The Plastic Surgeon To The TikTok Generation

Leslie Golden would never tell someone else that they need to get filler, but she’s pretty sure it changed her life. She got her lips injected for the first time in early 2018, and not long after, she connected on social media with Dan Bilzerian, an influencer who projects a life filled with women in bikinis, guns, money, and weed to his 32.6 million Instagram followers. Golden scored an invite to one of Bilzerian’s parties in Los Angeles — she was living in Texas at the time, working as an aerialist and as a dancer at a strip club — and when a video of her at the party came out, she says, her Instagram started blowing up.

Golden still isn’t convinced she would have gotten the same kind of attention if she hadn’t gotten her lips done. “Even if you get the tiniest bit of filler, even if it’s so subtle, it really does enhance your beauty,” she says. It was that fizzy moment of social media fame that jump-started her career, motivating her to move out to LA, where she now lives, to pursue influencing.

“I started feeling more confident, reading those comments, and wanting to take more pictures,” Golden says. “And wanting to be more seen because I was much happier with the way that my face looked.”

Golden, who is 23 and had long, bubblegum pink hair at the time of our FaceTime call, talks about her cosmetic procedures in the same frank manner as when she told me that the kombucha she was drinking was making her a little burpy. Lips are her desert island choice for filler — a kind of cosmetic injection that adds volume to a particular area and typically dissolves over time — but since that first lip job, she’s also gotten cheek, chin, under-eye, and hip filler. She gets Botox, too, for the deep forehead wrinkles inherited from her mom’s side of the family.

In the course of her beauty pursuits, Golden entered the orbit of Dr. Kay Durairaj, a facial plastic surgeon in Pasadena who has a large clientele of all ages but that most visibly includes the young and social media famous. Take a scroll through Durairaj’s own Instagram or TikTok account, and you’ll see influencers and content creators sitting in her chair, from Ethan Dolan (21 years old, Botox for migraines) to Cynthia Parker (16, lip filler and stomach skin tightening) to Emmy Hartman (21, jawline contouring and lip filler). Even Charli D’Amelio has stopped by for a facial.

In her videos, Durairaj’s pink-gloved hands administer all manner of treatments: plumping lips, reshaping noses, melting jowl fat, adding volume under the eyes, dissolving filler that has migrated beyond the borders of the lips (placed by another injector, she notes), and delivering platelet-rich plasma therapy to the scalp for hair loss. Somewhere in the archive, a blue-haired Golden serenely receives a dose of cheek filler, the video edited so that Durairaj’s needle flies across her face at warp speed.

For a generation of influencers who have made careers out of documenting their lives, cosmetic procedures that were once shrouded in secrecy and, for some, a degree of shame, have become just another part of the beauty regimens they share with their audiences. And medical professionals like Durairaj are happy to kick open the exam room door in the name of patient education and brand-building.

Jazmin Whitley, a 33-year-old stylist who works with a number of young content creators and goes to Durairaj for lip filler, says that it’s almost as though people flaunt their procedures the way they might a new Chanel bag. “I think there’s a huge trend with transparency and being genuine. Showing the behind-the-scenes is such a big thing with social media,” says Whitley, who has vlogged about her appointments with Durairaj, as well as a recent nose job consultation with a different doctor.

With 302,000 followers on Instagram and another 265,900 on TikTok, Durairaj has built her own significant following on the platforms that made some of her younger clients famous. Her posts often draw questions about pricing and technique, and a mix of critique and emoji-laden compliments. In the comments section of videos featuring especially young patients, some have asked about the legality of getting filler as a minor; anyone under 18 needs a parent or guardian’s permission, with that adult present for the procedure, Durairaj says.

Like many beauty professionals, Durairaj occasionally works with influencers on advertising partnerships. Golden, for example, says she got a discount on the filler work Durairaj posted about, as a way for both parties to grow their social media pages. While social media has no doubt been a strong marketing vehicle for her, Durairaj says that it also demystifies cosmetic procedures for the public, shaking their fears about emerging with a frozen or overly tight face. “People come into the office very educated because they’ve watched a lot of my videos and they understand my thinking and my approach,” she says.

