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A photomontage of a person getting injections in their face and breasts, which have been replaced with cherries. Beth Hoeckel for Vox

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The morbid appeal of “botched” plastic surgery

Cosmetic procedures are on the rise. So is our voyeuristic fascination with how they go wrong.

Part of the Horror Issue of The Highlight, our home for ambitious stories that explain our world.

Haley Layne, who stars on the British internet documentary series Hooked On The Look, has spent about half a million dollars on plastic surgery. While she’s 32 procedures closer to achieving what she considers the “perfect body,” the 28-year-old needs, by her estimate, at least another 10. “Once you get to this level, there’s never any stopping,” Layne admitted on the show. “You have to maintain [this look] for the rest of your life.”

Part of this maintenance has involved 13 breast operations over the past two years, and resulted in four trips to the emergency room. When Layne nearly doubled the size of her existing breast implants from 650 cubic centimeters to 1200 ccs, her body couldn’t handle them, and she needed reconstructive surgery to repair the damage to her breast tissue. (For context, the average breast implant size is between 300 and 400 cc.) Still, Layne wasn’t deterred from trying to increase her cup size.

Layne is practically a caricature of Western standards of beauty, with long blond hair, bulging J-cup breasts, and a peach-shaped derrière that appears out of proportion to her petite waist. She is a real-life distortion of the “slim thick” body type sought by many American women today (an ideal appropriated from Black and brown body types). In fact, Layne’s physique serves as an endorsement for some of the fastest-growing plastic surgery procedures in the country, as well as the most popular: liposuction, breast augmentation, lip injections, and the now-mainstream Brazilian butt lift (BBL).

Why, then, has her appearance been subject to ridicule, morbid and voyeuristic fascination on plastic surgery forums, and, among a devoted group of fans, erotic observation? To her harshest critics, Layne’s surgical pursuits seem delusional. Her body is “too plastic,” “cartoonish,” or “botched” beyond repair. Commenters on social media, some of whom are rabidly fascinated by plastic surgery extremities and faults, bemoan the loss of her pre-surgery features, claiming she was “so cute and natural” before she went “too far.”

Layne is just one of the many not-quite-stars who’ve gained tabloid-level notoriety for their plastic surgery preoccupations. In the early 2000s, “makeover” reality television shows like The Swan, Extreme Makeover, and Addicted to Beauty helped normalize the dystopian concept of a plastic surgery transformation for regular people while reinforcing Eurocentric standards of beauty. These shows eventually gave way to media that sought to divulge the darker realities of these procedures. Perhaps the most culturally enduring show to date from this genre is Botched, a series that followed two Beverly Hills surgeons who consult with patients to try and reverse the damages from their botched procedures. (Layne was briefly featured in its sixth season.)

Over the course of its seven-season run, Botched developed a cult following, one driven by our lurid interest in plastic surgery nightmares. A growing online subculture of plastic surgery patients, enthusiasts, and voyeurs has thrived on the visual schadenfreude of scrutinizing certain “botched” figures such as Layne’s.

This mix of revulsion and fascination with the human form has a name: body horror, a term generally used to describe works of fiction depicting grotesque images, intended to frighten and reveal social anxieties. The overwhelming impulse toward pity or fear or even derision — “You paid money to look like that?” — applies to real-life bodies we gawk at, whether through a screen or on the streets.

It speaks to how we, the observers, are perhaps more shaken by the pretense of artificiality than any actual body-modification procedures or the industry that peddles them. In this way, the botched body becomes a warning, a reminder of the unspoken standards we are held to. What’s most revealing, and most similar to when we find ourselves drawn to horror movies, is our inability to look away.

Sometime over the past two decades, the stigma attached to getting plastic surgery lessened dramatically. More celebrities opened up about the work they’ve had done. Influencers began filming their procedures and sharing in-depth information about their surgeries. And more people started seeking out work: According to data from the American Society of Plastic Surgeons, 18.4 million cosmetic procedures were performed in the US in 2019, compared to 13.1 million in 2010. Advances in plastic surgery and the popularity of minimally invasive procedures such as Botox and filler meant it was easier and more affordable for people to tweak their appearance without needing to fully go under the knife.

Part of this cosmetic procedure craze, which is attracting young and even teenage patients, has been attributed to social media — its ability to amplify certain physical traits and, through fillers and Facetune, disseminate beauty ideals to the masses. Tweaking one’s face is not only normalized but also driven by the internet’s accelerating trend cycles. See: the saturated demand for brow lifts, BBLs, and facial (especially lip) injections. That has greatly affected our understanding of what’s “normal” or “natural.”

“I think of it as the Kardashian-ization of our young people,” said Anthony Youn, a Michigan-based plastic surgeon. “The Kardashians have popularized a certain facial ideal that many people aspire to have: high cheekbones, slightly tilted eyes or arched eyebrows, hollow cheeks, plump lips, and a chiseled jawline.”

What passes for the norm today looks very different from the standards of the 2000s. Desirable traits — and the unnatural, funhouse-mirror versions of them — are more identifiable and more achievable than ever before, thanks to the influx of images and information on the internet. Yet there remains a fine but fluid line that separates normative ideals of beauty (Bella Hadid, although she’s denied ever having surgery) from apparent artificiality (Haley Layne), even if both likely poured thousands of dollars into achieving their given looks.

For many, the second-worst outcome of a procedure, besides death, is one that is — or appears — botched. It’s a sign of a bad doctor or an illicitly performed procedure. In some cases, as online viewers have speculated, it’s a reflection of a person’s self-delusion.

