The first thing you notice is the lips. No, the eyes. Well, not so much the eyes themselves, but the eye region: the plump cheeks, the bold brow, and the plumed lashes offset by all that dewy, sculpted skin. Maybe you see beauty. Maybe you see artifice. Maybe you want some of it anyway. The good news? You have options.
We’re living in the age of facial tweaks. In addition to the rising number of masks, serums, and contour kits we’re buying, a growing number of American women are taking it a step further and seeking treatments that won’t rinse off in the pool. According to the latest report from the American Society of Plastic Surgeons, the use of minimally invasive cosmetic procedures grew by 186 percent between 2000 and 2017. The favorites include Botox, up 819 percent in the same period, fillers, up 312 percent—collagen is out, hyaluronic acid, in—and laser-skin resurfacing, up 244 percent. (Botox and other neurotoxins temporarily paralyze muscles, which leads to a softening of the wrinkles those muscles create. Fillers, which plump skin, add volume to lips and cheeks, fill out the area around the eyes, and smooth wrinkles.)
Meanwhile, the “going under the knife” variety of plastic surgery is down 6 percent in the same timeframe, with nose jobs down 44 percent, chin augmentation down 40 percent, and eyelid surgery down 36 percent.
So how, exactly, is all this reflected in the faces of the women around us? We know the answer in big, coastal cities, where many women are inspired by their reality-TV-star neighbors and tend to go for a more-is-more approach when it comes to their faces. While they may not go full Kardashian-Jenner-West, the family’s influence is evident, especially in New York and Los Angeles. But what about the rest of the country? Are women elsewhere seeking out Botox and fillers with equal gusto? And, if so, are they looking for a radical transformation? Or subtle tweaks to their “problem spots”?
Glamour.com reached out to plastic surgeons, medical spa employees, and women in eight states across the country to learn what treatments local women are turning to, and what they’re hoping to achieve with them.
Plastic surgeries and cosmetic procedures remain rare in New Hampshire, which seems to have the most trigger-shy women among the states we surveyed. And when women do go under the knife or needle, they don’t like to talk about it—with each other, other the press. Many of the plastic surgeons and medical spas that we reached out to refused to speak with Glamour.com. This didn’t happen in the other seven states.
“Women here are more skeptical and conservative,” said Dr. Lawrence Gray, a plastic surgeon in Portsmouth, New Hampshire. While he sees a demand for fillers and Botox, they’re mostly used to address aging concerns—not to create a whole new face. He said lip lifts are growing in popularity, as they create a fuller lip that some feel appears more natural than fillers.
“It’s definitely not about creating what isn’t there,” said Emily Sullivan, a physician’s assistant at Concord Med Spa in Concord, New Hampshire, who uses Botox and fillers to smooth her face. “Women here get nervous about looking like a Kardashian or Joan Rivers. There’s not a ton of knowledge about what aesthetic procedures can achieve. It’s just not super-popular here compared to the rest of the country.” She said the vast majority of women she sees in the local supermarket or mall don’t appear to use fillers. “It’s maybe 10 to 15 percent.”
Thought facial tweaks don’t appear to be popular, overall, in New Hampshire, the youngest fans in the state are getting a little bolder. “People see social media and want that look,” said Jennifer Lawson, a surgical scheduler for Richard Zeff, a plastic surgeon in Stratham, New Hampshire.
Still, the culture surrounding plastic surgery remains hush-hush. Sullivan said the over-40 women she knows tend to keep their treatments entirely to themselves, while women in their 30s tend to tell one or two close friends. “There’s no shame or guilt, but they’re still close-lipped about it.”
Arizona has two vastly different plastic surgery cultures: In Phoenix, the state’s most populated city, and nearby Scottsdale, women whose looks were obviously inspired by the Kardashian-Jenner-Wests are a common sight. In Sonoran Desert-adjacent Tuscon, women “want to look like themselves, but refreshed,” said Dr. Raman Mahabir, a Scottsdale plastic surgeon and editor-in-chief of the American Society of Plastic Surgery’s education network. “You have that sharp contrast.”
