The thing is, I’ve seen some people get a lot more success from changing location or social scene, or from losing lots of weight. But I don’t think I ever saw anyone getting a strong boost from plastic surgery / limb lengthening etc. It just seems oversold to me, and lots of ads outright manipulate people into it.
Ah okay this is helpful. It seems that many commenters do not share my priors on the high returns of the exogenous procedures I recommended, which I did not expect.
I think the evidence here is really strong that these procedures are great, and underappreciated by men outside of the entertainment industry.
Cosmetic stature lengthening provides favourable height gain, patient satisfaction, and functional outcomes, with low rate of major complications. Clear indications, contraindications, and guidelines for cosmetic stature lengthening are needed.
Mean height gained is 6.7 cm. The most common problem is limited ankle mobility, but again the rate is low.
Seven studies were included, with a total of 489 patients undergoing EF or IMN for cosmetic limb lengthening. Procedure-related mortality was zero across all studies. EF was associated with higher rates of Paley problems (56 %), obstacles (48 %), and complications (10 %) compared to IMN, which had 37 % problems and 42 % obstacles, with no significant complications reported. Patient satisfaction was generally high, with EF studies reporting satisfaction rates of up to 95 %.
...
EF and IMN are both viable options for cosmetic limb lengthening. While EF may present more complications, it maintains high patient satisfaction, whereas IMN offers a safer profile with fewer complications. A collaborative approach, combining surgical options with psychosocial and psychiatric support, can help individuals achieve improved physical and emotional well-being.
Literature on Plastic Surgery:
Rankin (1998) tracks large mental well-being benefits:
...Mean scores for depression [determined by using the Center for Epidemiologic Studies Depression Scale (CESD)], improved from 11.2 preoperatively to 6.5 at 1 month, and to 6.3 (f= 79.3, p = < .0001) at 6 months after surgery. Surgical intervention produced no significant differences between preoperative and postoperative ways of coping and social support scores. Cosmetic surgery produces positive psychological benefits by significantly improving quality-of-life outcomes that persist long term, without adversely affecting social support and ways of coping.
Parsa (2019) shows for men there are large increases in obviously attractiveness, but also masculinity, youthfulness, likeability, extroversion, and trustworthiness:
Score increases were significant for perceived attractiveness (0.29; 95% CI, 0.13-0.46), likeability (0.41; 95% CI, 0.24-0.57), social skills (0.25; 95% CI, 0.08-0.40), and trustworthiness (0.27, 95% CI, 0.11-0.44) when evaluating all facial cosmetic procedures together (upper blepharoplasty, lower blepharoplasty, face-lift, brow-lift, neck-lift, rhinoplasty, and/or chin implant). Upper blepharoplasty was associated with positive changes in perceived likeability (0.72; 95% CI, 0.06-1.50) and trustworthiness (0.74; 95% CI, 0.22-1.25). Lower blepharoplasty was associated with decreased perception of risk seeking (−0.78; 95% CI, −1.45 to −0.10). Face-lift was associated with increased perception of likeability (0.69; 95% CI, 0.08-1.30) and trustworthiness (0.66; 95% CI, 0.05-1.27). Neck-lift was associated with increased perception of extroversion (0.60; 95% CI, 0.10-1.09) and masculinity (0.70; 95% CI, 0.21-1.19). Patients who underwent rhinoplasty had improvements in perceived attractiveness (0.51; 95% CI, 0.03-1.00) and likeability (0.40; 95% CI, 0.03-1.00). Chin augmentation did not show any significant improvements.
And then obviously there are many results showing how many facial plastic surgery procedures make you more attractive, with the procedures having low regret rates.
I don’t like being that person, but I guess I am that person: I defy the data. There are many people around me (mostly women) who have had work done, and it always looks horrible. Low regret rates don’t mean much to me, because another thing I see clearly is that the people who had work done become delusional about how it looks, and often get tempted to do even more. I see people look at themselves in the mirror and see themselves delusionally. I see people having unnaturally less movement in the face. I see people whose procedures age badly, and are by now impossible to reverse. It’s not something I’m repeating from the internet, it’s what I’ve seen in reality for years. How those studies got those conclusions, I don’t know, but they must be doing something wrong.
Hm, I don’t know. This seems pretty subject to what Aella was talking about:
Plastic surgery is more common than you think (people don’t tell you) and has better results than you think (the only surgery you notice is bad surgery; all the great surgery is invisible). It’s also a great mental health boost, if I supported public funding I might for that
Maybe there are some non-subjective local factors going into this as well? I live in Los Angeles, I see a lot of pretty good plastic surgery.
It’s possible that the plastic surgery literature is compromised and is just a part of the sales department of the plastic surgery industry, but I don’t think so? The literature is quite large and diverse, and it doesn’t seem to me that they are making big enough methodological mistakes to line up with your data defiance.
Maybe different people have different ways of seeing. For example, most AI art kinda scares me and makes me close the tab as fast as I can. My reaction to plastic surgery is similar. Photos of Aella online have the obvious worked-on lips, when I see something like that in real life I want to walk out of the room. These are instinctive, immediate reactions. Judging from reddit, many people have the same reactions. But many don’t; maybe that set includes you. So folks like you will talk about “tasteful surgery”, and folks like me will keep being freaked out by each actual example we see.
