Findings From the RealSelf Culture Report

RealSelf, the medical aesthetics industry's leading community and resource for patients seeking qualified providers, has announced its new RealSelf Culture Report that breaks down Americans’ attitudes around cosmetic procedures in 2023. The study, conducted independently by YouGov, spans politics, finance, celebrity and influencer culture, social media, as well as how career and motherhood influence cosmetic decisions.

Among the top findings, the report found nearly one in four people (24 percent) in America have had at least one cosmetic treatment or plastic surgery procedure — and 12 percent have had two or more.

Motivations for seeking a cosmetic change

Overall, 18 percent of respondents say plastic surgery attitudes among their social group have become more positive over the last three years. This varies among generations, with 27 percent of 18-29 year-olds reporting this shift versus only 13 percent of those ages 45-64.

While many media outlets attribute the rising popularity of cosmetic treatments to more time spent on Zoom and social media since the onset of the COVID-19 pandemic, both men and women attribute their more positive feelings toward cosmetic procedures being increasingly safe, less invasive, and requiring less downtime (51 percent of men and 57 percent of women). In addition, Americans see the societal focus on self-care and building confidence as a key driver of the trend (48 percent of men and women).

The pop culture effect

Celebrities have long been at the center of plastic surgery conversations and trends. Reflecting today’s culture of constant commentary on aging and appearance, the study found a range of reactions to those making high profile cosmetic changes. 

When asked about opinions when seeing a celebrity with obvious cosmetic work, such as Madonna, women are more likely to feel empathy for celebs’ feeling like they have to stay relevant (41 percent), while men are more likely to judge them for seeming desperate (34 percent) or vain (30 percent).

Among respondents who mentioned a celebrity who has had good cosmetic work done, both women (20 percent) and men (11 percent) cite Kim Kardashian as their top choice.

Men most admire the features of Brad Pitt, George Clooney and Christiano Ronaldo overall. Women’s most coveted celebrity features variation by age group:

  • Top celebs for women 18-29: Rihanna, Beyoncé, Jennifer Lopez
  • Top celebs for women 30-44: Jennifer Aniston, Jennifer Lopez, Scarlett Johansson 
  • Top celebs for women 45-64 and 65+: Angelina Jolie, Jennifer Lopez, Jennifer Aniston

With the popularization of sharing cosmetic experiences and conversations growing on platforms like Instagram and TikTok, younger generations are much more likely to have learned about cosmetic procedures via social media or influencers: 41 percent of 18-29 year olds, versus 28 percent of 30-44, 11 percent of 45-64, and only eight percent of those 65+.

Procedures of politicians

As the American political news cycle and our opinions of politicians become increasingly focused on how our elected representatives conduct themselves in all aspects of their lives, the study examined attitudes about cosmetic work among the country’s public servants. 

Across party lines, opinions of plastic surgery vary greatly, with self-identified Republicans most likely to describe it as fake, dangerous, and vain. Democrats consider plastic surgery to be a form of self-improvement, an empowered personal choice, and a way to build confidence. 

However, the majority of the nation remains more focused on the issues, with both Democrats (72 percent) and Republicans (69 percent) reporting they’re not more or less likely to vote for a candidate who has had a cosmetic procedure. 

The politicians respondents mentioned as having the most notable work done were Nancy Pelosi, Donald Trump, and Joe Biden.

Following the money 

Even amidst a challenging economic climate, 26 percent of those 30-44 say they would spend from $10k to $100k to achieve a physical feature they want if they could make payments over time. Among 45-64, 65 percent say they wouldn't spend anything to make a cosmetic change — and neither would 74 percent of the 65+ set. 

While 24 percent of the general population reported having had some form of cosmetic procedure, this increases to 40 percent of those who make more than $150k annually. But, not everyone is telling their spouse or partner about the purchase. Of those who have had a procedure, men are more likely to hide how much they've spent on treatments (35 percent of men have hidden—or would hide—the cost versus 20 percent of women). In addition, younger people are more likely to have hidden the amount spent versus the older generations.

Other societal factors at play

Staying relevant at work: Among respondents who reported feeling pressure to appear youthful in the workplace, 37 percent believe they’ve legitimately lost out on professional opportunities due to not looking young enough. The top fields where people feel they’ve experienced this were: 

  • Marketing/Advertising/Communications: 29 percent
  • Tech/Science: 28 percent
  • Construction: 23 percent
  • Entertainment, Hospitality, Finance/Insurance: 21 percent

Pregnancy and childbirth: For those who have given birth and would consider a procedure to address their post-baby body, a tummy tuck is the top choice at nearly 40 percent, with 32 percent who would opt for a breast procedure such as a lift, augmentation, or reduction.

Among those who said that a major life event inspired a cosmetic procedure, they were prompted by weddings (11 percent), vacations (10 percent) and appearance-altering accidents (12 percent).

With talking openly about procedures continuing to become more normalized, Americans who have had a procedure said they shared their choice with:

  • Friends: 45 percent
  • Spouse/Partner: 37 percent
  • Family, including: Parent (23 percent), Children (15 percent), Other relatives (16 percent)
  • Coworkers: 14 percent

Since its founding in 2006, RealSelf has been the leading destination for helping consumers considering plastic surgery or cosmetic procedures make smart, confident decisions. 

For the full report, visit