Do you know what a tweakment is? I didn’t, not really, until I was lying on my back with a woman dressed in white poised to inject a needle into my face. Tweakment sounds cute, right? Well, tweak does. Like in the Mary Poppins song: “My father gave me nose a tweak.” A tweak is a gesture of affection, like pinching the cheek of a toddler. Tweak tweak.
A tweakment is a minor cosmetic procedure, one that doesn’t involve being cut open or going under general anaesthetic or hiding from the world for a fortnight. (Actually, it might involve the last.) The word has come to prominence over the past few years, and is used to cover many different techniques and therapies, mostly done to your face.
Botox and fillers are two of the most common tweakments, and they are the ones I’ve agreed to undergo. I didn’t really think about any of this properly before arriving – I’ve been busy, and this is research for a book I’m writing, rather than something I’ve been fretting over – so it’s a bit of a shock to find myself in Caterham, Surrey, in the Rakushka clinic of Dr Elena Karnovitch. Karnovitch is medically qualified (she works in an NHS hospital as an acute medicine consultant) and far from an idiot. She insisted on a half-hour Skype consultation before I came in, during which she explained what could and could not be done with my fiftysomething, insufficiently moisturised face. She was managing my expectations, though my expectations were low and ill-informed, boiling down to two things. Does this stuff wear off? And: I don’t want to look mad. (Yes, and she knows.)
Beauty clinics are much like any other private medical clinic: clean and bright, with certificates on the wall and a bed that goes up and down. And they contain syringes. Thin-needled syringes are the primary instruments for tweakments, though there are others: cannulas (blunt needles), lasers, spiky rollers, LED face masks that make you look like a cyborg, other strange instruments that would make anyone who is scared of the dentist automatically clench their teeth.
Karnovitch, 46, has, as you might expect, blemish-free skin. I couldn’t see a single mark on her face, not even an open pore. She tries every treatment on herself first and is her own living advert. She’s less expensive than Harley Street practitioners, because she doesn’t have high rent or a receptionist, and some clients get cabs to her clinic from central London, especially as she speaks fluent Russian. Tweakments are still far from cheap, though: a single syringe costs between £200 and £500. Be aware that, according to my accountant, you can’t claim any of this back against tax. Not even if you’re a drag queen.
Karnovitch shows me each needle before she injects it. She has already explained that if something goes wrong, she has an antidote to hand, and that’s why she works with the products she does: because there is an antidote. We don’t need it. Some of the injections hurt a bit, but not much, and after half an hour, I’m done. She takes pictures of my face before and after, not just to show me, but for her insurance. (I don’t tell her until later that I’m writing about this.)
I get into the car and turn the rearview mirror to look at myself. I appear to be the same, but without frown lines and with more prominent cheekbones. Do I look weird? Am I still me? I feel a bit sick.
Should I feel odd? I’m simply joining a party that started many years ago. A tragic latecomer, in fact.
I remember when Botox first arrived in the UK, in the 1990s, those innocent, messy years before it became normal to be slick. Back then, by today’s standards, we were a bit unkempt. Nails were clippered, skincare uncomplicated. No one had heard of retinol. And Botox was the preserve of the wealthy, whether celebrities or not; not an everyday maintenance, like getting your hair cut, but something more serious, like a facelift, or a boob job.
But that was then. These days, you can’t move for immaculate manicures, fleeky eyebrows and skin like almond icing. Over time and especially in the past few years, Instagram, reality TV, older media stars and self-promoting celebrities have combined to offer up a new aesthetic. For the young, may I present the Love Island look, or “rich girl face”. Full lips, wide eyes, straight nose, smooth skin, sleek lines. Plus body to match. For those seduced by this look (and many young people are) an Instagram selfie requires more than a bucketful of foundation and pulling a duck mouth. Because to be Instagram pretty – phone arm up, lighting behind you, always photo-ready! – is to be absolutely perfect. A flawless cartoon, a Disney princess.
If you’re older, the look is different. Harder to spot, because it’s a sort of stasis. To be deemed good-looking in your middle years, your face should remain the same as it did in your late 30s/early 40s. Actually, for some stars, their faces get younger: plumper cheeks, especially just beneath the eyes, shallower lines around the mouth, a tauter neck, more defined cheekbones. On Facebook, adverts show me women in their 50s smoothing lotion on their foreheads or concealer under their eyes, and I think: surely that’s not what makes you look so young? In magazines, media stars and actresses a full decade older than I am display skin that looks like my nine year old’s.
I’m unsure what’s going on. Maybe these people are all special, maybe it is all “good bones” and daily sunscreen. Because the effect of excellent tweakments is not Simon “Sweet Jesus!” Cowell, but something far more subtle. I look at famous people whom I’ve looked at for years, and they seem to be gradually fading into the background, replaced by a smoothed out, less characterful, very beautiful person. They look great, but they don’t look like them.
