The rise and rise of tweakment culture is a window into the world in which we live. Now, people far outside the realms of the rich and famous regularly participate in procedures like Botox and dermal fillers, as the medical aesthetic boom of the last decade has resulted in the normalisation of cosmetic treatments. Today, having your face ‘done’ seems as standard as getting your nails done.

Besides a moratorium on professional procedures due to lockdowns in 2020 and 2021, the aesthetic sector has mostly been a beneficiary of the pandemic. Last year, searches for aesthetic treatments soared by 50 per cent, which many put down to the insidious pressures of seeing ourselves on video calls so frequently. It’s thought that this, plus the effects of social media in shifting what we perceive to be ‘normal’, has been a huge driver in demand for altering one’s appearance on a semi-permanent basis. Now, according to a recent survey, one in four of us would consider an aesthetic tweakment, which is a figure that only looks set to grow.

Of all cosmetic treatments, “nonsurgical and minimally invasive procedures, otherwise known as ‘tweakments’, are predicted to grow at the fastest rate,” Clare Varga, director of beauty at trend forecasting specialists WGSN tells me. Indeed, the UK’s non-surgical market is set to be worth a whopping £3 billion by 2024, according to reports.

While the motivations behind the demand might align with our collective increase in tech use, The Harley Medical Group says that internally it boils down to a “confidence crisis”. In a new survey that the cosmetic group commissioned of 1,000 British adults, 40 per cent admitted they feel self-conscious about the way they look, while a quarter (27 per cent) feel insecure, and 23 per cent are unhappy with their appearance. It also found that women are twice as likely as men to feel unhappy with how they look (30 per cent vs 15 per cent).

Procedures may be one way to address this – whether used to enhance one’s appearance as it’s perceived online or in real life. And, as award-winning cosmetic doctor Dr Esho tells me, “aesthetic treatment in the right hands on the right patient really can change lives”. But the allure of tweakments may be more nuanced than injecting does of confidence alongside that of fuller lips, smoothed-out lines, or sharper contours.

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In the past, aesthetically ‘enhancing’ one’s appearance generally required surgery, which involved a much bigger decision. Now, with ‘non-surgical nose jobs’ and face lifts achieved using dermal filler, results are reversible and/or temporary, downtime is minimal, and costs are lower. Ergo, some of us do it in our lunch break. And we multi-tweak while we multitask.

The biggest new trend here, Dr Esho reveals, is for what he’s coined “filler stacking”, whereby “patients are stacking multiple filler procedures into one session”.

He previously saw this behaviour after multiple single tweakment appointments, “after the fear from having a procedure had passed and patients had gained trust,” but now he’s seeing it more and more at the initial consultation. “I think it’s because of what patients are seeing on social media and TV,” he tells me. “We are no longer seeing single-feature transformations, but total makeovers on our favourite celebrities, as well as the aesthetic ‘before and afters’ on social platforms.” Here he’s referring to the side-by-side photos – with captions and comments playing ‘spot the difference’ – that are fuelling our obsession with celebrity transformations. As someone regularly served these posts on my social search feeds, I have questions over what this means for our self-esteem.

On the one hand, they serve to demonstrate what is possible to achieve from cosmetic procedures and that those in the limelight aren’t all born ‘perfect’. On the other, it reinforces a beauty ideal by presenting the post-tweaks result as a marked improvement – and one which is easily obtainable for all who can afford it. Whether such makeovers are debuted as ‘a new look’ by someone with a following, or they’ve contributed to the gradual ‘glow-up’ of someone famous, it plays into the same cultural trend. And, is a trend a good reason to seek a tweak?

A homogenised beauty look

Health psychologist Joanna Konstantopoulou feels that the culture of tweakments can directly influence how we think as well as ultimately how we look. She says “there can be a herd mentality over physical appearance” whereby a certain standard is set, and we’re made to feel we should aspire to it. “This is arguably leading to a homogenised beauty look, with fuller lips, contoured cheeks, smoothed out skin and curves in the ‘right’ places”.

Dr Alia Ahmed, a consultant dermatologist specialising in psychodermatology, agrees. “Seeing people with ‘perfect’ faces via various media creates an expectation of how people ‘should’ look and can create unhealthy comparisons. This unrealistic portrayal can affect confidence, self-esteem, and body image negatively.”

As well as compounding notions that certain features are undesirable – for example a nose that is not straight, or lips that are thin – Dr Ahmed feels that living in a culture where tweakments are both so visible and readily available also contributes towards anxiety around ageing, something which is already entrenched in our society. “It creates a culture that seems unaccepting of natural changes in appearance that come with age. People observing this may start to experience appearance dissatisfaction and develop unhealthy fixations with looking a certain way.” In addition, there’s the psychological impact of the privilege involved. “Tweakments can be expensive and knowing this will make some people feel disadvantaged and despondent that they cannot afford or have access to the same resources as others. This deepens socioeconomic divides,” Dr Ahmed feels. And those who seek out cheap options are at risk of substandard work which may be at best disappointing and at worst dangerous.

“Ultimately it is not good for self-esteem for anyone to feel that they should be adjusting how they look to fit in with societal standards of attractiveness,” she adds.

When are tweakments good for your self-esteem, and when are they bad?

While Konstantopoulou agrees with Dr Esho in that “many people will gain self-esteem through undergoing tweakments,” she feels that “there can also be negative knock-on effects”.

