled out the Derriford Appearance Scales, which asks them how they respond to questions or statements like “How distressed do you get when you got to the beach?” By this measure, body image improved for 75 percent of patients post-filler—a huge boon. But self-esteem, measured with the Rosenberg Self-Esteem Scale, which asks people to rank statements like “I feel I do not have much to be proud of,” remained unchanged.
There are many ways to interpret this data. One may be that self-esteem, at least as precisely defined by psychologists, isn’t actually a presenting problem for people pursuing plastic surgery (in this small study anyway). Notably, the patients in Sobanko’s study had an unusually high mean self-esteem score of 24.7 (out of 30 possible points on the Rosenberg scale) before getting filler. Instead, plastic surgery and surgery-lite might affect body image—itself a complicated term, both deeply personal and difficult to separate from larger social and commercial forces. Importantly, Sobanko says that patient outcomes depended a lot on their expectations going in. Filler recipients who believed a quick doctor’s visit would radically change their faces were inevitably disappointed, while those who looked forward to more modest improvements likely fared better in the long run.
The fact that Sobanko’s work separated out self-esteem and body image remains instructive, in that it untangles “feeling good about one’s self” from “feeling good about one’s body.” While a change to the body may help someone feel better very specifically about their corporeal form, it does not necessarily alter their overall sense of well-being—or when it does, the chain of causation is complicated. That we would even expect a cosmetic enhancement to alter our inner selves is a modern notion, says Heather Widdows, a moral philosopher and author of the 2018 treatise Perfect Me: Beauty as an Ethical Ideal. In the 19th century, people journaled about wanting to change their inner selves—to be slower to anger, or more pious. While the opportunity to transform through fashion and makeup has long been alluring, today women and, increasingly, men overwhelmingly emphasize their desire to improve their physical selves—shinier hair, smoother skin, and smaller bodies make up our New Year’s resolutions.
At some point in the intervening century, the body has effectively become the self, Widdows argues. And that means improving the body is now a moral imperative—a thing of great importance, a reason to act, a way of signal one’s inherent goodness to others, and a way of, maybe, feeling some of that inherent goodness in yourself. But as almost everyone knows from lived experience, the stakes of having a “good body” can feel perilously high: The body-as-self has infiltrated every aspect of life. People feel they must be beautiful (or any number of other synonyms, including “toned” and “healthy”) to be a good bank teller, spouse, or parent.
This isn’t the fault of the individual, or an accidental shift in cultural moors—there is an entire system of goods and services and images that have made things this way. “Beauty products can only replace the confidence that beauty standards stole,” says beauty writer Jessica DeFino. And of course, a main driver of beauty standards are the people and corporations hawking the beauty products that claim to help you achieve them. If the world has convinced someone there’s something wrong with their thin lips, then plumping them very well could be a confidence boost—but only because thin lips were made shameful in the first place.
Unfortunately, this dance of depleting people’s well-being—and restoring it through increasingly expensive external means—creates a situation in which one person’s confidence boost routinely comes at another person’s expense. “They might ease age anxiety for the individual who gets it,” DeFino says of cosmetic interventions, “but it actually compounds the issue for the collective.” And when anyone can walk into their neighborhood medispa or create an account at a direct-to-consumer online pharmacy and come out with new weapons in their anti-aging arsenal, “more is required just to be good enough,” Widdows writes, “which results in the narrowing of what is acceptable or normal and a parallel expansion of abnormal.” The plumped limp is, suddenly, everywhere—and your perfectly normal lips suddenly feel not so great.
That the beauty ideal can never be achieved is obvious. But whether you’re getting filler or proudly resisting it, the ideal still defines us. That’s a problem we can only solve together, says Clare Chambers, a political philosopher and author of Intact: A Defense of the Unmodified Body. Chambers writes that people have the right to modify their bodies, but they “also have the right to live in a society that does not constantly tell us that the bodies we have are wrong.” Getting there is tricky, but Chambers is hopeful that the rise of the body neutrality movement, more forceful regulation of DTC cosmetic companies and their ads, and changes in our “visual diets” (so that we actually see images of disabled bodies, fat bodies, and otherwise marginalized bodies—in other words, the natural diversity of the human form, and not just the modified bodies of models and celebrities) are a good start. Together, they offer a glimmer of a world in which our corporeal forms might be freed from the binary of confidence or shame. That is: Our bodies could simply exist. And we can get our self-esteem elsewhere.