A Deep Dive Into Gen Z’s Relationship With Cosmetic Procedures

Studio portrait of fashionable Gen Z woman

Getty Images / We Are

Born between 1997 and 2012, Generation Z grew up wired to the internet. They've spent their days Googling, YouTubing, and elevating selfies to an art form. Their early and constant exposure to screens made connectivity a way of life and provided them with a new lens through which to see themselves—along with infinite ways to enhance the view.

Gen Z's coming of age also coincided with the rise of modern cosmetic treatments and the mainstreaming of plastic surgery, making these digital natives bona fide aesthetics natives. "They've been brought up in an era where it's very much the norm to get plastic surgery," says Dr. Richard Reish, a board-certified New York City plastic surgeon specializing in rhinoplasty, which is the most frequently performed surgical procedure among teens and 20-somethings. 

The normalization of plastic surgery has fostered an uncanny level of comfort with procedures, ushering Gen Z into exam rooms at an unusually early age. "They're really going forth unafraid into the world of medical aesthetics," says Dr. Lara Devgan, a board-certified plastic surgeon in New York City. "Whereas Millennials were curious and research-oriented and Gen X and older were more reticent and cautious, the Gen Z patients in my practice are forward-thinking and open—to experimentation, invasiveness, risk, and downtime."

The Gen Z Aesthetic

Dr. Devgan notes that the Gen Z aesthetic is somewhat hard to characterize because their tastes are distinctly variable. "They're more fluid in their thinking—less rigid about what is feminine and what is masculine, what is beautiful and what is not." She views their "niche and individualistic" preferences as a sort of reaction to the looks popularized by previous generations. "Gen Z has truly leaned away from 'Instagram face' and anything cookie-cutter," says Dr. Devgan. In rejecting past trends and classical archetypes, she adds, "they're able to try on uniqueness as expression, and that lends itself to more bespoke types of outcomes."

Dr. Camille Howard-Verovic (a.k.a. @dermbeautydoc), a board-certified dermatologist in New York City, also paints the Gen Z patient as unconventional. "They intuitively challenge the idea of ideals," she says, particularly those related to textbook notions of symmetry and proportion. When choosing Botox or fillers, they usually make small adjustments that align with their identity, not some arbitrary beauty standard. 

These traits and attitudes seem to transcend geography. According to Dr. Karan Lal, a double board-certified pediatric and cosmetic dermatologist, the Gen Z patients who visit his Scottsdale, Arizona clinic predominantly "want to look like themselves"—not clones of friends or famous faces. They're clear about their goals, and their vibe is refreshingly nuanced. If they feel their lips are a little thin, they'll try injectables, he says, but they'll emphasize contours and eversion over volume alone.

For Gen Z, "tweakments" are a form of self-care, and "they're applauded instead of stigmatized," says board-certified Seattle dermatologist Dr. Joyce Park (@teawithmd to her nearly 500K TikTok followers). "Getting Botox, which is a go-to procedure for Gen Z, is considered part of their regular skin-care maintenance rather than a way to treat wrinkles."

Frozen foreheads are a hard pass. And "anti-aging" is not in their vocab. But "they have definitely bought into the concept of prejuvenation," reports Dr. Kavita Mariwalla, a board-certified dermatologist in West Islip, New York. This includes getting baby doses of neuromodulators to stave off burgeoning expression lines. "They want to own this part of their life in terms of how they age and what they can do to best modulate it, whether it's topicals, supplements, or procedures," Dr. Mariwalla notes. 

Complexion concerns are a top priority for this age group, adds Dr. Lal, noting that the vast majority come in wanting to minimize pores and acne scars with chemical peels, non-ablative lasers, and microneedling. To bolster results, he says, "they all use sunscreen and topical retinoids at home."

Similarly obsessed with skin texture, Dr. Howard-Verovic's youngest patients are big into lasers and radiofrequency (RF) microneedling devices, like the Morpheus8 and Secret RF, which promise to smooth skin. This zest for procedures spans ethnicities in a way she's never seen before. (Gen Z is known to be the most racially diverse generation in U.S. history.) "When I was younger, aesthetic treatments weren't something we talked about in the house at all," she says. "But this generation, across ethnicities, they're all more informed."

Misinformation and Skewed Perceptions

However, failing to consider the source is often commonplace when investigating procedures nowadays. "There is a lot of misinformation on TikTok, which is where the majority of Gen Z gets their information," points out Dr. Catherine Chang, a board-certified plastic surgeon in Beverly Hills, California. 

