Cosmetic Procedures: Filling More than Lines and Wrinkles?

Cosmetic Procedures: Filling More than Lines and Wrinkles?Jennifer, a 26 year old former model, appeared in my office one summer day saying she was thinking of having Botox injections. My first response was surprise. “Why in the world would this beautiful young girl want a cosmetic procedure?”

My second response was curiosity. I asked her if we could explore her desire for injectables until we completely understood her motives and feelings before she acted. She was willing.

According to a report published by, 6,321,160 people had a Botox procedure performed in 2013, an increase of 703% when compared to 2000. In 2013, there were almost 100,000 documented Botox injections for people between 20 and 29 years of age. This number rises to 1,119,798 for 30-39 year olds. For women between the ages 40-54, this number almost triples.⁠

I am a psychotherapist. I see the trend in plastic surgery as having more to do with inner insecurities than about one’s looks. A person feels bad about themselves, they think injectables will help them look better and then feel better, but this doesn’t always happen.

An Unhealthy Road

Their long-term self-esteem doesn’t always change for the better. That is because there are deeper insecurities that lie underneath. These deeper insecurities are about inherent self-worth and lovability. When procedures don’t bring relief from insecurities, some women get additional procedures still searching to feel more confident. This road is not a healthy one.

“Jen,” I asked, “Let’s imagine in a very vivid detailed way what happens after the procedure?”

I often use fantasy with my patients to help them get in touch with what they think will happen. The brain doesn’t really know the difference between fantasy and reality, so fantasy can be used to conjure the same emotions and thoughts that would happen in reality. This approach gives us a chance to have a “dress rehearsal” before something irreversible if done.

“OK.” She replies.

“OK, so picture your doctor’s office. You have just paid and checked out. You exit the office. Got that picture? (She nods) Now what happens…where does your imagination go?”

“I go straight home to examine myself in the mirror.”

“Great, what happens next?”

“I am home standing in front of my bedroom mirror. The lines are gone. I am pleased.”

“Ok that’s great but lets slow it down again so we can flesh it out more. So it feels more real. You are at home and your wrinkles are gone. Now what?”

“Now I go out to meet friends for dinner and I feel prettier and have a nice time because I feel good about myself.”

“Ok, I understand. You imagine yourself without lines and you feel better.”


“Can we reverse it now? Let’s imagine you don’t have the injectables and you’re out to dinner with friends. What happens that is different?”

“I don’t feel as pretty. I can see the lines on my face.”

“How can you see the lines on your own face?”

She smiles and lets out a little laugh, “Well, I obviously can’t. But I remember what my face looks like in the mirror and I think my friends see that face.”

“And what do your friends see when they look at your face.”

“They see my wrinkles.”

“Yes and…I’m going to play devil’s advocate here…so what if they see your wrinkles. What do you imagine they think if they see you have a wrinkle?”

“They think, ‘Jen has wrinkles. She is not as pretty as she used to be.’ Then they think that is why I don’t have a boyfriend.”

“So your friends will think ‘Jen has wrinkles and she is not as pretty as she used to be and that’s why she doesn’t have a boyfriend.’ Does that feel true as I say it back to you?”


“So I am just wondering,” I say gently and playfully, “Given that, 1) you are not a minder-reader; and 2) people are so busy worrying about what others think of themselves that they hardly notice other people, we actually don’t know what your friends are thinking. But, is that what YOU think about YOU?”

Jennifer thinks for a moment, “Yes! That is exactly what I think.”

Cosmetic Procedures: Filling More than Lines and Wrinkles?

Hilary Jacobs Hendel, LCSW

Hilary Jacobs Hendel, LCSW, takes the complex world of emotions and makes them easy to understand for all. She is author of the award-winning self-help book, “It’s Not Always Depression: Working the Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to Your Authentic Self” (Random House & Penguin UK, 2018). She is a certified psychoanalyst and AEDP psychotherapist and supervisor. Hilary’s blog on emotions and how to use them for wellbeing is read worldwide. For more FREE resources on emotions and emotional health, visit:


APA Reference
Jacobs Hendel, H. (2015). Cosmetic Procedures: Filling More than Lines and Wrinkles?. Psych Central. Retrieved on September 18, 2020, from


Scientifically Reviewed
Last updated: 16 Dec 2015
Last reviewed: By John M. Grohol, Psy.D. on 16 Dec 2015
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