What’s popular in Phoenix and Scottsdale? “I still have my original nose and my boobs. It’s rare around here,” said Phoenix resident Teresa Strasser, 48, an Emmy-winning writer and co-host of The List. “The lips here are not conservative. The lips and boobs are competing to see who can be most inflated. I don’t know who’s winning. Maybe we’re all losing.”
Strasser said plastic surgery, including Botox and fillers, appears to be more common in Phoenix and Scottsdale than in Los Angeles, where she used to live. There’s also a lot of enthusiasm in the Phoenix area, she said, for facials and skin-rejuvenating treatments.
From what she’s seen, women often start small and then continue to tweak until there’s little left to do. “You add a little of this and it’s so pretty,” she said. “So you want you more.”
With this enthusiasm comes little taboo. Strasser said people talk about it openly—and exchange notes: “There is not a lot of derm-shame here. Nobody cares.”
Many Minnesotans are in pursuit of the youthful femininity that a syringe of filler can offer.
“People think of us as a flyover state, but we still really see a lot of volume with our fillers, Botox, and skincare,” said Kally Karjala, a medical aesthetician at Edina Plastic Surgery, located in an affluent suburb outside of Minneapolis. “They’re out there, people do want them. They just might not talk about it as much.” Her patients are mostly 40 and older, though she does see women in their 20s and 30s as well. The younger patients, she said, want the #Instaface look—poster child: Kylie Jenner—but they want to enhance their natural beauty, and “do it without looking extreme.”
“We all want to look like Kylie,” said Samantha Prestidge, a 22-year-old web developer in Minneapolis, who said she and her friends are inspired by what they see on social media. “I think the Minnesota version of Kylie is less about her body, and more focus on the top end. We want to be youthful looking, with a feminine face.”
Dr. Joe Gryskiewicz, a plastic surgeon in the Twin Cities said, that his younger patients tend to go for bolder looks with fillers and neurotoxins. “The younger they are, the harder they want to hit it,” he said. “They want to like what they look like in their selfies.”
Oregonians aren’t against getting work done, but they’re not willing to give up on their individuality in the process.
“Our community is about being different. Portland prides itself on being less cookie-cutter than other places,” said Portland plastic surgeon Dr. Juliana Hansen. She said the women she sees of all ages want to look like themselves, not like one particular celebrity. “Our version of beautiful is so much wider. … People here aren’t buying into this notion that there’s one look that’s great or beautiful.”
Heather Moffenbeir, a 31-year-old registered nurse, began getting Botox in her forehead and filler in her lips last year. She said her goal with Botox was never to achieve a completely smooth look.
And while she’s noticed a rise in the use of injectables in the Portland area, the effect tends to be subtle. “There’s way less vanity here than in other cities,” she said. “Obviously they want to look younger, but they look for a natural-looking way to do it. And they don’t like to talk about it when they get things done.”
Kentucky women want a polished, feminine look with a little glamour, and they’re not ashamed to get help to achieve it.
They’re “looking at Kim Kardashian, they’re all looking at social media, but they’re much more conservative than that,” said plastic surgeon Dr. Sandra Bouzaglou, who has an office in Lexington, Kentucky, and also works in Ontario, Canada. “They have the same reference points” as the rest of America, she said, but they’re not going to extremes.
Marica Jenkins, 42, an order-filler at American Greetings Corp., said her favorite source of inspiration is the Bravo Housewives franchise. “They’ve influenced me more so than the Kardashians, both in terms of treatment and look,” she said. Jenkins gets Botox and fillers regularly to smooth and plump, and had a facelift at 40. “It’s really natural. I didn’t go crazy overboard.”Her most recent tweak was a lip lift: “I’m six weeks out and absolutely adore it.”
Dr. S. Randolph Waldman, a plastic surgeon in Lexington, Kentucky, said he’s seen a rise in patients interested in filling out their lip and cheek areas in recent years. “They’re recognizing the importance of the mid-face, even at younger ages.” Still, many request “a subtle, natural looking, result.”
