A Seattle-based plastic surgery site that functions like a combination of Yelp and HotOrNot, RealSelf.com claims that it helps “millions make confident health and beauty decisions.” Users of RealSelf, which has been around since 2006, discuss and review cosmetic procedures and the doctors who perform them. From Botox to breast augmentation, the site is a one-stop shop for people (mostly women) looking to alter their appearance in a doctor’s office.

The site’s layout is slick, but its posts have the unvarnished, confessional feel of a long-abandoned message board thread. A 19-year-old from Spokane, Washington discussed her upcoming breast augmentation on August 5, 2015 in a typically candid manner:

As everyone I have been reading many reviews on this site, I go on here daily . Ever since I hit puberty I was waiting for the day I would get boobs . Ive had the same size basically since the first day I had my period. Ive always been wishing I had larger breast for YEARS and kept waiting thinking I was a “late bloomer” an I had hear that breast done fully develop til 18 years or older. Well here I am 19 years old still tiny as ever.

The $7,000 operation is scheduled for December 4, 2015. How do I know such specific details about a stranger’s upcoming breast enhancement surgery? The date, location and cost of the procedure are listed at the top of the post.

The treatments are sorted by category—liposuction, facelift, breast lift, rhinoplasty—and most deal with reversing the ravages of time on the female body. “I love being older, I just don’t want to look it,” writes a woman from Little Rock, Arkansas about her eyelid surgery. “The result is beyond my exceptions [sic].”

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There are 2,400 reviews total for eyelid surgery (average price: $4,525), accompanied by 4,546 pictures and 334 videos. Users can sort these reviews by rating (worth it, not worth it, not sure) or the condition that prompted the surgery (eye bags, wrinkles), or the ethnicity of the recipient, or their gender. In general, eyelid surgery is reported as “worth it” by 94 percent of this website’s population: most of the surgeries have “worth it” ratings above that 90 percent marker, or close to it—rhinoplasty, for example, comes in at 89.

The “mommy makeover” (average price: $12,375, 98 percent worth it) is a series of treatments including a tummy tuck, breast lift and liposuction “to help you get your pre-baby body back.”

“After two kids born natural and one c section, my body has definitely seen better days,” gripes a 38-year-old Newport, California mother of three.

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Another “mommy makeover” patient, a 33-year-old women from Manchester, New Hampshire writes of a husband willing to put off the purchase of a new car to foot the bill for her surgery, because he “knows that this is the only thing that will fix me.”

“With the advent of consumer culture after the turn of the [twentieth] century, outward appearance, achieved solely by external means made available by the growth of commercial beauty culture, easily superseded inner character in the quest for beauty,” wrote Elizabeth Haiken in her 1997 book Venus Envy: A History of Cosmetic Surgery. “Women were given to understand that they must avoid mental and physical exertion to avoid the appearance of aging—that conserving unwrinkled skin was more important than anything else they might achieve—and older women were not only allowed, but expected, to spend time and effort maintaining their looks.”

Many treatments proliferated at the dawn of the cosmetic surgery industry. Unfortunately, many of the treatments were harmful or didn’t work, like the paraffin nose job, which had the unfortunate side effect of melting in the sun.

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But the alluring thing about about contemporary cosmetic procedures is that they do work. Ubiquitous media coverage of celebrities going under the knife (or needle) shows us that plastic surgery gets results. On RealSelf, before and after pictures show undeniable changes before and after procedures, provided by real patients, not companies peddling their goods and services. From Botox (average cost: $575, 93 percent worth it) to a facelift (average cost: $11,050, 96 percent worth it), the ability to transform into your ideal physical self is closer than it ever has been.

Another popular treatment focus, on the site, is teeth. Invisalign (average cost: $5,000), dental implants (average cost: $6,450) and various modes of tooth whitening (average cost: $425, but intriguingly, only 68 percent worth it) are counted among RealSelf’s more popular procedures.

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“I’ve been saving up for a really long time and I’m finally able to afford it,” gushes a 25-year-old from Omaha, Nebraska about a $5,600 Invisalign treatment. “I was told this orthodontist is a perfectionist so even though this will take 2 years I trust him.”

In American culture in particular, straight, white teeth are directly tied to wealth. Not only do crooked, discolored teeth reveal one’s lowly origins, but they can actually prevent poor people from getting jobs that pull them out of poverty. Two years and several thousand dollars is a pittance for a ticket to America’s upper echelons.

Other procedures might not seem directly tied to creating a “professional” image, but a 2011 article from the career website Glassdoor suggests that, “for those returning to the workplace, a bit of filler that smoothes out the years could help focus an interview away from guesses as to your age, and more on what you can bring to the team.” While the article shies away from any mention of gender, it’s not a stretch to imagine that the such advice is aimed more at women than at men (though it’s worth noting that, in youth-obsessed Silicon Valley, career-related plastic surgery is on the rise among women and men).

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Legal scholar Deborah Rhodes argues that people—women especially—who aren’t conventionally attractive face workplace discrimination. And in 2009, the National Organization for Women denounced a proposed tax on elective cosmetic procedures. Terry O’Neill, the organization’s president, argued that the tax would disproportionately affect women relied on the procedures to remain competitive in the job market.

“They have to find work,” she told the New York Times. “And they are going for Botox or going for eye work, because the fact is we live in a society that punishes women for getting older.”

As pernicious or cold as it may seem to outsiders, RealSelf is merely a comparison shopping site, an Angie’s list for navigating the often taboo world of plastic surgery and cosmetic procedures. It is a neutral tool, existing within a culture that punishes people, especially women and other marginalized groups, if they fail to look a certain way.

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But the aesthetic bar for “that certain way” is inching higher, along with the cash required to clear it. Perusing RealSelf, it becomes apparent that, with an unlimited amount of money, there is a seemingly unlimited list of bodily gripes that cosmetic procedures can remedy. There is ear surgery for ears that stick out, Radiesse injectable gel for aged hands, lasers for acne scars, tattoo removal and ear lobe surgery to remedy youthful body art decisions. From a thigh lift to Cellulaze cellulite reduction to a butt lift (regular and Brazilian), the site boasts treatments I’ve never even heard of, yet somehow begin to seem reasonable. I’m reminded of the episode of Sex and the City where the doctor injecting Samantha with Botox upsells her on “a refreshing chemical peel,” which leaves her face looking like steak tartare on the night of Carrie’s book launch. Perhaps if Samantha had checked the recovery period for a chemical peel on RealSelf, she’d have known better.


Colette Shade is a writer living in Baltimore. Read more of her work here, or follow her on Twitter here.

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Illustration via Tara Jacoby