I Wasn’t Going To Tell People I’ve Had Work Done, But I Have To Be Honest

Photographed by Megan Madden.
I didn’t register the enormity of what I was watching at first: an influencer speaking directly to the camera, recounting every single injectable she’s ever had, along with her reasons for doing so. From exact measurements and locations to the longevity of each so-called tweakment, the video details years of filler and forehead Botox.
The influencer in question goes on to dispel rumours that she’s had under-eye filler but confirms that she has had it injected elsewhere, including her cheekbones, chin and, on a couple of occasions, her lips. Knowing so much about the inner workings of her face and the choices she has made felt confronting. Such a level of transparency will always be startling in the chronically murky world that is social media.

A culture of transparency

In 2023, aesthetic procedures are no longer spoken about in hushed tones. In its most recent global survey on aesthetic/cosmetic procedures, published in January this year, the International Society of Aesthetic Plastic Surgery found that surgical and nonsurgical procedures increased by 19.3% in 2021, with Botox the most popular nonsurgical treatment worldwide. Search 'tweakment' on TikTok and you'll be served a litany of videos with a combined 309k views. There are clips showing faces being marked up into injection sites and post-surgery selfies with dissolvable stitching still visible. Others show before and after images, often with a floating head narrator explaining the ways they’ve altered their appearance. Over the past three years, a culture of unabashed honesty has been fostered online, with people sharing intimate details about the changes they’re making. The range of these videos is vast but they share one thing: a distinct lack of shame or embarrassment.
@skndoctor Replying to @bita complete breakdown of all the botox & filler i've had done 😅 #botox #filler #injectables #fillertransformation #blackwomen ♬ No Lyrics - Kilo G
This new era of transparency feels radically far removed from the 2000s and 2010s, when celebrities strove to conceal and even deny the work they were having done. There’s no denying our culture of demanded honesty can feel overwhelming but this change appears to have occurred alongside the unfettered access we now have to each other online. There isn’t an area of people's lives — particularly famous people's lives — that we don’t feel we deserve the truth about. When it’s their appearance that morphs, often right in front of us, the desire to know what’s happened is palpable. 
Influencer and aesthetician Alicia Lartey is an expert voice in the skincare and cosmetic world online. She has 31k followers on Instagram and TikTok combined. In one video, Alicia shows her under-eyes being injected with filler to address "hollowness" and "dark under-eyes" as a result of weight loss. She is entirely upfront with her audience, taking them inside the office of her injectable practitioner. "I think when you’re 'online', you don’t really have a choice," Alicia tells R29. "People see your face so much that they will see it change. Because I’ve created a 'transparency in everything' vibe on social media, it’s just better for me to be honest with my audience. That’s what resonates well with them."
"I wasn’t going to share any of this," Alicia adds. "Whenever people have asked me, I always tell them what I’ve [had] done but that’s on a small scale and usually through direct messages." Initially, Alicia wasn’t sure if she was going to film her procedure. "That’s mostly because I’m very sensitive and have had some very mean things said about me," she adds. "It doesn’t matter how confident you are, these things do get to you over time. And coming from a West African background, I was very wary about how my mum would take it."

Is this content empowering informed choice or normalising a level of cosmetic enhancement and, ultimately, perpetuating unattainable beauty standards?

Littered among clips that range from product reviews to gym diaries and holiday recaps, tweakment videos have become normalised fodder — as expected as any other form of social content. My For You feed on TikTok is often replete with surgical procedures and aesthetic treatments including thread lifts and lip flips, each one garnering hundreds, if not thousands, of likes, shares and comments. 
"I’ve been wanting this! But I hear all filler migrates. Is this true?" asks a commenter under one of Alicia’s videos. Another video detailing a tweakment session shared by reality star Amber Turner also received multiple comments, many praising her for her transparency. "Looking good, and fair play for filming it at least u don’t pretend u have had nothing done xxx," writes one user. "How refreshing you are honest," comments another. "So many people aren’t. You look lovely regardless."
On the face of it, tweakments aren’t going anywhere soon and sharing information about them seems to be having an observably positive effect. This transparency demystifies treatments and makes people aware of the intricacies involved, including the various side effects such as filler migration, which is incredibly common, especially when administered by an underqualified practitioner. Then there’s what you can and can’t do post-procedure, such as exercising soon after Botox injections, not to mention how often you might consider a top-up. But for the silent majority — the users not leaving supportive comments below viral videos — is the effect equally positive? Is this content empowering informed choice or normalising a level of cosmetic enhancement and, ultimately, perpetuating unattainable beauty standards?

