Social media isn’t driving the plastic surgery boom. Who doesn’t want to look better?

Plastic surgery is a brutal business. No wonder it makes a good subject for a horror film. In fact, the subject may be too much for the genre. Hardened gore fans all over the world have been walking out of Demi Moore's new film, The Substance , in which a "younger, more beautiful, more perfect" version of herself tears its way out of her back. Blank silence has reportedly followed several screenings.

It's imaginative stuff, but not, I suppose, a million miles from the operating room itself. Injecting, stretching, chopping, gouging, poisoning, freezing, stitching, slicing: it's the grisly and invasive nature of these beauty treatments that make them such a cause for worry, especially when young people decide to do it. The problem is the risk: only two weeks ago, a 33-year-old British woman called Alice Webb died after reportedly undergoing a non-surgical Brazilian butt lift, with a coroner stating further investigation is needed to confirm the cause of death. According to her mother, hospital staff were unable to resuscitate her following the procedure, which had taken place at another location. Last week, another apparent plastic surgery tragedy hit the news – Viviane Lira Monte, 24, died after undergoing six cosmetic procedures during an eight-hour operation in Brazil.

It is a concern, then, that rates are soaring . The American Society of Plastic Surgeons reports an increase in custom every year. There has been a boom in Britain too: rates of plastic surgery exploded after the pandemic to higher levels than before it began. The all-party parliamentary group on beauty, aesthetics and wellbeing has said that there was also " rapid growth " in non-surgical treatments such as Botox and filler, which can also be dangerous. Meanwhile, Britons are going abroad in droves to places such as Turkey for cheaper breast implants and liposuction.

Why is this happening? Surprisingly, for such a pertinent problem, the answer remains rather vague. Two phrases we often hear are "unrealistic body standards" and "beauty culture". The idea is that patriarchal forces have – via the mass media, models and airbrushed celebrities – set a "standard", which women are then pressured to live up to. But is that really what is happening?

Let's examine it. First, the timing doesn't fit. Plastic surgery rates have rocketed over the past decade or two, but in that period body standards in the mass media have actually relaxed. The 00s, remember, was a time of open and relentless female fat shaming in films and TV – "fat Monica" in Friends, Anne Hathaway's "fat" character in The Devil Wears Prada, the nine-stone (but somehow "fat") Bridget Jones.

Or take women's magazines. In 2004, Heat ran a celebrity cellulite special, drawing "circles of shame" around patches on Beyoncé's and Martine McCutcheon's legs – typical for the time. But now that sort of thing would cause a backlash. When, two years ago, First for Women magazine ran a feature titled "Drop 48lbs by Christmas", there was a social media outcry. " I thought that was from 1997 or something! " one social media user wrote.

It was once unthinkable that fashion designers would send anyone over size zero down the runway. Not now. In Hollywood, older actresses are sweeping awards categories and expanding their roles, and on TV we see many more older female newsreaders and programme hosts. And when, in 2023, Vogue airbrushed supermodels Cindy Crawford, Linda Evangelista and Naomi Campbell, there was a huge backlash.

So why are more people than ever signing up for plastic surgery? Could it be social media? Is it that young people are being bombarded with perfect images of their peers, pressuring them to look the same? It's likely this has some effect, but I'm not convinced it is the total explanation. After all, the body positivity movement has hit Instagram too: airbrushing and filters are increasingly frowned upon, diverse body shapes accepted and even rewarded. Let's think about this another way. If we could fill Instagram with ordinary-looking people, would that really solve the problem? Or would people still want to look more beautiful than they are, given the chance?

We may have been asking the wrong question when it comes to plastic surgery. Concerned politicians and researchers ask what could possibly be incentivising women to want to improve their appearance – and land on "beauty culture", "body standards" and the rest of it. But the incentives are already there. Beautiful people will always do better in one fundamental competition: the dating market. Who wouldn't want to look better than they do? Let's say you found a woman whose society has never heard of "beauty culture" – a medieval villager, say – and offered her the chance to be prettier. Wouldn't she take it?

There will always be demand for plastic surgery. So to address the problem, we should be looking at supply. And that's where we see the trend that fits. In the past two decades, it has become far easier to get plastic surgery: it is more affordable, more widespread and more advertised. Another huge barrier to treatment is meanwhile falling away: stigma.

Plastic surgeons who once had to help patients sneak in via the back door now see them live-posting their recovery on social media – or requesting to feature on the surgery's Instagram feed. Since 2015, posts on RealSelf, a plastic surgery review site, have more than doubled , with users often posting before and after pictures of themselves. As the stigma drops further, it is even becoming acceptable for men to get plastic surgery. Such procedures are rising.

Celebrities are more open now: last week Ariana Grande openly admitted to having filler and Botox in 2018. Kim Kardashian has spoken about using Botox, and supermodel Bella Hadid has said that she had a nose job at 14. No doubt they think they are combating unhelpful "body standards". But they might be doing something more harmful – helping to normalise plastic surgery and encouraging more people into these risky procedures. Sometimes, stigma is a force for good.