All of this means that after I leave Karnovitch’s clinic, the biggest effect of my tweakments has nothing to do with how I see myself. It’s how I look at others. Suddenly, I’m a derma-detective. The Miss Marple of tweakments, the Botox PI. I see tweakees everywhere. It seems to me that every TV presenter, and many actors over the age of 35, male and female, are tweaked. Spot of Botox in the frown lines, bit of filler in the cheeks. Now I’m in the club, I see it. Those cheekbones! That smoothness! I watch Graham Norton, check the faces of his guests, and I see it. I watch films with award-winning actors, known for being authentic, and I see it. Among my friends, I don’t: most people don’t spend money this way. But some who work in fashion or beauty, yes; also a couple in the music industry, where it’s cool to look natural, like “I just woke up like this”.
This new knowledge is a bit disturbing. I don’t want to be looking at people I admire, and thinking: “Cheat”. Not because they’ve had work done – it’s their face, after all – but because they don’t admit that they have. Because they’re embarrassed. I understand that. I am, too.
My new spotting power is not unusual, says Alice Hart-Davis. “Once you know what you’re looking for, you see it everywhere,” she says. And neither is my sick feeling. This happens every single time you’re tweaked, she says. An initial, stomach-sinking, “what have I done?” dread is part of the process. “I have it every time,” she says. “And I have a lot of tweakments.”
Hart-Davis, 56, is the go-to beauty journalist for tweakments. She’s written The Tweakments Guide, and has a well-researched website that lists qualified and recommended practitioners (Karnovitch is there). She posts videos, holds seminars and is honest about which procedures she has had done: recently she had SVF facial rejuvenation, which seems to me like a major operation. Stem cells were removed from her thighs, spun around in a centrifuge, and then the resulting “concentrated stem-cell soup” (her words) reinjected into her face. The cells mix with fat and regrow, transforming her face from the inside out. Is this a tweakment? Apparently so.
Hart-Davis, like all the beauty experts I talk to, divides those who have tweakments into two distinct camps. The first, and largest group, is the middle-aged (35 to 55, according to Karnovitch, who says 25% of her clients are men). These people are cautious. They want a very light effect, just a wrinkle or two softened, a bit of skin-smoothing. They don’t want to look younger. They want to look “fresher”, “less tired”, like “the best version” of themselves. As with the beauty industry in general – “you’re worth it”, “real beauty” – tweakments have moved to a positive, pseudo-feminist language to sell their wares.
There are other clients. Karnovitch mentions a small but significant group of people: women whose marriages have recently broken up. But much more common are younger people, men and mostly women in their 20s and early 30s. They’re after “enhancement”, says Karnovitch. “Drama,” says Hart-Davis. “Blink impact – where you make an impression in the blink of an eye. Someone sees you and goes, ‘Wow!’” These clients want cheekbones more dramatic, lips fuller, to strengthen their chin. They’ve grown up with the Kardashians and know what Kim and co looked like before they went to beauty clinics. “The problem,” says Hart-Davis, “is that they’re young and don’t have much money. So they choose what they get according to price. And the cheapest person is not the one who is medically qualified.”
Cosmetic surgery, being elective, isn’t regulated like the NHS. Anyone can set up as a practitioner. (Love Islander Rykard Jenkins went on a week’s training course and started offering microneedling, injectable fillers and microblading.) You can even buy syringes of dermal fillers online and do it yourself (if you’re mad). Unlike Botox (there are other makes, but no one remembers them), which is careful to only supply medical professionals, fillers are widely available in the UK as they are not classed as prescription medicine.
When I ask Karnovitch which hashtags she uses to get attention on Instagram, she mentions a few. But not #Botox. Regulation brought in this month by the Committees of Advertising Practice and the Medicines and Healthcare products Regulatory Agency means medically qualified practitioners aren’t allowed to hashtag Botox any more. Anyone else can use #Botox until they – or their clients – are blue in the face.
Botox and fillers are often confused. After all, they’re both injections. But there’s a big difference. Botox takes about two minutes, and doesn’t really hurt. It’s a type of protein, a toxin that temporarily relaxes muscles. So if you have wrinkles around your eye, or on your forehead, you get Botox. It relaxes the muscles there so they stop working as well. (It can also be used to stop excess sweating and, sometimes, migraines.) The effects last around three months.
For other so-called problem areas, fillers are used. The injections go deeper, and hurt a little. For hollow eyes, the filler isn’t injected directly beneath the socket, but at the top and side of the cheeks, so the extra volume there pulls the skin tauter. That’s why tweakment lovers have such prominent cheekbones. Fillers are also used on lips: often over four or five sessions, so that the skin stretches to accommodate the new fullness. They can be injected into the lines around your mouth, so they are fainter; and in the corners of your mouth to stop drooping. They can be used on the chin, to make the jawline sharper. They can even be used on saggy earlobes. The effects last around 18 months.