Normalising vs demystifying

Ashley, 31, found that the constant access to content about tweakments warped her sense of what is 'normal'. "I originally wanted lip filler because I had a naturally thin top lip; I just wanted them a little plumper for when I wore bold shades of lipstick," she tells R29. Then Ashley started to look into cheek filler, too. She says that social media was great for researching what she wanted — and didn’t want — from the procedure. "However, following certain celebrities and clinics online made me feel that I could always get more [procedures done] and it spiralled out of control," says Ashley. "My entire face morphed."
Dr Steven Harris, an award-winning aesthetic doctor, is something of a whistleblower when it comes to dramatic cosmetic enhancements. He wants to call time on 'alienisation' in aesthetics, which is a distorted appearance that has become normalised among young women on social media: lips so overfilled that they are folding back on themselves, or brows so heavily Botoxed, they are stretched to an unnatural angle. There is currently a lack of regulation of nonsurgical cosmetic procedures in the UK and as a result there are plenty of unqualified 'experts' practising aesthetics.
Rather than offering a window into a tricky-to-understand industry (there are countless treatments and tweakments, not to mention bundle and package deals with different names), Ashley found that social media provided her with unbridled access to content about procedures. She quickly lost sight of what she had initially wanted. "I ended up dissolving it all and did a social media detox, unfollowing any accounts that offered things like the 'Kylie Jenner package'. I had to remember that a tweakment is just that: a little change to myself. Not the opportunity to create a whole new person." 
On the other hand, Megan, 24, suggests the scope of social media content on aesthetic treatments helps to underline what a serious decision it is to modify your appearance. "I think it’s quite a good thing, especially when it shows the process and how much goes into it," she says. "From doing the research and finding the right surgeon to making the initial appointments and attending consultations, it shows that it’s a hard thing to get right and that there are still some barriers to entry." Megan adds that she finds it more problematic when the content is obviously sponsored and the person is having the tweakments paid for by the brand or company in question.
Sponsored or gifted content (that of celebrities or influencers receiving procedures for free) can be difficult to decipher online, especially when it’s not disclosed properly. There are strict rules in place, set by the Advertising Standards Authority (ASA). Botox is considered a prescription-only medicine, for example, and cannot be advertised to the public. When it comes to other procedures like filler, much of what should be considered an advert or promotional material isn’t always marked up accordingly, making transparency difficult to gauge.
"In general, I take everything I see on social media from influencers and celebrities with a pinch of salt," says Megan. “It might be because I work in the [beauty] industry and I’m quite familiar with what goes on, or just because I’ve grown up on social media." Megan adds that seeing aesthetic procedures online has become so normal that she has become desensitised to it. "I just expect to see it and presume influencers and celebrities have all had work done. What makes me feel better is understanding what’s real life and what isn’t."
Megan says she would have found it difficult as a teenager to navigate this relationship between reality and social media. As a result, she worries about young women and girls online now. "Back in the day, I didn’t understand that there was a disconnect between real life and social media," she says. Megan thinks more should be done so that younger girls understand the difference between reality and social media sooner. In a positive move, a number of aestheticians have called on social media influencers in particular to declare when they have had free filler or Botox, while both are now illegal for under 18s in the UK for cosmetic reasons.

The transparency trap

Using social media to pull back the curtain on a procedure you’re considering makes perfect sense. Perhaps it’s even sensible. Where else can you find so many case studies ready for consumption? Where else can you get an idea of the ins and outs of what happens behind clinic doors? And where else can you investigate the differences in placement and proportion or gauge the differences between practitioners and practices? The benefits of being privy to this information are many, with increased satisfaction and advocacy among the most tangible. But when that transparency fuels a level of hyper self-criticism, driving the idea that we can, in Ashley’s words, always "get more", how exactly do we stop?
"Patients are definitely more in tune with what’s available and what they want based on what they see and follow on social media," skin specialist and aesthetician Dr Amrita Bhogal tells Refinery29. "The discussion I must then have is that yes, those treatments are available but everyone is different. There are different skin types, different skin goals and one size never fits all." What we see online may not be suitable for us, says Dr Bhogal, or there may be an alternative that could give people the same or even better results. "[As a practitioner] I am happy to say no to someone who is adamant they want to have a tweakment after seeing something online if it’s not in their best interests — even if they’ve done their research." 
Dr Bhogal isn’t the only one to turn away prospective clients for ethical reasons. Aesthetics doctor and trainer Dr Jonny Betteridge of JB Aesthetics has been honest about asking patients to leave his clinic. In a viral TikTok video, Dr Betteridge recalls a consultation with a prospective patient. "On first inspection, it was evident that [the patient] had multiple filler treatments done before," says Dr Betteridge, adding that they looked "overfilled". During the consultation, the client explained that she wanted more treatments. "I spoke through things at length with her, discussing why I didn’t feel it was appropriate to do these treatments," says Dr Betteridge. When the client became defensive, Dr Betteridge decided to end the consultation. "It’s so important to say no," he adds. "If I don’t feel comfortable and I don’t think the patient is suitable, I will turn them away."
This is why it’s important that your chosen aesthetic practitioner is competent and thoroughly qualified. Your first port of call should be to check if they are registered with a governing body such as the British College of Aesthetic Medicine (BCAM), the General Medical Council (GMC) or the British Association of Cosmetic Nurses (BACN). Don’t be afraid to ask to see before and after photos of your chosen aesthetician’s work or to ask for further information about their training and qualifications.
It is clear that there is a fine line between what empowers us as individuals and what normalises unrealistic beauty standards. Where you sit will depend on the time you spend on social media and how fast you consume content, not to mention the type of content the algorithm serves you. The key — and it’s a crucial one to remember — is that tweakments (no matter how transparent we are about them) reflect a specific set of financial and personal decisions; they are not delivered via a one-size-fits-all syringe. Underlining the science and processes behind changing your appearance, as well as the knock-on effect it can have on self-esteem and identity, could help to better inform a generation of people likely to try it anyway. In my view, that can only be a good thing. 

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