Speaking over Zoom from her office, Durairaj comes off as measured and matter-of-fact, unflappable in a way that a person might want in a head and neck surgeon. She describes her work as a combination of medical technique, artistry, and psychology. When she meets a new client, she pays attention to unspoken clues about their personality and their self-image: their vibe, their style, the things that make them happy, the judgments they issue against their own faces.

“To allow people to bring down their barriers to say what they’re worried about, what they’re concerned about, what they don’t feel pretty about — that’s a very vulnerable thing,” Durairaj says.

At the same time, she says that she’s often brutally honest with patients who want a level of filler that might end up looking overdone, asking them, for example, whether they want people to be looking at their eyes or their lips when they’re talking. Durairaj likes to draw up a three-step beauty plan with her clients, focusing first on what’s bothering them, then looking at how she can bring out their best features and tackle age-related changes over time.

“I think that too often people just are like, ‘I’m going to get some lips.’ It’s like you’re purchasing a pair of shoes or boots. Yes, you can see those lips on Instagram and you can go purchase them. But if you stick them on a face that does not have youthful volume everywhere, you’re going to look like a saggy, droopy, falling-forward face,” she says.

If a patient comes in looking for lip filler but Durairaj sees another opportunity for a more transformative change to their face, she might suggest they redirect their filler dollars elsewhere.

“Some patients will go with [my recommendation], but mostly a girl wants what a girl wants, and we’ve got to give it to them,” she says.

Durairaj, 53, grew up in a medical family in Malibu and Santa Monica — she went to the same high school as Emilio Estevez and Sean Penn — and stayed in Los Angeles through college, medical school, and residency, first at the University of Southern California, and then at UCLA. Head and neck surgery is her father’s specialty, too, but when Durairaj explains why she got into the field, she cites a love of anatomy and the psychological implications of working with a person’s face.

“Facial anatomy happens to be the most complex and intricate and elegant,” she says. “It’s all of the critical real estate, right here. And it’s so intimately attuned and tied to identity.”

She finished her medical training in 2000, two years before the FDA approved Botox for cosmetic use. From both a technological and aesthetic standpoint, cosmetic procedures have come a very long way since then. Durairaj’s professors were big into face lifts, neck lifts, and ablative lasers — “That was the generation of getting red, raw faces,” she says — and she feels that she’s helped the field evolve away from aggressive initial treatments toward smaller, more regular maintenance.

The American Society of Plastic Surgeons estimates that, among its member surgeons, the total number of cosmetic surgical procedures dropped by 5% between 2000 and 2019; during that same time period, the number of minimally invasive procedures rose by 237%, led by a 878% increase in the use of botulinum toxin type A injections. (Botox, like Kleenex, is a brand name, produced and marketed by the company Allergan.) Those numbers don’t fully account for growth in the use of filler, since the ASPS’s available data for all types of filler doesn’t go back that far, but between 2009 and 2019 the estimated annual number of soft-tissue filler procedures rose from more than 1.7 million to over 2.7 million. Total spending on cosmetic procedures increased from an estimated $10 billion to $16.7 billion during the same decade.

“I think that people are, in this day and age, less inclined to want to take a week off, two weeks off, to do a big, major surgery,” Durairaj says.

(The pandemic seems to have switched up patients’ cosmetic priorities again, at least for the time being. According to a recent survey from the American Academy of Facial Plastic and Reconstructive Surgery, minimally invasive procedures took a hit during 2020 while surgical procedures made a comeback, motivated by our newly empty social calendars and possibly a wave of “Zoom dysmorphia.”)

The rise of injections is also a function of technological advancements in the field. Put simply, injectors have at their disposal a wider range of materials that are more predictable and less likely to cause allergic or immune reactions than earlier kinds of fillers, including silicone, did. (That’s not to say that fillers don’t come with serious risks, particularly if the injector isn’t well-versed in facial anatomy: Accidentally injecting into the blood vessels can cause issues like blindness and skin death.) Many fillers are now made from hyaluronic acid, a substance that the body naturally produces and that absorbs water to give, in Durairaj’s words, “a nice juicy turgor to the skin.” And there are a variety of hyaluronic acid fillers on the market, each one tailored to a different use.