“Botched can refer to surgical complications, in cases where the surgeon didn’t perform the procedure satisfactorily,” explained Youn. “It’s also used more subjectively to describe the appearance of a patient. This person might be happy with the result of their procedure, but others might dislike it and call it ‘botched’ because they think it’s too much.”

The verb “botch,” which has origins from the Old English word bocchyn, originally meant “to repair or fix.” Over time, this definition changed to signal a clumsy repair job, which is closer to how the word is used to refer to plastic surgery today. The word is frequently tossed around (often in a derogatory manner) by an online subculture of plastic surgery patients, enthusiasts, and voyeurs. In some cases, botched patients have shared videos of their follow-up procedures and recovery on social media to educate or build an audience after a surgical mishap.

On subreddits like r/BotchedSurgeries, users share and discuss images of a person’s botched results, typically after they’ve healed from surgery. These screenshots are gleaned from the social media accounts of plastic surgery enthusiasts — Layne, influencers, models, regular people — and labeled under various categories, such as “extreme plastic surgery,” “lip filler migration,” “too much filler,” “extreme body mods,” and “before and after.”

The fixation on faulty BBLs and overfilled lips can seem frivolous and mean-spirited; in many ways, it’s a direct contrast to the body positivity movement that has saturated the internet. Even when it comes to celebrities and influencers whose job it is to put their bodies on display, observers obsess over the perception of appearing “natural.” The illusion is shattered when it’s clear that even the rich and famous can look “botched,” despite all odds. As a result, viewers are forced to confront the unattainable reality of hard-earned beauty: that plastic surgery is not a guaranteed solution to our insecurities. It requires a person to engage in a cycle of constant upkeep that could transform them from beautiful to uncanny. Layne, at least, is honest about how she never plans to stop.

The focus on the human body — as a site for disfigurement, transmutation, or sexual violation — can be traced back at least to the 19th century. The genre of body horror began with works like Mary Shelley’s Frankenstein and extended to films like Eyes Without a Face (1960) and The Fly (1986). Scholars have long speculated about society’s fascination with horror as it relates to the body in fictional settings. In most modern cases, however, the bodies fixated on are real, not fake — but we treat them like they are.

Many have claimed that this fear of body modification and disfigurement reflects our social anxieties: over the advancement of biological science and Western medicine, the perceived loss of agency over our bodies, algorithm-influenced beauty standards, or bodies that fall outside societal norms.

In recent decades, the body horror genre has seen more works that spotlight surgical procedures, specifically cosmetic surgery. The patients in fictional films like Faceless and The Skin I Live In are typically subject to horrific violence and pain inflicted upon them against their will by crazed surgeons or scientists. This kind of “surgical horror,” according to Gothic scholar Xavier Aldana Reyes, is “the logical conclusion to the postmodern subject’s fear of advances” in science and technology. The genre tackles questions of individual agency and vulnerability in the modern world. The body “becomes the object under attack by tyrannical individuals or, in some cases, companies or systems of punishment,” wrote Aldana Reyes in his book Body Gothic: Corporeal Transgression in Contemporary Literature and Horror Film.

“We’re interested in but afraid of the artificial,” Aldana Reyes told me. “When we talk about horror, the idea of the uncanny tends to come up, like the phrase ‘uncanny valley.’ It seems like we’re interested in the tipping point at which something human tips over into the unnatural or the artificial. To what extent do we lose our sense of self in the process? What constitutes us, and how much of it is external?”

Some modern fictional works, however, have begun to invert this dynamic by giving patients a sense of command over their physical alterations instead of portraying them as tragic freaks. The 2012 film American Mary follows a medical school dropout who performs extreme body modification surgery on consenting patients. Rather than conform to the “mad doctor” trope, the surgeon is depicted as a likable, complex protagonist, while her patients are given backstories and agency over their surgical procedures.

Reality shows like Botched and Plastic and Proud try to humanize their patients, but these attempts are often paradoxical. Behind the facade of cosmetic surgery, these shows hint at a person grappling with his or her own desires, fears, and mental health, who is worthy of the audience’s compassion and time. Yet this type of media depends on a base level of voyeurism. Viewers display varying levels of empathy for those who need surgery (for reconstructive or gender-affirming purposes) versus those seeking out cosmetic, and therefore arguably unnecessary, procedures.

Ultimately, this morbid fascination and disdain is just a cover for that same old set of fears: that people, particularly women, are subject to the harsh whims of a society that demands they look a certain way (some far more so than others); that our bodies, despite our efforts, are at their core unruly and ungovernable; that we’re actually not so different from the people we gawk at after all.

Popular procedures like breast augmentations, brow and butt lifts, and facial fillers are marketed as tools for assimilation, for crafting a body and face to fit a certain standard of beauty. It’s an ideal that devalues anyone who falls outside the Eurocentric norm, particularly Black and brown women who are expected to conform to the unattainable.

The real winner here is the plastic surgery industry, which has been touted as the solution to these anxieties. And the real villain is the very present danger of actual complications and risks that can afflict patients (remember Layne’s four emergency room visits?). Still, there is something perhaps a little transgressive, however intentionally, in the aesthetic of a “botched” body such as Layne’s. What we care about as a society isn’t the “natural,” it seems, but what can successfully be perceived as such while checking all the elusive boxes. With such an impossible standard to live up to, why not run all the way in the other direction?

Terry Nguyen is a reporter for The Goods at Vox. She broadly covers consumer and internet trends, and technology that influences people’s online lives and behaviors.


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