Ironically, adds Dr. Mariwalla, Gen Z patients will fall for myths touted by non-experts on social media, yet they'll question a medical diagnosis from their board-certified dermatologist. Perhaps empowered by a steady intake of skincare content, they tend to resist "the traditional doctor-patient relationship—meaning: we know, we tell you, and you do what we say," explains Dr. Howard-Verovic. Instead, they want a provider who is more of a collaborator or sounding board than a sole authority.

Other physicians also noted glitches in the typical Gen Z research process. For example, in Dr. Reish's experience, many nose job-seeking Gen Zers are easily duped by fake before-and-after photos. "They'll find a surgeon on TikTok or Instagram who filters all of their results," he says. "Or, they'll be drawn in by a 3D simulation [a photoshopped image of their nose] rather than real results—which is extremely dangerous in rhinoplasty." Dr. Reish attributes the rise in teenage revision surgeries primarily to inadequate research. 

Dr. Dara Liotta is a board-certified facial plastic surgeon who performs nose jobs almost exclusively. In her New York City practice, she's seeing a "huge increase in younger patients requesting rhinoplasty"—many of whom have unrealistic nose goals, fueled by a heavily filtered digital diet. "I think Gen Z patients feel like nobody else has to filter or Facetune their pictures as much as they do," she says. Despite their digital savvy, "they somehow don't understand that 98% of what they're consuming visually is not reality, [which has caused] this crazy increase in expectations of what you should look like when you wake up in the morning."

According to a 2021 survey, 62% of U.S.-based Gen Zs routinely use filters. The nagging urge to filter images when they'd rather be natural only sharpens their focus on bothersome features. "Every time they take a selfie and feel like they have to filter it, it's turning up the dial on the desire for surgery," says Dr. Liotta. "And the drive for surgery to make you look filtered—an unattainable goal—is high and super-emotional." 

She says prospective patients occasionally bring inspiration images of extremely filtered or stylized noses—currently, the scooped, upturned nose is trending. "It's visually impressive, which plays well to this generation," Dr. Liotta notes. "It exaggerates the way light hits you in a photo." IRL, though, the overdone nose is pinched and unnatural-looking and can age the face over time. But for many Gen Z patients, she says, "they almost care more about what they look like in a picture than in person."

In the dermatology realm, too, there's sometimes "a skewing that happens due to TikTok and Instagram filters, where people still want to look like their selfie version," Dr. Mariwalla says. She warns of a "potential for dysmorphia" in this group, related (in part) to their reliance on tech. "They use their iPhones as mirrors, not realizing the distortion the camera creates, especially in the midface and nose," she says. "Mirrors [offer] a truer depiction."

How to Approach Cosmetic Procedures

Based on our doctors' generalizations—and, to be fair, they are just that—Gen Z is enthusiastic, confident, and transparent about all things aesthetics. They're tuned in to treatment options, and their skincare literacy is off-the-charts. They're also a study in contradictions. They can be informed but not properly educated. They can value authenticity but not always exemplify it. They may be torn between embracing an unvarnished individuality and maintaining the airbrushed status quo. But who's to say they can't be both candid and curated?

Like every generation, Gen Z is a product of the times. And beauty has never been more complex—from the untold ways we can modify our looks to what it all means for our identity and esteem. To elucidate the journey for cosmetic newcomers, we've rounded up expert advice for skirting the most common pitfalls and getting the results you want.

Do Your Research

First things first, don't use social media to find your doctor. On these platforms, where "anyone can be a self-proclaimed beauty expert, it can be difficult to assess who is actually qualified to do your procedure," says Dr. Park. 

Instead, ask friends for referrals or use reputable organizations like the American Academy of Dermatology, The Aesthetic Society, or the American Academy of Facial Plastic and Reconstructive Surgery to locate a licensed derm or surgeon. This handy website, run by the American Board of Medical Specialties (ABMS), also makes it easy to confirm any U.S. doctor's board certification status. Depending on the procedure you're getting, you'll want a physician who's board-certified in dermatology, plastic surgery, otolaryngology (head and neck surgery), or ophthalmology (for eye-area concerns).

When meeting with doctors, Dr. Park suggests asking where they completed their training, how they diagnose and manage cosmetic complications, and what kind of experience they have treating different skin colors and types.

In most cases, adds Dr. Lal, "medical spas are not the way to go if you're trying to get the best benefit from your hard-earned money."

Seek Specialists

If you're seeing a dermatologist for injectables, lasers, and the like, be sure they're a cosmetic derm (not strictly a medical derm) who frequently performs your treatment of choice. It helps if they have a varied armamentarium of tools—an extensive selection of devices and injectables—so they can truly tailor your treatment. 

