I was 22 when Botox was FDA-approved as a temporary cosmetic treatment for moderate to severe frown lines in adults. It was 2002; I was fresh out of college and working as a beauty editorial assistant at a women’s magazine. Frown lines never crossed my mind then—I didn’t even use eye cream. As I climbed the editorial ranks that decade, vouchers for the neurotoxin from top cosmetic dermatologists would land on my desk. “I don’t need Botox at 26!” I thought, a bit smugly.
Despite two decades of free offers, I was almost 42 when I finally tried it. I opted for “microtox”—just a tiny bit of Botox to relax my facial muscles—because I still wanted movement. It was magic. Within a week, I looked well-rested and softer. When I returned to my cosmetic dermatologist several months later, I said, “Give me a full dose!”
Now 44, I’m conservative with Botox. I get it twice a year. I’ve tried filler in my nasolabial folds but didn’t continue out of fear of the dreaded puffy-face look. In my circle of friends, I’m one of the only fortyish moms who's dabbled with injectables. Some are working up the nerve, others are decidedly anti anti-aging. Yet, recent research shows there’s one age group that's taking the plunge wholeheartedly: Gen Z.
The use of Botox and other neuromodulators has increased 73 percent overall between 2019 to 2022, according to the American Society of Plastic Surgeons (ASPS), and Gen Zers (those born between 1997 and 2012) under 20 are all-in on the growing trend, with Botox injections in those 19 and younger increasing by 9 percent between 2022 to 2023, says the ASPS. And it’s not just injectables: A staggering 75% of plastic surgeons have seen a spike in clients under the age of 30, according to the American Academy of Facial Plastic and Reconstructive Surgery.
Between filters and AI, we’re creating unrealistic expectations for what people should look like—and the under-30 crowd is extremely impressionable.
The trend has been dubbed “prejuvenation,” a new term to describe Gen Z’s preventative approach to aging, according to a paper published in the Aesthetic Surgery Journal Open Forum. The authors write that "the most notable change in cosmetic dermatology over the past two decades lies in the shift from correction and reversal for millennials to preventative measures for Gen Z."
I’m no millennial (baby Gen Xer here), but I can’t help but notice the stark contrast between those in my age group and the younger set. As buzzy terms like “pro-age” and “aging well” gain traction with my peers, Gen Z seems determined to erase lines they don’t even have yet.
Why the about-face?
Experts point to the obvious impetus for this trend: social media. Gen Z is the first to fully grow up in the digital age; even its oldest members likely don’t remember life without Facebook or Instagram. "Skinfluencers" have stripped the stigma attached to aesthetic treatments by being more transparent about the treatments they receive. That's a plus in my book, but it may also be skewing our standard of beauty.
“Between filters and AI, we’re creating unrealistic expectations of what people should look like—and the under-thirty crowd is extremely impressionable,” says Usha Rajagopal, MD, a board-certified plastic surgeon and medical director of the San Francisco Plastic Surgery and Laser Center in San Francisco, California. “I saw someone on TikTok recently adding filler to the tip of the nose to change its shape, and the person ended up looking like a Who from Whoville.” Indeed, as this generation dives deeper into the metaverse, some are adopting, if not normalizing, beauty standards that could be conservatively described as avatar-esque.
Under the Influence
The social media connection isn't just speculation either. Research supports Dr. Rajagopal’s theory: There is a distinct correlation between time spent on social media platforms and photo editing apps and the desire to undergo cosmetic procedures, says a 2024 Journal of Clinical and Aesthetic Dermatology study. The researchers also found that following and engaging with celebrities, influencers, plastic surgeons, and dermatologists significantly increased the desire to have a cosmetic procedure.
Pop culture played a role in Ali Pereless’s decision to get lip filler at 26 (she’s now 28). “I’d seen a ton of really good representations of it—and some really bad ones—on social media and TV,” she says. “I’ve always been insecure about my lips not being that full, especially my top lip, so I decided to make an appointment for my birthday.” Pereless, who lives in Charleston, South Carolina, gets her pucker plumped every eight months to a year and is generally pleased with the result.
It’s not just strangers on the internet driving this trend; young women say their social network IRL heavily influences their decision to get aesthetic treatments—good, old-fashioned peer pressure in a modern world. Emma McCormack, 29, of New York City, started getting Botox at age 25. “At the time, I lived in Chicago, and many of my friends were getting it,” she says. “They felt like their makeup was going on smoother, it looked natural, and they felt more confident. Eventually, I said, ‘Screw it; I want to try!’” McCormick had visible forehead lines and wanted her foundation to look flawless. She’s since treated her crow’s feet, which she says she’s had since she was 15. “I’m a very smiley person.”
