An increasing number of selfie-obsessed young women are seeking out cosmetic surgery under the guise of "female empowerment." Is social media to blame?

Dr. Simon Ourian told me that if I were to see his old clay sculptures, they resembled the Kardashians so closely that injecting and sculpting the family itself “was almost destiny.” The Beverly Hills plastic surgeon, who rocketed to fame after the entire family admitted to working with him, is at least partly responsible for helping to engineer the signature Kardashian look—an Egyptian-statue-face style that has spread like wildfire across social media.

Ourian himself actually resembles a Kardashian. Whether he was born that way or did it himself is up for debate. But sitting across from him, I felt like I was staring at Kim’s male twin.

“Altering your appearance used to be a sin because it was impossible,” he said. “Like wanting to grow wings, it was madness.”

Ourian admitted that, in general, the Kardashian’s combined Instagram presence helps drive most of his business, and has informed some of his most popular procedures: lip enhancements, facial contouring, brow lifting and Brazilian butt lifts.

“Once we accomplished the lips,” Ourian said, of Kylie Jenner’s transformation, “all of a sudden I noticed that there was a surge in the number of younger people who wanted to get their lips done. A lot of the people from all over the world would come here.” Ourian estimated that 10 years ago around one percent of his patients were in “the younger category” (by which he meant 18-19 year olds), whereas now, that age group has grown to comprise about 10 percent of his patient population. His younger patients bring in photos and announce unselfconsciously, “I want to look like this,” whereas older patients—“and by older, I mean 30s and 40s,” he clarified, staring at me—can’t find the words for what they want. They arrive at his office clutching timeworn photos, wanting to look like themselves, only younger. But 18 to 19 year olds come to him wanting to look “different”—like “someone else,” Ourian said.

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“They bring pictures of themselves that they’ve done on Facetune, or another app.”

Ourian hastened to add that, personally, he doesn’t see patients who are under 18. “For many reasons,” he explained, “but I think number one is having been on the other side.” Ourian wanted a nose job when he was only 15 years old, but “had to painfully wait” until he was 18—and waiting was good, he told me, because during those formidable years, what a young person wants changes every day.

I was so distracted by Ourian’s beautiful description of adolescence—“formidable years” spent waiting “painfully”—that it took me a second to fact check him.



Wait, I thought, after a beat—Ourian just said he didn’t treat underage clients, but he had famously worked on Kylie Jenner when she was only seventeen.

His caveat?

“I know the family,” he said, “and I understand that she’s a very mature person.”

When I sat down with Dr. Ourian, I was hugely pregnant with a little girl and didn’t love the idea of my fetus being born healthy (fingers crossed) only to develop a deeply unhealthy relationship with technology that one day drove her toward butt injections. According to recent statistics released by the American Society of Plastic Surgeons, more people than ever before are getting plastic surgery. Many are doing so to look better in selfies (“our patients are indeed blaming their weird appearance in selfies as a reason to consult a plastic surgeon and seek minor or major cosmetic procedures,” according to an article from the National Institutes of Health), and little girls are going at it, too—traipsing off in their training bras, clutching permission slips from parents to see doctors for booster shots of unregulated chemicals. In 2015, a nine percent uptick in lip enhancements was reported among 13 to19 year olds alone.

The media responded to these statistics with hysterical headlines about “millennials” and “the selfie craze.” But even as I grappled with the uncomfortable idea of my future daughter asking me for bigger lips, I wondered: was this the real epidemic people were making it out to be, or simply another (extreme) fashion trend—a troubling instance of young girls wanting to be pretty as the culture currently defined it, and of parents and doctors colluding to let them? “It’s nothing new that people want to look better,” Ourian said to me before I left his office. “What is different is that now we can do something about it.” He nodded at me. “You are born with your face but you don’t have to die with that face.”