The field of plastic surgery is a bit more involved. There are general plastic surgeons who are qualified to do cosmetic and reconstructive procedures across the entire body, from head to toe; facial plastic surgeons (or otolaryngologists/ENTs) trained exclusively in facial plastic and reconstructive surgery; and oculoplastic surgeons who operate on the eyelids and brow.

Many aesthetic surgeons specialize beyond these parameters. Plastic surgeons will often choose to treat only the breasts and body. Within that group, some carve out subspecialties, becoming known for their tummy tucks or breast work. Likewise, facial plastic surgeons commonly have niche practices built around rhinoplasty or deep-plane facelifts.

As you can imagine, specialized surgeons tend to shine at their signature procedure. By immersing themselves in the anatomy of a particular area and honing their craft, day in and day out, they develop the know-how to produce reliably great results—and to correct less-than-stellar outcomes, which is an even more exacting skill.

Most of the teens who call on Dr. Reish for revisions originally got their noses done by surgeons who were not rhinoplasty specialists—usually because their parents were driving the research, he says. "What often happens with younger patients is that Mom had a breast lift in the past, so she sends her kid to that surgeon, even though they don't do noses all that often—and then the patient gets a terrible result and ends up needing a revision," he explains.

Be Critical of Before and Afters

Social media is awash in deceptive B&As, with unscrupulous providers enhancing their afters with filters, editing apps, and lighting and camera tricks. Equally misleading are posts comparing bare-faced before photos to fully made-up afters. Same for on-the-table pics taken in the operating room, immediately post-op, absent any swelling or healing: "Those are meaningless," Dr. Reish says. "If you're looking at a surgeon's page and that's all you see—that's a major red flag."

He recommends reviewing B&As on surgeons' websites, not their social accounts exclusively. "Most doctors don't mess with websites," he says. "If they're going to alter photos, it's going to be on Instagram or TikTok. But you should be able to go on a surgeon's site and see hundreds of real, unedited, non-photoshopped B&As." 

Look for multiple views of standardized images (not selfies) with consistent lighting, focal length, patient positioning, and facial expressions. After photos should show long-term results that are months to years out from surgery.

Consider a Consultation

"Gen Z should embrace that consultation moment, where you just talk with your doctor about what you're thinking, without any pressure to get work done that day," says Dr. Howard-Verovic. Part of ensuring a great experience, she adds, is discussing not only the benefits of treatment but the risks as well.

Don't Chase Trends 

You've heard it before, but it bears repeating: Your body is not a trend. The tilt of your eyelids, the contour of your buccal sulcus, or the size of your butt shouldn't be subject to the whims of fashion. "If you're going to have a cosmetic procedure, do it because you like the look of the desired result—not because it's 'in' right now," Dr. Park says. Even then, be sure the intended effect will suit you and live in harmony with your other features.

Think Better, Not Perfect 

To paraphrase elementary school teachers everywhere: There's no such thing as perfect. And in aesthetics, "the pursuit of perfection can cause a very slow decay of self-confidence," cautions Dr. Howard-Verovic. 

While your doctor should strive to deliver the best possible result, "as a patient, you want to be thinking of your outcome as an improvement over a baseline," says Dr. Devgan. "If you think of it as a shortfall from perfection, you'll never be happy; you'll never find fulfillment." 

This advice becomes especially poignant with age as time transforms the topography of the face, creating shadows, nasolabial folds, and hollows under the eyes. "These are natural anatomic features," Dr. Devgan points out. Without them, we hardly look human—yet it can be tempting to try to erase them. "We need to make peace with signs of normal aging," she says. 

Go Slow

When refining your appearance via syringe or scalpel, "you want to slowly achieve your endpoint in a way that allows you to have a safe and predictable outcome," Dr. Devgan explains. There's value in doing less and making smaller moves. When in doubt, she adds, "it's never the wrong answer to sleep on it."

Respect Surgery

"With Gen Z, there seems to be this feeling like injections and surgery are no big deal," Dr. Liotta tells us. "It's nice to have procedures not be stigmatized, but I'm constantly struggling to convey that surgery is serious, even though you can encapsulate it in a 45-second TikTok." 

It's crucial to consider the risks of an operation and the nitty-gritty of the recovery period. Above all, realize that plastic-surgery regret is real. While "reversal" has become a beauty buzzword of late, the truth is, "you can't get a million revisions and change into whatever you want," Dr. Liotta says.

The best way to avoid the spiral of a bad outcome is to be sensible and specific about your goals from the outset, she adds, and to think carefully about how your aesthetic ambitions might evolve.  

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