It’s a trend in Pereless’ friend group, too. “We’ve all done some sort of aesthetic treatment, whether it’s Botox, lip filler, a lip flip—everyone has dabbled,” she says. “My generation is spending money on daily coffee runs and lip filler. Maybe our priorities are out of whack, but it's about feeling and looking good.”
Ozempic face (and neck)
New York City-based double board-certified plastic surgeon Lesley Rabach, MD, says another phenomenon is driving the trend at her practice: the explosion of GLP-1 drugs such as semaglutides like Ozempic, which are being used both on- and off-label for weight loss. “In the last year and a half or so, we’ve noticed a big trend of people who've lost forty to fifty pounds and now have excess skin and want a neck lift,” says Dr. Rabach. It's a phenomenon that's been dubbed "Ozempic face." “With any shift in weight, up or down, the skin gets stretched—even when you’re at peak age for collagen and elastin production,” she says. “If skin stretches too much, you may need to lift it.”
Dr. Rabach, who has turned young patients away for procedures they don’t need (and may regret later), says weight loss-related surgeries require different considerations. “I ask myself, ‘Am I okay with this from an ethical standpoint?’” she says. “I take it case-by-case, but if someone loses a lot of weight and the skin is sagging, I can’t say in good faith, ‘we’ll just do some radiofrequency to tighten it.’ That’s not going to cut it.”
After shedding some weight, Devin Patterson, 26, had breast augmentation to restore volume in her breasts, and then also tried cheek fillers to reduce what she saw as a hollowing out in that area. Patterson, a medical assistant at North Shore Cosmetic Surgery in Melville, New York, had been getting Botox and lip fillers for several years. Working in an office where it was accessible and more affordable for employees played a big role in her decision to try it.
My generation is spending money on daily coffee runs and lip filler. Maybe our priorities are out of whack, but it's about feeling and looking good.
Her then-injector also suggested filler in her tear troughs to fill hollows and connect the undereye area to her newly volumized cheeks. But as more information came out about the risks of tear trough filler, including lymphedema (swelling), as the filler can block the lymphatic channels under the eyes, Patterson decided not to continue the undereye filler. “I was 23 and getting four syringes to my face that I didn’t need,” she says. She has kept up with the cheek filler because she likes the facial balancing effect and the subtle lift that pulls up her nasolabial folds.
Seeking balance
Patterson’s cheek filler brings up an important point and another buzzy term driving Gen Z’s desire to tweak their faces: facial balancing. This aesthetic trend, gaining steam on social media, involves placing dermal fillers and neuromodulators in certain areas of the face to create balance or symmetry. It’s also referred to as nonsurgical facial optimization.
“It’s more about facial structure, not necessarily aging,” says Rukmini Rednam, MD, a plastic surgeon based in Houston, Texas. Dr. Rednam says someone may want to do facial balancing if they have a receding jaw, chin, or disproportionate features, but stresses that young people must do their homework on the provider and the treatment. “There’s a higher likelihood of choosing the wrong person to do the work when you’re younger.” (See "Choosing The Right Pro," below)
Surgical procedures can also create balance, but Dr. Rednam cautions doing anything you can’t reverse. “Try facial balancing with a temporary filler first to decide if you like the effect before doing something more permanent.” Dr. Rabach agrees, adding that while facial balancing is something most doctors consider in any sort of aesthetic treatment, asymmetry and uniqueness should also be celebrated.
Mary Grace Cannon, 24, of Philadelphia, went the permanent route at 22 with jaw reconstruction to correct an overbite and a chin implant to create balance. Cannon’s receding jawline and overbite could’ve led to issues like TMJ and sleep apnea, so she was able to get the surgery covered by insurance. Still, she says the aesthetic effect was her main motivation. The recovery was brutal—Cannon had to be on a liquid diet for about six weeks, and was left with numbness in part of the chin and side of her face that’s likely permanent now. But she still feels the surgery was worth it. “I’m especially happy with my side profile,” she says. The reshaping of her jaw and chin led her to try filler in her bottom lip to further balance her features.
Making the case for youth
As a woman in her forties who's grappled with the superficial part of wanting to tweak my aging face and wondered, what will people think? I admire Gen Z’s unapologetic attitude about tweakments. “I always wanted fuller lips, and I could finally have them, so why not?” says Patterson. There’s a boldness and a sense of bodily autonomy that the feminist in me finds worth celebrating.