“Some may find that as soon as one imperfection is ‘fixed’, they move on to worrying about another, which can lead to a snowball effect of further procedures with no end in sight,” she adds. Clearly, for those affected, this can become an emotional and financial burden. “There’s also the fact that such treatments may just be like sticking a plaster over a deeper problem, perhaps a way of avoiding confronting a psychological issue.”

Dr Ahmed says that studies looking at self-esteem in people who have undergone facial cosmetic procedures have indeed reported improvement in self-esteem, but she adds “there is little evidence to say how long this lasts”. Patient satisfaction with such procedures is also dependent on several factors, she explains, “including the expectation of outcome and how long it lasts, previous procedures, psychiatric history, and mental state”.

Think of it like this: “The ‘good’ side of having a procedure is that it can lead to positive psychological outcomes (like improved body image, self-esteem, and confidence). The ‘bad’ effects are that the good feeling becomes addictive or does not last long enough, and often unnecessary repeated procedures are sought, or the procedure does not ‘fix’ the problem, leading to dissatisfaction and low mood.” Although she does not discourage people from having cosmetic interventions, “I always ask them why they want them and, importantly, to consider how they think a physical change will make them feel better emotionally”.

This is not to say that there’s anything wrong with having appearance-related concerns in the first place. “Everybody has body image issues, to a greater or lesser extent,” confirms Konstantopoulou. “On the lower end of the sliding scale, someone might be unhappy but willing to live with whatever they see as an imperfection. On the other end, someone might be suffering from diagnosable body dysmorphic disorder (BDD), a mental-health condition that leads to an individual becoming obsessed with a particular part of their appearance.” It’s when fixations with one’s appearance start to take over an individual’s life that there’s a serious problem – and then cosmetic procedures are strongly advised against. “BDD requires appropriate assessment and management by experts such as psychiatrists and psychodermatologists,” says Dr Ahmed. If you are concerned, be sure to speak to a doctor.

Besides BDD, the experts note that other mental health issues can play into the motivation for seeking aesthetic procedures – and when this is the case a makeover probably won’t help. “The reasons behind unhealthy fixations are usually deeper than the physical issue,” says Dr Ahmed – not simply the fact that you’ve been scrolling through too many Hollywood surgery accounts on Instagram. “Investigating the emotional pain attached to these behaviours is integral to my psychodermatology practice.”

Know that spotting ‘problems’ with our appearance is also a normal, learned behaviour. Apparently, we humans are inherently negative, and often tend to focus on the bad over the good. This is something that consultant dermatologist Dr Sam Bunting tells me she works on in her practice: “Wanting to ‘fix’ different aspects of the appearance is a really common mindset and one I try to gently coach my patients out of. It’s so easy to chase what’s wrong, rather than to reflect positively on oneself, due to our brain’s negativity bias.”

However, if you suspect you have real self-esteem issues it’s important to address these before attempting to offset them in a cosmetic clinic. Konstantopoulou feels that “if you suffer from low self-esteem, then no amount of cosmetic work will tackle the underlying issues which prevent you from embracing self-acceptance and finding the confidence to be an individual.” As Dr Ahmed puts it: “A ‘perfect’ face does not equate to a ‘perfect’ mind”. For those affected by mental health issues surrounding their appearance, Konstantopoulou recommends exploring the causes more with a registered psychologist. This way, “they may be able to find alternative routes to cosmetic treatments and work through any psychological issues which are causing low self-esteem”.

Healthy relationships with the needle

For most of us, Varga is optimistic that we will continue to participate in tweakments simply “to look more healthy and vital rather than augmented and ‘samey’,” which may be a trend that’s about to pass. Her forecasting suggests that “individuality and self-expression will be the big drivers of cosmetic procedures,” rather than our concerns over not looking like a celebrity or influencer who shares our age or characteristics.

It seems two elements are key to achieving a healthy relationship with the needle: the patient’s ability to see beyond comparisons with others, and the practitioner’s ability to look more than skin deep.

Leading NYC board certified plastic surgeon Dr Darren Smith says that when considering a popular procedure, it’s crucial that people ask whether social trends play a part in their interest. “When done for the right reasons,” – which he sites as “personal joy rather than in response to external pressures” – procedures can be “very personally empowering and a way to realise one’s identity”. He’d like to see the default notion of cosmetic procedures as as a way of ‘keeping up with the Joneses’ reframed in that light. “There are tremendous pressures, especially on women, to look a certain way for personal or professional reasons, and plastic surgery can be seen as enabling that,” – as can tweakments, albeit on a less permanent level. He feels that responsible surgeons and practitioners, on the contrary, “will work with patients to feel good about themselves the way they are, and only have procedures when in line with personal desire”.

This is something Dr Esho echoes with his aesthetics practice. He often refuses to treat patients due to questions over their motivations. “They are actually all wants – not needs,” he says, “so we have to always make sure the decision is ethical and reasonable”. But the key isn’t just to say ‘no’, “but to counsel the patient as to why it’s a ‘no’”. He also feels it’s about “ensuring that the choice is just for the individual, and not due to the influence of social media or other people”. And then, “it should be about bringing out the best in you – not erasing who you are”.

Dr Bunting concurs. “I love to champion what’s beautiful about an individual and help them see that, rather than super-impose some external template of what’s considered attractive,” she says. “To me, that’s the real privilege of what I do.”

Dr Ahmed tells her patients: “Your skin is on a journey with you, it will show signs of change, and this is not something to be ashamed of but celebrated instead.” How you choose to honour your beauty should be as individual as you are.

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