What the women behind the front-facing cameras won’t tell you is that securing your place in the feed won’t necessarily thrust you into the balmy spotlight but might, instead, eat you alive: Between 1 and 6 percent of plastic surgeries go awry in a country where almost 2 million procedures occur annually. The death rate for outpatient cosmetic procedures is approximately one in 50,000; the mortality rate for Brazilian butt lifts, one of the 2010’s most popular surgeries, has been estimated at one in 3,000. Your bank account is at risk along with your life, not to mention your psychological safety: Patients are going into debt, developing surgery addictions, and suffering from body dysmorphia.

Noninvasive procedures, often termed “medical aesthetics,” represent a rapidly growing segment of cosmetic medicine, a market valued at almost $30 billion in 2025, projected to approach $100 billion 10 years on. Women, especially young ones, make up the majority of patients at injectables clinics: 89 percent are women, 76 percent under 55, and 22 percent between the ages of 18 and 34. Teenage girls are considered a growth market—or, in McKinsey & Company’s terms, one of a menagerie of “cutting-edge micromarkets” in the aesthetics injectables space.

On the mobile sites for medical spas, you can book an appointment, show up day-of, chat with your injector, and be at the checkout counter 10 minutes later, gel congealing beneath your skin before you dash back to the office. Supposedly, despite the sharp syringe, what a patient experiences is nothing like being cut into by a knife or a scalpel; rather, they are buffed, smoothed by something more like a nail file.The term “tweakment” abounds.

Between 2010 and 2019, the number of fillers injected into women’s faces in the United States more than doubled. As with the dentists and veterinarians targeting Gen Z and millennials with rapid-checkout apps, cutesy names and infantilizing, squiggly-scribbly aesthetics, private-equity firms are pumping money into the industry, envisioning a future where medspas weave themselves into the fabric of American downtowns, where Botox bars are as commonplace as workout studios. Between 2018 and 2023, 175 mergers and acquisitions occurred in the medical aesthetics space.

Supporting this booming industry is a cadre of artificial perma-girls who hope to avoid the loss of “beauty capital” they watched their mothers endure.“If this is the way the system is, I’m gonna get mine,” a 28-year-old friend recently told me of her “economically rational decision” to get filler and Botox in a world where the “return on investment of being beautiful” is sky-high. “Cosmetic surgery is not art for many people today but emotional survival,” Susie Orbach wrote in her 2009 book Bodies. The language of economics wends its way into the words of almost every woman I speak with about this subject.

Unsurprising, as we are surviving a financial era often deemed a casino economy. Like the tech and banking industries, the beauty market ascribes to the mores of industrialized gambling. Injectables chains’ marketing––promises of little downtime, few to no side effects, and transparent pricing––belies the fact that the consultation room is more akin to a Tropicana than a general practitioner’s office. Casino lighting is designed to be addictive, as are the filler membership plans proffered by injectors in rose-tinged rooms. In 2024, 73 percent of medspa patients were repeat customers, an almost 10 percent spike from two years prior. Too many women leave medspas mired in cycles of debt and dysmorphia, self-defeating spirals not unlike those haunting your average addled crypto bettor. The house always wins, as both industries’ growth projections demonstrate.

At my desk one day, unable to focus and procrastinating on integral responsibilities related to my job, I decide to look back into a potential purchase, one I’ve been trained to understand as both productive and an act of self-care. I never followed up on my “perscription” from Plump, but I’m once again considering if I should. The beauty industry deftly presents its offerings on a tightrope, balanced between tech-enabled, hyper-capitalist optimization culture and spirituality-infused self-care rhetoric. Surveying its offerings when I’m not feeling traditionally productive can, in turn, feel like a harmless strategy for self-soothing as well as a smart investment in the career I’m avoiding.

I navigate to the Instagram account of a medspa called Ever/Body and see a grid post purporting to offer scientific novices a definition of hyaluronic acid, the chemical basis of most dermal fillers. Formatted like a dictionary entry, the copy reads: “Hyaluronic Acid (noun): 1. A naturally occurring compound produced by the body that helps retain moisture & improve texture 2. The main ingredient in Dermal Filler 3. The go-to ingredient in your moisturizers and serums 4. Naturally found in foods like bone broth, leafy greens, and citrus!” This framing casts HA as a nourishing, natural substance. Yet the HA injected into your face is far different from the HA in your moisturizer, let alone your bone broth.