Dr. Rajagopa says it also points to this younger generation’s willingness to take care of their skin—and themselves—with advanced skincare products and better diet choices, including drinking less alcohol because they want to look and feel their best. She's also a fan of the idea of preventative Botox (micro or baby Botox) in the mid-to-late twenties. “It has to be done judiciously,” she says. “When your face is at rest, and you see faint lines, doing a little Botox is worthwhile.” And research suggests that, over time, the use of neuromodulators improves skin elasticity.
There’s also this to consider: If you start making subtle tweaks to your skin in your twenties, you won’t look wildly different to everyone around you. But if you wait to try an aesthetic treatment in your forties and fifties when the signs of aging have set in, your results are more likely to be dramatic—and noticeable. “Even when I had my undereye filler, it was subtle enough that no one noticed,” says Patterson. “And that’s something to highlight in all this: Younger women are starting earlier, and a lot of the time, you’d never know. You attribute their look to them just being young.”
An age-old concern
On the flip side, some say these early interventions can make twentysomethings appear older. Contestants on the popular reality show Love Island have recently gotten flack for this very thing in TikTok vids and news articles. Many viewers speculate that it’s the filler and Botox visually aging them, with one commenter writing that one 24-year-old contestant looks 44.
Dr. Rednam agrees that this is a potential consequence of seeking out treatments meant for an aging woman. “The ideal that many young women are striving for is something you might see in a more mature face, so the procedures themselves can prematurely age them.” She points to the more sculpted, contoured face that often comes with age, and is now a standard of beauty for the younger set.
Take buccal fat removal, for example. This surgery removes fat in the lower cheeks to create a more sculpted look, and is a prime example of this theory. “It’s a trend that started with dramatic contouring on social media,” says Dr. Rajagopal, who removes buccal fat to reduce facial fullness, but typically not in patients in their early 20s. “Your face slims with age, so we don’t want to prematurely remove the buccal fat because that fat is valuable—it makes your face look more youthful.”
And all these treatments and procedures can be a slippery slope. “Because people tend to go overboard, super big lips can make your face look unbalanced, and now you need to do something to enhance your chin,” she says. “Doing too much at a very young age winds up making you look much older.”
And, of course, we have to talk about a big elephant in the room: cost. It should be a major factor in decision-making, says Dr. Rabach. “However, I do think that these younger generations are spending a lot and are definitely willing to go into debt for aesthetic services,” she says. "In my practice, patients, even younger patients, are prioritizing cost for the services over other things, because they view this as an investment.”
Choosing the Right Pro
Speaking of the investment: Picking the best doctor for the job significantly increases your chances of getting a good result, and your money's worth. Here are some things to consider as you search for the best medical professional:
1/ Look for a board-certified surgeon.
But don’t stop there; check the actual boards. “There are two leading boards for plastic surgeons: the American Board of Plastic Surgery (ABPS) and the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS). Other boards aren’t true boards, says Dr. Rajagopal. “Someone can be, say, a gynecologist, do a few months of cosmetic surgery training, and say they’re a cosmetic surgeon, but their training is inadequate.”
2/ Check hospital privileges.
Specifically ask if they have the privilege to do the procedure they propose at the hospital they’re affiliated with. “If they can perform that specific surgery at a hospital, they’re well-trained and have the right certifications,” says Dr. Rajagopal.
3/ Get the goods on expertise.
This is especially important if you’re going to a med spa. You'll want to make sure the nurse practitioner, registered nurse, or physician’s assistant is well-trained to inject. Ask about training certificates, experience level, how long they’ve been injecting, and who the physician in charge is and where they are. “They are supposed to be in close proximity to deal with any adverse effects, and it should be a physician who is well-trained in aesthetics,” Dr. Rajagopal adds.
4/ Start with a consult.
“Make sure you feel very comfortable with the person because you’re giving up your autonomy to someone you don’t know that well,” says Dr. Rabach.
5/ Don’t be swayed by social.
“There are people in my field with millions of followers on TikTok and Instagram. Does that mean they’re a better surgeon than me? Maybe. Or maybe they have a really good social media team. On days I'm operating all day, I don't have the time to post on Instagram,” says Dr. Rabach.
A FINE LINE
So, a little Botox never hurt anyone—even in their twenties—but overfilled lips, a snatched jawline, and sculpted cheeks could have the opposite effect. Understanding the potential risks, especially for permanent procedures, and going to a trained medical professional who understands facial balance while maintaining uniqueness and proportions and who is willing to say, “Come back in 10 years,” may be the best way for Gen Z to preserve their youth—without looking like a Love Island castaway.