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I wanted to know more about whether the veritable gatekeepers of popular cosmetic trends were actually sticking needles into pre-pubescent cuties, or simply clocking their requests before turning them away—like Ourian claimed to do—and focusing their work on older people, like me. So after leaving Ourian’s office, I called up Dr. Norman Rowe, a high profile plastic surgeon in New York City. During the #KylieJennerChallenge, a 2015 Instagram trend where girls sucked on shot glasses—sometimes until their blood vessels burst—to achieve Kylie’s big lips, Rowe remembers about 50 underage girls pouring into his waiting room requesting lip injections—plus a dozen or so who “needed lasers to take care of the effects [of the shot glass challenge]—bursted capillaries, that sort of thing.” Dr. Rowe agreed to treat the underage girls who’d deformed themselves trying to look like Kylie, but turned away the ones who wanted lip enhancements.

“I think it’s wrong,” he said, of young girls seeking cosmetic procedures that augment rather than repair.

But again, like Ourian who admitted to waiving his usual policies to work on the “very mature” Kylie Jenner, Rowe also has his caveats; for clients who are under 18, he’ll routinely perform what he calls “appropriate procedures.”

“What’s an ‘appropriate procedure’?” I asked.

“They need it,” he said.

“How do you know if they need it?”

Rowe paused before citing one example: “A girl comes in, in 110 degree weather, wearing a sweatshirt because she doesn’t want people to see her double F breasts.” (He also deemed rhinoplasty “appropriate,” but didn’t provide an anecdotal justification for his willingness to give underage girls nose jobs.)

I mostly knew what Rowe meant—the girl in his story was insecure, and uncomfortably overdressed for the weather—but I still found it interesting that someone who cared so much about appropriateness viewed a girl’s not wanting to show her breasts as an argument for surgery.

Instead of feeling reassured by Rowe and Ourian’s hesitance (at least in most cases) to work with underage girls who desired plastic surgery, I found myself pausing at the moralistic way in which they seemed to dismiss that desire as wrong. Might Rowe's willingness to give underage girls nose jobs and breast reductions have more to do with these procedures being old and familiar and socially acceptable? As Ourian had pointed out, the availability of cosmetic surgery normalizes our desire to get it.

In 50 years, will we say of a teenage girl with thin lips, “She needs it”—?

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According to Nancy Jo Sales, an author and journalist who spent years interviewing girls ages 13-18 about their relationships with social media, one of the barriers to having a productive discussion about the unhealthy nature of such relationships is the relatively modern notion that selfies, nude pictures, and lip enhancements are an expression of personal empowerment, or feminism. Sales told me that some of her subjects seemed to have been so conditioned by advertising and media to believe that sexualization equals feminism, that simply asking whether the constant adjustment of their appearance using editing software (then looking in the mirror and seeing the un-retouched image) might be bad for their self-esteem, sometimes left them upset. “Some of them think that even raising the question is being sexist. That's the dirty little trick of this messaging. Anyone who questions whether sexualization is feminism is 'sexist'."

In American Girls, the heavily researched book that sprang from these discussions, Sales nimbly deconstructs this third-wave feminist idea that self-objectification online, and trying to look like a Kardashian, is in and of itself a form of body positivity.

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I liked Sales’ book—in fact, prior to reading it, I’d seen the Kardashians as a kind of matriarchal powerhouse (one in which men were treated as props, or became women, and where women, by virtue of being wealthy business owners, were by definition feminists). But Sales’ book had changed my mind. As she put it to me over the phone: it’s fine to be Madonna and have plastic surgery and call that an expression of your personal agency, but what about when 12 year olds take up the same philosophy as some kind of feminist mantel?

She reminded me of the #KylieJennerChallenge.

“You had all these girls walking around with damaged faces,” Sales said, “trying to get those Kylie…”

She trailed off.

“It’s Kylie, right?” she asked uncertainly.

In Sales’ defense, it’s hard to get all the K-names straight. But it’s also true that anyone younger than us would get them right on the first try. Was our concerned tone when it came to discussing lip injections a marker of age?

I asked Sales whether our collective discomfort with new media and its effect on young people might just be another example of old people freaking out about youth culture.