These chemicals are stabilized in labs and culled from streptococcal bacteria, and can have disastrous, permanent effects when improperly injected: HA fillers have caused tissue death, blindness, and stroke. While laws vary somewhat by state, most require only one fully licensed physician to be employed by the chain in that state, and they are often not required to be present on-site. There are no industry-wide standards for training of cosmetic injectors, and while chains like Ever/Body and Plump tout “rigorous training” programs run in-house to “ensure the highest level of care and expertise,” these programs often require between six to eight weeks of education. There is no oversight body regulating such programs.

Hyaluronic acid was approved by the FDA in 2003 for use in the face’s nasolabial folds, those lines on either side of one’s nose. Its injection into the rest of the face is done off-label, a practice in which a drug approved by the FDA to treat one condition is used to treat a condition it is not FDA-approved to treat; this means that the practice has not undergone the long-term studies into side effects required for FDA approval. Nevertheless, HA’s approval in 2003 opened the floodgates for filling agents. Over a dozen were approved by the FDA in the following decade, in which little research on filler’s long-term effects was carried out, while it became the second-most-common noninvasive cosmetic procedure in the United States. Near the end of the 2010s, many people began experiencing filler migration in the months and years after injection. This incited a spike in filler dissolver procedures (from 2020 to 2021, there was a 57 percent increase in the number of filler reversals in the US, which is done with another under-studied chemical used off-label).

Speaking to Allure in 2023, surgeon Jessica Weiser admitted, “I don’t think you ever get 100% back to having no filler in your face.” Allure itself turned to surgeons for anecdotal evidence after facing what their journalist described as “a frustrating dearth of formal studies investigating hyaluronic acid fillers over the long term.” Yet patients report injectors promising that the procedure was not only reversible but that the chemical would dissolve naturally. In the same article, surgeon Paul Jerrod Frank pointed out that the “commoditization” of injectables is motivating companies to focus not on patients’ faces but on numbers, fostering a mindset of “how many syringes can I sell to patients.” Injectors with “very little training” are “incentivized by only one thing: money.”

Injectors might not be purposefully lying, but there’s little data demonstrating that fillers ever entirely dissolve, and just as little information on how they move around in the body over a decade and beyond. Researchers have started putting people who have been receiving injections for years through MRI machines, which have shown that dermal filler remains present in the faces of patients who last received filler injections over a decade prior. Meanwhile, on Ever/Body’s FAQ page, the company claims that fillers disappear from the face in, at most, 18 months.

The more time I spent on beauty-focused Reddit forums and plastic surgery review sites like RealSelf.com, the more I began to realize that filler was not a safe, smart investment in my future but a bet as risky as a seat at a roulette table. I stood to lose not only my savings but also my psychic stability, my physical health, and the moral commitments I most value: my belief in collective cures for the individual anguish elicited by my learned yearning for a kind of beauty I don’t want to want.

On these sites, women write threads about side effects, post-op syndromes, and disfiguring results. Someone recalls being “talked into having 4mls of filler injected into my cheeks & nasolabial folds…by [a] self-appointed “cosmetic medicine specialist” and told that the gel was “temporary.” Over time her “facial structure…collapsed,” and, despite her receiving dissolver, an MRI years later revealed that the filler was still present in her face. Another described her eyes “caving in,” ending her post with the admission that her self-confidence has been irrevocably depleted as a result: Her “life will never be the same.” Yet another “developed extreme pain in the injected area and the chronic inability to fully open my mouth,” which became “more intense with chewing, talking, and smiling, and eventually became so debilitating that I could no longer talk for extended periods of time or eat solid foods.” Others report Ehlers-Dahnlos-like symptoms, nerve damage, burning cheeks, and “eye floaters and blurry vision” (incorrectly injected dermal fillers can induce blindness).