“Certain ones are softer and squishier, and they’re great for lips. Certain ones really provide tons of volume, ones that hydrate and are great for cheeks,” says Dr. P. Daniel Knott, director of facial cosmetic and reconstructive surgery at UCSF. “A good injector knows what each product offers in particular, and each company wants to offer the whole product line.” In her own practice, Durairaj likes hyaluronic acid gel fillers, which she says typically last one to two years, for soft tissue areas in the center of the face, like the under-eyes, lips, cheeks, and nasal folds. There are calcium-based fillers that are stiffer and more supportive, which she uses for contouring jawlines, cheekbones, and chins. And then there are collagen biostimulators, a separate class of product that she might use for sunken temples or jowls.

As the medical aesthetics field has grown up, the culture around it has shifted, too. “I remember when Botox came around because it was so shocking to think of something that was a botulinum toxin being injected in the face,” says Linda Wells, the editor-in-chief of Allure magazine from its launch in 1991 until 2015. “It was really like, ‘Are you kidding? We’re putting a poison, a toxin, in our body? How dangerous is that?’”

She first got Botox while in Paris for Fashion Week — a friend was going to see her dermatologist and suggested Wells come along — and remembers scolding herself for being so irresponsible. At the time, Wells says, Botox was something you’d get in secret. “We didn’t talk about it. We didn’t show anybody,” she says.

Botox was initially the domain of Hollywood celebrities and elite clientele, says Dana Berkowitz, author of Botox Nation: Changing the Face of America, but it very quickly trickled down to the masses, helped along by the proliferation of medical spas around the country and exposure from reality television programs like The Real Housewives. “You saw these pseudo-celebrities getting beautiful and doing body work in public on TV,” Berkowitz says. “Then it shifted to where we became the celebrities and started documenting it on social media.”

Wells thinks that Botox has relatively little stigma attached to it at this point, with lip filler raising a few more eyebrows; the more a procedure alters one’s appearance, she says, the more secrecy there is around it. Golden notices that people are less judgmental about it in LA than they were in Texas. “It’s so frowned-upon, especially being from the Bible Belt,” she says.

In LA, Botox wasn’t discussed 10 years ago, Durairaj says. Today it’s the baseline. “There is no more stigma about getting Botox. There still is a little stigma about getting fillers, although that I find more to be in the 40- to 50-year-old age group than the 20-year-olds and TikTokers that are coming in,” she says.

“Why use a lip plumper or a lip liner when you can actually have the fuller lips that you want? You’re creating the life you want. Why not have the image you want?”

About a third of Durairaj’s clients are in the 20-30 age bracket, and over the last three years, she has noticed a growing number of patients under 30. (Most don’t start seeing her until they’re at least 23 or 24.) For that younger cohort, Durairaj compares the use of filler to other forms of bodily self-expression, like tattoos, piercings, and hair dye. The under-30 crowd most frequently requests lip filler and “baby Botox” — a lighter application of Botox around the forehead to soften fine lines and wrinkles — though a growing number of young men are coming in for contouring to create a “very projected, masculinized chin.”

“Why use a lip plumper or a lip liner when you can actually have the fuller lips that you want?” says Durairaj. “It’s very much a manifestation of the avatar you want to be. You’re creating the life you want. Why not have the image you want?”

It helps, too, that filler is temporary — if you don’t like your look, you can get it dissolved or simply wait for it to fade away. But while impermanence may be part of the appeal, Durairaj says that she takes minimally invasive procedures as seriously as she does surgery, since they have the potential for long-term complications, and discourages people from thinking of filler as a commodity on the level of a haircut or manicure. “If you really reduce it to that and just see any [provider] with any pricing because you want to get your lips done, then you’re going to end up having potential risks and complications,” she says.