Hadn’t we been blaming technology for changing patterns of feminine behavior for centuries?

“It’s such a lazy question,” Sales snapped. “That’s such a canard. This technology is unprecedented. MTV videos are not the same as AOL chat, and AOL chat is not the same as sexting on iPhones. You can’t sext with Prince because you’re seeing him on a video! It’s beyond interactive—interactive actually sounds like a 20th century term for the Internet. It’s immersive. You’re inside your phone.”

But Dr. Jennifer Lewallen, PhD. tended to agree with my growing hunch that blaming Instagram for female insecurity in general is a little like blaming Twiggy for anorexia.

Kim Kardashian, 2008 and Kylie Jenner, 2012. Getty Images

Lewallen wrote a paper about the effects of Instagram on social comparison, and discovered a distinct relationship between perusing photos online, getting insecure about one’s looks, and then fantasizing about changing one’s appearance. But she told me that women have always done this; Instagram, by virtue of proliferating millions of such images for free, simply affords greater opportunity than ever for such comparisons.

“We know it’s pervasive in our culture that women are objectified, and issues of body image have been around for quite some time,” she said. “Social media is taking the blame for phenomena that already exist.”

In other words, ladies suffer for fashion. We have for a long time—and our desire to self-improve, often at our own peril, predated our logging onto social media. Roman women smeared arsenic on their faces to smooth fine lines. During the Victorian era, dressmakers mixed arsenic with copper to create vibrant, emerald green, which was on-trend at the time, and women who wore the green died horrible deaths—vomiting green, seeing green and eventually turning green before they perished. Today, women in the Kayan Lahwi tribe, called “giraffe women” by tourists, still wear brass coils stacked so high on their necks that it eventually becomes impossible for them to remove the coils, or they will die (because their necks are so long and weak), but no one blames the masochistic tradition on giraffes. Imagine staring up at one of them and saying, “Kylie Jenner did this to you.”



How do you win in a society that called Kylie ugly when she was natural and fake when she tried to fix the things we’d criticized her for?

Kim and Kylie, 2017, for their new cosmetics line. @kyliejenner

One way is to hide the fact that you’ve tried at all.

In a research paper published in 1950, authors discussed how “customary” it was for young people in metropolitan areas to get nose jobs, and went on to claim, with a tone of faint alarm and wonderment, that brand new psychological forces were driving rhinoplasty trends. Using the male pronoun, but really referring to women, the authors wrote, “None [of the patients studied] wanted to be transformed into a creature so startling that his friends would fail to recognize him. A vague, subtle, mysterious change was hoped for which would have magical effects upon all within in range. In many cases, the surgical processes were regarded as ordeals to be survived from which would arise a new self capable of personal success”—as if, before then, patients underwent rhinoplasty to feel pain, to fail in their various careers, and to look like monsters.

That young people seek out plastic surgery, a practice we tend to associate with aging, should not be so surprising. Not only is a pubescent or post-pubescent person going through the most striking physical changes at the most psychologically sensitive stage imaginable, she’s also at a time in her life where, being in the midst of such aesthetic upheaval, she might undergo cosmetic surgery and get away with it—which is to say she could get her lips inflated, or her nose shaved down, or her breasts reduced, and everyone around her might attribute the change to the rebalancing or hormones, puberty, and mother nature, rather than to some vain choice.

Were the young girls currently considering more modern procedures really more impressionable than any other previous generation of women?

The only way to find out was to talk to them directly.

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“Kylie stays true to herself. There's something to be said for that,” argued Gabi and Niki DeMartino, 21-year-old twins and beauty influencers, who’ve been on Instagram for so long that their handles are simply @Gabi and @Niki. The DeMartino twins have about four million Instagram followers between them, and, although identical, they look different—mainly due to Gabi’s public decision to get lip injections.

“in my bedroom sits a vanity with many many un-used lipsticks,” she wrote in a statement posted on Twitter in 2014. “why? well obviously you all have noticed that i don't have lips. i read it in the comments all the time.”

