America's plastic surgery heyday

• "Both men and women want to look good. They want to look refreshed ... But they don't want to have that operated look," Bob Basu, president of the American Society of Plastic Surgeons, tells Axios. The American cultural aesthetic "is moving towards more undetectable plastic surgery."
• Not even the financial anxiety of COVID (and staring at yourself on Zoom) slowed people down. In fact, it sped them up; researchers have found a correlation between time spent online and desire for plastic surgery. As stigmas faded, more ordinary people in their 20s and 30s said: Never too early, me too.
• "As the world becomes more virtual, and therefore more visual, we are really living through images. And the main quality of an image or a video is that it's really stuck in time. And this is becoming the beauty ideal," Jessica DeFino, beauty critic and writer of the "Flesh World" newsletter, tells Axios.

How we got here: Several forces collided to make plastic surgery more mainstream, even as it reinforces narrow ideals around body size and youth.

• The GLP-1-era: Weight-loss drugs like Ozempic fuel demand for "maintenance" work to tighten skin or restore lost volume often called "Ozempic face."
• Tech advances: Better equipment and skill has yielded faster recovery and subtler results.
• Medspa surge: Botox and fillers are now buy-now-pay-later routine care, backed by private equity in a market exploding across urban centers and suburbia.
• Influencer effect: Certain doctors and procedures are viral or day-in-the-life content.

The money quote: After attending Paris Fashion Week, New York Times Styles editor Stella Bugbee reflected on the thin bodies on runways and in the audience: "Is it worse than what I'm actually seeing people voluntary do to themselves? ... I can't read another story about how happy someone is with their facelift at the age of 37."

State of play: Younger patients are bringing the cosmetic surgery industry a fresh round of potentially lifelong customers.

• "Preventative Botox" is popular on TikTok, and 20- and 30-somethings are now getting facelifts and injections. Gen Z made up 20% of the overall "minimally invasive" skin treatments (using combination lasers) in 2024, according to the American Society of Plastic Surgeons.
• More than 142,000 people aged 20 to 29 got injections like Botox, while more than 141,000 got hyaluronic acid fillers.

• Men outnumber women in categories like hair transplants, though more men are getting procedures for post-weight loss maintenance or to modify the face. A small segment are "looksmaxxing," an aesthetic trend born in incel circles that's based on improving one's "sexual market value."

Zoom out: Botox, which changed beauty culture in the early 2000s, is booming — and it's no longer taboo alongside premium procedures like the deep-plane facelift.

• Botox "forever changed the way that we think about aging faces," Dana Berkowitz, author of "Botox Nation," tells Axios.

Celebrities and TikTok took it all a step further; whether we like it or not, we're keeping up with the Kardashians.

• "It's no longer enough to know if someone went under the knife," Harper's BAZAAR beauty director Jenna Rosenstein wrote earlier this year. "We now want to know what they did and who did it."
• She adds: "In my decade-plus as a beauty editor, I have never been asked about facelifts more."

The big picture: The U.S. has historically lagged behind other countries on cosmetic surgery openness, which has led to medical tourism abroad. But with GLP-1s, medspas and AI-driven innovation, that demand looks more set to be met at home.

• "I can't imagine what technologies we will have available at our fingertips in just 10 to 15 years, because AI accelerates scientific innovation," Basu says.

The bottom line: Plastic surgery is still surgery.

• "The priority should be safety and quality and not cost," Basu says.