While the women of Baltimore are well aware of the #Instaface and there seems to be a small population of Kylie wannabes, the majority of women opting for facial tweaks there want to look like a better version of themselves.
Dr. Michele Shermak, a plastic surgeon in Baltimore, said her average patient wants to “normalize, not exaggerate” her look. “People want to look refreshed and proportionate, and get back to the middle of the spectrum,” she said. They want fillers and Botox to help them look “like they’ve been on a vacation, not in the doctor’s office,” she said.
Women in Maryland “don’t use fillers and Botox like make-up,” said Amy Ford, a surgical assistant at Dr. Shermak’s office.
Mesha Ross, 40, who owns Lux Lash Spa in Pennsylvania, just over the Maryland border, said she got injections to feel rejuvenated. “I had kids, and saw my body and face transform for the worse,” she said.
She also got fillers in her lips, which she said was controversial among her African-American peers. “They question why I’m doing it,” she said. “It isn’t to make me look like Kylie Jenner. I do it get a little fuller, but I don’t get ridiculous with it.”
Ross said that the women she knows seek inspiration from plastic surgeons’ Instagram pages, not from celebrities. “What entices us are the before-and-afters of regular people,” she said. “This is the big thing. Who did her butt? Who did her face? That’s what we want to know.”
Like Arizona, we saw two distinct plastic surgery cultures in Utah: In Park City, which has a large population of transplants from big, coastal cities, women tend to go for a bolder, more obvious look. In Salt Lake City, there’s equal enthusiasm for facial tweaks, but the desired effect is more muted.
Plastic surgeon Dr. Larry Sargent said Park City clients prefer minimally invasive procedures that have no downtime, including injectables and lasers. It’s “more of a healthy, athletic sort of look,” he said. “They don’t have any problems having something done,” but the goal is to “look youthful and fit, like you’re taking care of yourself.”
Dr. Renato Saltz, a plastic surgeon with offices in Salt Lake City and Park City and president of the International Society of Aesthetic Plastic Surgery, said the “mommy makeover”—a tummy tuck and breast lift with optional augmentation—is popular among Salt Lake City moms, who also get facial tweaks to help them maintain a vibrant look.
Maddie Bryant, a 23-year-old student in Salt Lake City, said women there, above all, like to look younger: “Kind of ageless.” She gets chemical peels and fillers in her laugh lines. “I saw them peeking through and I wanted them to be gone,” she said. “It’s definitely a smoother look.” Facial tweaks are common among the women she knows in their late 20s, who get Botox and fillers, often in their lips.
She said Salt Lake City women want to look good and are inspired by celebs’ appearances, but “there’s a limit to how much we’re getting done. I’m not going to take away every single flaw. I just want to slow down [aging] a little.”
Women in Ohio embrace plastic surgery, including minimally invasive treatments, but most don’t want to look too “done.”
“We’re down to earth, but we also want to look like rock stars,” said Dr. Anne Taylor, a plastic surgeon in Columbus, Ohio. While she’s seen a big rise in women, particularly younger ones, seeking fillers to make them look more youthful, they don’t want their faces to look “pulled” or fake. She said a lot of her patients enjoy the impermanence of fillers, and often view them as an opportunity to “test out a new look.”
“I don’t have one friend who doesn’t [use fillers] to enhance and contour. Everybody gets filler under their eyes,” said Allison Newman, who does marketing and PR for Ponsky & Frankel, a plastic surgeons’ office in Cleveland. “Getting Botox … is as common as getting your nails done.” But the end goal isn’t #Instaface: “We want to feel pretty and groomed.”
Rachel Fife, 45-year-old stay-at-home mom, said that in Cincinnati, fillers and Botox are common among the women she knows as well. But, unlike in Cleveland and Columbus, the effect in Cincinnati isn’t always subtle. “Everyone’s trying to look the same with the big huge lips,” but she says the results aren’t always good.
Fife gets fillers to help reverse the effects of aging and plump her face. She said it can be hard finding someone who’ll give her subtle work, so she often turns to RealSelf to find good doctors. “When you live in a small city, you need help to scope out the scene,” she said