A 2018 study investigating patient motivation for pursuing cosmetic dermatological interventions like filler found that 67.2 percent did so to “feel happier and more confident or improve total quality of life” and that’s only the women who self-reported it this way. Nevertheless, Harvard cosmetic dermatology fellow Dr. Rishi Chopra, who conducted a study on the long-term psychic impact of such procedures, concluded that “studies evaluating the effect of filler on happiness have failed to demonstrate an impact” in that vein. Meanwhile, doctors warn that these procedures can exacerbate existing body dysmorphic disorder (which is associated with high rates of depression and suicidality), an affliction that is two to five times more common in cosmetic surgery patients than in the general population.

Today, procedures like filler injection are not just embraced en masse as a rational avenue to increased quality of life but entirely reinvisioned as acts of feminist bodily autonomy simply because women are choosing them, despite feminism’s centuries-long effort to excavate the bodies buried by beauty culture and illuminate its misogynistic bedrock. “You CAN have plastic surgery and still be a feminist so please stop judging,” Glamour admonishes. On her podcast, Emily Ratajkowski, one of the model references in Jia Tolentino’s seminal essay defining the societal slide toward Instagram Face, answered the question “Can You Be A Feminist and Get Plastic Surgery?” in the affirmative.

Meanwhile, critical inquiries into cosmetic intervention risk accusations of anti-feminism, an underestimation of women’s intellect, assumptions of vanity, or an impulse to control women’s bodies. But these allegations are lobbed from the perspective of a disciplinary, individualistic feminism that fosters competition, castigation, and a culture of silence around a phenomenon that is permanently shaping multiple generations of women’s bodies and minds, burdening women already exhorted to wear makeup, inject Chinese peptides, and dress a certain way with yet another unspoken financial, emotional, and labor requirement.

When the influencers and injectors call those syringes investments in my future, I remember that I’ve reaped the purported rewards of self-harm in service of beautification before—gone cold from hunger only to be warmed by gazes. But the price is steep, sucking energy, time, and mental space down a sparkling drain. Not to mention solidarity, a sororal certainty that our natural bodies belong on this planet, and the filtered ones should stay in our phones, preferably in their trash folders. We are ambivalent, anxious, trapped between the desire to be beautiful and a buried awareness that turning ourselves into iPhone images dooms us to a cycle of constant upgrades. So I’ve resisted the allure of the mobile booking platform, but find my fingers hovering over the consult page every so often.

I wanted to know whether these cosmetic technologies could be liberatory, allowing women agency over our appearances when we’ve never been allowed agency over how those appearances inflect our life circumstances. I want to believe the well-meaning women in my phone, but I worry they’ve simply discovered a skeleton key to the same old set of gilded cages, the ones that enclose one woman at a time, and have been convincing us we’re in competition for centuries.

A friend of mine who gets injected frequently told me that though she “would like to stop one day,” she’s unlikely to, because she fears strangers’ reactions to her former face, and wonders if it would even emerge intact after so many injections. Knowing what she knows now, I ask, would she do it all over? She answers confidently: no.

The woman who considered filler “an economically rational decision” hasn’t been able to bring herself back to the injection room since her first visit, in part because of a realization: This “hamster wheel is distressing and hurting young girls.” Everyone who clambers aboard keeps it spinning faster. Once it’s moving swiftly, bending into a blur, we lose sight of each other. What if we tried to steady our gaze, stopped scrolling, and really stared until we saw each other?

I haven’t been back to Plump, Ever/Body, or JECT yet, not because I don’t want to invest in myself but because I want to believe that there’s a world where financial metaphors for our futures wouldn’t feel so apt.

At JECT, I found the feminine abject, what Julia Kristeva argued was woman’s burden: proof that we live in a liminal state, always almost dying, evidence that “what disturbs identity, system, order” is inescapable, no matter how many lines we draw and chemicals we bottle. Individualized subjecthood attempts to “radically cut off the subject from what threatens it” while “abjection acknowledges it to be in perpetual danger.” Existence is risky; femininity hurts. This is true whether you undergo plastic surgery, receive facial fillers, or disavow the entire beauty industry. Girls have always known this—because women showed us the way.