As to your hypothesis about “part of the sales department”, this is a bit funny. You linked to a paper by Parsa et al. Have you tried googling Keon Parsa?
Women are using AI models to create “better” versions of their face and then asking plastic surgeons to make them look like that. So even if the surgery comes out exactly as intended, the effect is to make people look more like AI slop in real life. But apparently AI slop is like that because it’s what the modal person tends to upvote, so a lot of people won’t see any problem.
If the only thing you see about Aella is that she had work done on her lips, then I think that sufficiently well demonstrates the point that you don’t notice most “high quality” plastic surgery.
(Separately, even accepting for the sake of argument that you notice most work done and have a negative reaction to it, that is not very strong counterevidence to the original claim.)
I agree that one should be concerned about bad incentives in the cosmetic surgery outcomes research. Most of the “researchers” are surgeons. Outcomes research in medicine in general suffers from this problem. I am still comfortable with saying that cosmetic surgery outcomes research does provide net evidence for surgery results being good, even after correcting for conflict of interest concerns.
I’ll write a follow-up post focusing on this question (on my blog, not LW).
The thing is, I’ve seen some people get a lot more success from changing location or social scene, or from losing lots of weight. But I don’t think I ever saw anyone getting a strong boost from plastic surgery / limb lengthening etc. It just seems oversold to me, and lots of ads outright manipulate people into it.
Ah okay this is helpful. It seems that many commenters do not share my priors on the high returns of the exogenous procedures I recommended, which I did not expect.
I think the evidence here is really strong that these procedures are great, and underappreciated by men outside of the entertainment industry.
Starting anecdotally: Aella tweet on plastic surgery, other Aella tweet on cosmetic surgery. She estimates a 5%-10% increase in attractiveness due to two facial cosmetic surgeries.
Literature on Limb Lengthening:
Marwin et al.’s review article Cosmetic Stature Lengthening (2020) finds:
Mean height gained is 6.7 cm. The most common problem is limited ankle mobility, but again the rate is low.
Similarly Bulut et al.’s Meta-analysis of complications and functional outcomes in cosmetic limb lengthening (2025):
Literature on Plastic Surgery:
Rankin (1998) tracks large mental well-being benefits:
Parsa (2019) shows for men there are large increases in obviously attractiveness, but also masculinity, youthfulness, likeability, extroversion, and trustworthiness:
And then obviously there are many results showing how many facial plastic surgery procedures make you more attractive, with the procedures having low regret rates.
I don’t like being that person, but I guess I am that person: I defy the data. There are many people around me (mostly women) who have had work done, and it always looks horrible. Low regret rates don’t mean much to me, because another thing I see clearly is that the people who had work done become delusional about how it looks, and often get tempted to do even more. I see people look at themselves in the mirror and see themselves delusionally. I see people having unnaturally less movement in the face. I see people whose procedures age badly, and are by now impossible to reverse. It’s not something I’m repeating from the internet, it’s what I’ve seen in reality for years. How those studies got those conclusions, I don’t know, but they must be doing something wrong.
Hm, I don’t know. This seems pretty subject to what Aella was talking about:
Maybe there are some non-subjective local factors going into this as well? I live in Los Angeles, I see a lot of pretty good plastic surgery.
It’s possible that the plastic surgery literature is compromised and is just a part of the sales department of the plastic surgery industry, but I don’t think so? The literature is quite large and diverse, and it doesn’t seem to me that they are making big enough methodological mistakes to line up with your data defiance.
Maybe different people have different ways of seeing. For example, most AI art kinda scares me and makes me close the tab as fast as I can. My reaction to plastic surgery is similar. Photos of Aella online have the obvious worked-on lips, when I see something like that in real life I want to walk out of the room. These are instinctive, immediate reactions. Judging from reddit, many people have the same reactions. But many don’t; maybe that set includes you. So folks like you will talk about “tasteful surgery”, and folks like me will keep being freaked out by each actual example we see.
As to your hypothesis about “part of the sales department”, this is a bit funny. You linked to a paper by Parsa et al. Have you tried googling Keon Parsa?
Women are using AI models to create “better” versions of their face and then asking plastic surgeons to make them look like that. So even if the surgery comes out exactly as intended, the effect is to make people look more like AI slop in real life. But apparently AI slop is like that because it’s what the modal person tends to upvote, so a lot of people won’t see any problem.
If the only thing you see about Aella is that she had work done on her lips, then I think that sufficiently well demonstrates the point that you don’t notice most “high quality” plastic surgery.
(Separately, even accepting for the sake of argument that you notice most work done and have a negative reaction to it, that is not very strong counterevidence to the original claim.)
I agree that one should be concerned about bad incentives in the cosmetic surgery outcomes research. Most of the “researchers” are surgeons. Outcomes research in medicine in general suffers from this problem. I am still comfortable with saying that cosmetic surgery outcomes research does provide net evidence for surgery results being good, even after correcting for conflict of interest concerns.
I’ll write a follow-up post focusing on this question (on my blog, not LW).