In Durairaj’s view, the ethical considerations for treating patients in their teens and early 20s are largely the same as those for people in their 40s or 60s, though she’s “extra careful” with her youngest patients. She wants to treat the right patient for the right reasons, looking at their full medical history, making sure they don’t have unreasonable expectations, and screening them for signs of body dysmorphic disorder. Regardless of age, Durairaj has turned down clients who don’t meet those criteria.

While young influencers may not see much of an issue with getting filler, their public doesn’t always agree. One of Durairaj’s TikTok videos, featuring 16-year-old influencer Parker at a lip filler appointment, has accumulated more than 1,700 comments, many of them some version of “She’s too young for this!” or “It’s her body, leave her alone!” Is there such a thing as too young for filler? Durairaj thinks about it on an individual basis, related as it is to a person’s identity. She makes sure young patients have parental approval for the procedure, though she notes that many under-18 influencers are independent minors.

“It’s such a case-by-case issue that you really need to respect the person who’s put themselves out there and understand that they are trying to represent the version of themselves that they want to be,” she says. “And that’s their personal choice.”

When I asked Durairaj which celebrities tend to come up in her clients’ reference photos, the first name out of her mouth was Bella Hadid, followed in quick succession by Kylie and Kendall Jenner. For Whitley, it all started with Kylie’s pout.

“I saw the way that it transformed her face. I thought she looked really beautiful with the filler,” she says. “I was like, ‘OK, I have skinny lips. I need to get lip filler.’”

That was about four years ago. While Whitley stresses the importance of loving yourself as you are, she also feels less cute when her filler is gone. With it, she says, “I feel more on.”

Whitley has the advantage of working in an image-making field as a stylist, but Durairaj says that social media has warped many of her clients’ perceptions of what is natural and achievable. Clients come in “on a daily basis” with reference photos that are Photoshopped or filtered. (Indeed, a study from 2019 suggests that there is a relationship between the use of social media photo filters and increased acceptance of cosmetic surgery.) Meanwhile, she says, filler-enhanced lips are so ubiquitous in people’s feeds that they have started to rewrite what we think of as natural. It’s all part of the ubiquitous look known as Instagram Face, a beauty ideal that, writes The New Yorker’s Jia Tolentino, “favored white women capable of manufacturing a look of rootless exoticism.”

“I can’t tell you how many times I’ve had the most gorgeous influencer come into the office, and you feel completely catfished because their image is very different from what they present publicly.”

“The most common thing I see is I say, ‘Show me the lips you like,’ and they show me a model with really lovely, voluptuous, perfectly shaped lips. They say, ‘I want really natural [lips] like hers.’ And I say, ‘Well, that’s like three syringes in those lips, that’s not natural,’” she says.

Durairaj has four children — three in college and one in high school — and in addition to teaching them about skin care and the science behind aging, she tries to instill in them a healthy skepticism about celebrity media. She aims to talk to her social media followers the same way.

“I can’t tell you how many times I’ve had the most gorgeous influencer or someone famous come into the office, and you feel completely catfished because their image is very different from what they present publicly,” she says. “The people that look so glamorous and beautiful, they’re just normal people. They have all these flaws. They have all these insecurities.”

It’s true that Durairaj sends newly juicy lips, straightened noses, and chiseled jawlines into the world, where they too might wind up misconstrued as natural. It’s also true that her TikTok and Instagram videos are a sparkly filtered testament to all the needle sticks, winces, and drops of blood that make those looks possible.

On her own channels, Golden is open about having her lips done but tries to be vague about her other filler work. She’ll tag the spas she goes to in her photos, but she might not make the caption too obvious: “More contoured,” she wrote in a recent post. It’s not that she wants to be inauthentic — it’s that certain members of her significant male following don’t understand cosmetic procedures and can get opinionated in the comments.

When women reach out to Golden, though, she says she has no issue getting specific about the work that she’s done. “Girls will message me all day long. They’ll be like, ‘Your parents did great, God has favorites’ — and I’m like, no,” she says. “First of all, I bought this.”

Photographer: Jessica Pons