When I asked Gabi and Niki (via email, through their publicist) whether the reported rise in young people seeking out cosmetic procedures shocked them, they responded abstractly, and in unison: “[Instagram] can make people want to get work done and it can also help to empower women.”

I heard this over and over again in my conversations with young Instagram users who’d undergone cosmetic surgery—that, sure, selfies and Instagram enhanced the desire to get cosmetic procedures, but selfies and Instagram and cosmetic procedures were also “empowering,” because…

Well, nobody could quite explain that part to me. The word “empowering” seemed, more than anything, like a way to deflect questions and shut down the conversation about cosmetic work altogether—because despite photographic evidence posted on Instagram, and actual confessions published on Twitter in lowercase letters, part of the game of getting cosmetic work still involves pretending you never had it—that you simply woke up prettier, because of God. Femininity remains inextricably entwined with notions of modesty. Effort is unattractive. Good plastic surgery looks like you never had it done. It’s all tied up with the myth of natural beauty. So, ironically, while we’re all purportedly very proud of our decisions, none of us want to own up to them.

Niki (left) and Gabi (right) DeMartino. @niki

It looks like Blake Lively underwent a nose job or two, but that’s not what she talks about in interviews—probably because it conflicts with the earth mama persona she operates under. Supermodel Bella Hadid also appears to have had work done as a teenager, but that decision, although assiduously dissected by media for at least three years now, is still referred to as “alleged” or “rumored” because Hadid refuses to discuss it interviews, and her publicity team outright denies the claims—probably for the same reason Blake Lively’s team calls the nose job rumors untrue: because depending on who you are—and especially if your career hinges on being beautiful, copping to cosmetic surgery feels “off-brand.” In our supposedly progressive, Internet-entangled society, calculated oversharing online is couched as a form of personal branding; beauty influencers are also expected to be professionally honest—or “always 100 percent ourselves,” as the DeMartino twins put it to me—and cosmetic procedures, regardless of how many people tell you they’re fine with it, that women should do what they want, are seen as superficial, vain, and off-brand for anyone whose job it is to be professionally themselves.

If it’s empowering, then why is it a secret?

One night, after poring over the Instagram accounts of Internet-famous teenagers who were rumored to have gotten “stuff done,” and whose publicists would not return my emails, I began to consider getting “stuff done” myself. “Would that be crazy?” I asked my husband before bed. “Not again,” he said—at which point I remembered that I’d already done a round of botox and fillers, about three years ago, but in keeping with the ethos of plastic surgery, had kept it such a secret that I’d apparently forgotten it myself. It had not been easy to forget. The results had been traumatic—something about how the foreign substance slid around my muscles made it hard to smile afterward, and although I had no wrinkles in my wedding photos, I also looked stricken and insane. Weeks later, my husband actually started to cry, saying he missed my “old face,” and I snapped at him to “pull it together! This is harder for me than it is for you, and it’s temporary, and I’ll never do it again.”

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Yet here I was, wishing for the same stuff all over again—just because I’d spent too much time looking at pretty girls on Instagram—and I’m a grown-ass woman with a Harvard degree. I love my job. I am happily married to a person I feel cherished by. Yet I’m vulnerable to the same sinister forces that are compelling young girls to make startling changes to their fresh, young, healthy, perfect bodies. Scientifically speaking, I have better executive functioning, better impulse control than your average teenager. Just imagine how enticing it must be for her.

Ultimately I reached out to around 40 young, social media influencers rumored to have gotten “work done,” but Gabi and Niki were the only ones to even respond once they heard what the article was about. And although a few more young, non-celebrities agreed to speak to me, most requested pseudonyms. Yet they all used the word “empowerment” at one point or another—and in a way, that word, when used to discuss and justify cosmetic work, began to feel more insidious and potentially dangerous to me than the ways in which social media had influenced their choices. They’d paid to have their lips plumped or their noses shaved down for the same reasons that Victorians had died wearing green. Yet they couldn’t admit a very simple, girlish truth: that they care—deeply—about what other people think.

Megan, a 24-year-old who works in media told me she viewed her decision to get rhinoplasty as a “feminist act.“ ("Part of body positivity is accepting that there are certain things you dislike about your body…That’s what’s empowering.”) Loren, a 24 year old, who also works in media (and wanted to use a pseudonym because “there’s a stigma around plastic surgery”), got a breast reduction when she was a teenager, and now plans to get a nose job—but she has misgivings about the rhinoplasty, in part because it conflicts with the image she’d like to project online. “It feels like I want to be the kind of person who’s like, ‘accept yourself,’” she said. “But then why would I undermine that message by getting plastic surgery?” She acknowledged that she isn’t a celebrity—“It’s not like I’m a role model for anyone. But it’s a circular logic: seeing myself and wondering whether [the nose job] fits with how I want to present.”

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This sense of third person awareness permeated all my conversations with young Instagram users, making our interviews frustratingly repetitive and formal. Since I was planning to write about their decisions, I wanted to include them in the conversation, but I felt like I was getting a lot of sound bites. Because regardless of how open-minded we pretend to be about another person’s decision to get “work done,” we’re still conflicted. Just like in the 1950s, when people wanted natural looking nose jobs, the dream of plastic surgery is still for no one to catch you doing it. Effort, or the appearance of it, belittles the beautification process. It’s something to do with that unrealistic confabulation of modesty and perfection that’s endemic to girlhood. We must always look amazing, but trying is cheating, and cheating is ugly.

In other words: cosmetic procedures may appear to be less stigmatized in the sense that they’re more available than ever before, and philosophically, the women I spoke to said that everyone should do what they want. But cosmetic surgery itself is not out in the open—it remains a closeted procedure. Kylie Jenner admitted to getting lip injections—to temper her insecurities around kissing boys—but only after being hounded and berated for it online for about a year, and only then, I think, to throw the press a bone. She could use the injections as a stand-in for all the other work she’s gotten done, none of which she’s admitted to getting. Most importantly, she only talked about it because keeping it a secret had come into conflict with her personal brand, which, like any reality TV brand, is caught up in breaking down the fourth wall and showing the real life of star. Bella Hadid and Blake Lively are not reality stars. They don’t need to own up to their plastic surgery in order to keep fans engaged or to sell product. Can we blame them for their reticence to speak about the darker professional necessities of their job? It’s part of their career to look perfect, and if they don’t look perfect, we tear them apart and they can’t get work. But what are lip injections doing for the careers of 13 year olds?

Is it just teaching them, and reminding us, that beauty is currency?

And is that what we’re ultimately most upset about? —That these youngsters are holding up a mirror to what we hate most about our society, and ourselves? In order to ignore what they’re reflecting, are we pretending that they, and not us, are the problem?

Whether we use our bodies to promote “natural” looks or to privately embrace synthetic ones, we are still leveraging our appearances as vehicles for identity. And as long as fashion remains an expressive business, it’s neither feminist nor sexist nor pathological, just another indicator of our sometimes empowered, sometimes vulnerable—but always human—need to be seen, and accepted.

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Whether or not she was famous, every girl I spoke with about her cosmetic surgery responded like a well-prepped celebrity, hitting all the trendy talking points like body positivity and feminism, terms that have become at once fashionable and meaningless. Everyone admitted that social media probably played a part in her decision to get cosmetic procedures. Everyone admitted that being on Instagram often made her feel insecure. But no one would admit to getting cosmetic surgery because of that insecurity—because that’s off brand. Insecurity isn’t marketable—it doesn’t jive with our stylized version of feminism—and most of all, it isn’t pretty. You can dress up plastic surgery however you want—you can give it feminist injections—but we do it because we doubt ourselves. And in an age of carefully curated, branded self-expression disguised as honesty, that’s the one thing women aren’t talking about—the eternal truth that predates even my Stone Age 80s birth: there is nothing less attractive than a lack of confidence. And there’s nothing feminist about plastic surgery. It’s just female.