Filler is a strange word. It sounds permanent and rigid, like Polyfilla. And at one point the products were a little like that. (Karnovitch tells me that she still sees some women, usually those who have had work in Brazil, who have permanent fillers in their faces. Any changes to those require surgery.) These days, though, fillers are usually some form of hyaluronic acid, the current beauty wonder ingredient. It occurs naturally in connective tissue, but we lose it as we age. Lots of moisturisers have hyaluronic acid as an ingredient.
The filler effect is not always dramatic, but can be transformative. At the clinic, Karnovitch shows me pictures of her clients. They are ordinary, middle-aged women, with messy hair and half-smiles. They’re having their jawline sharpened, their eye bags reduced; their insecurities made smaller, or muted. They look… normal. And I don’t mean celebrity normal. Normal-normal.
Fiona Golfar, 57, journalist and broadcaster, is cohost of The Guinea Pig podcast. (The other host is Dr Maryam Zamani, a cosmetic practitioner who offers a vast array of treatments and tweakments at her Sloane Street clinic.) The first time Golfar had Botox was in the 1990s. Her husband had said that if she had anything done to her face, he would divorce her. So she chose a clinic that was some distance from where they lived. She went overboard: “I got Botox everywhere,” she says. “I was frozen like a lake.” When she left the hospital, she crossed the road, and who should she see at that very moment but her husband and his brother. She was so stricken that when her brother-in-law said to her, “What are you doing here? Are you having an affair with a doctor?” she replied, “Yes!” “It seemed better than the truth,” she says. (She and her husband are still together. He’s got used to her changing her looks.)
Golfar says there are two reasons tweakments have become more popular. One is that the available options are “much less obvious and more effective”, and the other is that “honesty is the new black”. “It’s fashionable to be open,” she says. “Self-revelation is in. We’re all aware that it’s better for our mental health to be honest about our insecurities and our lives. And I’m happy to say that I love Profhilo [a brand of filler]. I’d drink it in my coffee if I could.”
She also highlights the “treat” part of treatment. “In the past, if you’d had a horrible week at work, then you might go out and get drunk. Or have a cake. Now, that something for yourself could be a spot of Botox. It’s all in the promise, isn’t it? The promise of something that might make you feel better. You can find it in drugs, or exercise. Or a needle or a laser. I’d rather spend £300 on a filler than on a high-class face cream,” she says. “It’s a better investment.”
It’s because she understands all these feelings that she and Zamani started The Guinea Pig. They want, says Golfar, to be “the breath you take before you do anything”. And because the podcast is out there, she finds that other people are talking more openly to her. “Asking someone where they got their teeth bleached, or their skin hydrated, or their eyebrows microbladed, or their lips done, is the same as asking them where they bought their shoes,” she says.
Are tweakments now so normal that we chat about them with strangers? I’m not so sure. Rare is the Hollywood actress or older model who looks her age, and yet very few speak about what they do to maintain their appearance (Cindy Crawford is an honourable exception.) Partly, I suppose, this is because it would be rude for an interviewer to ask a star about such things. May I ask you to attempt to frown? How come you don’t have any laughter lines?
Plus, they don’t talk about it because it’s so prevalent. Within certain demographics, not just actors, “Botox is like going to the dentist. You make a regular appointment, and you nip out in your lunch hour and get it done.” So says Funmi Fetto, the Observer’s beauty columnist and executive editor of Glamour. “There are loads of girls in their 20s who have it. It’s about preventive measures – they want to prevent wrinkles from ever coming.”
Fetto is one of “a handful” of UK beauty writers who have had no tweakments at all. But she understands the pressure. “I completely understand why actresses get tweakments,” she says. “If everyone else is doing it, it’s hard to be an outlier. There aren’t so many parts for older women anyway, and if everyone else looks fresher than you, then you’re going to join the club.”
Fetto says that fillers and Botox are not so prevalent among women of colour. “We’re more concerned with pigmentation,” she says. “Ageing isn’t so much of a concern, partly because of that cliche, black don’t crack – it takes a while before we get wrinkles. But it’s also because age is not seen as such a negative thing. Particularly in African culture, age is seen as a thing of beauty in itself, because it comes with wisdom.” However, she says this is changing. Western society has a disproportionate impact on the world. And when it comes to younger people, there’s a strange, pick-and-mix racial attitude to the looks that they want. A recent New Yorker article pointed out the fashion for “a South Asian influence with the brows and eye shape, an African-American influence with the lips, a Caucasian influence with the nose, a cheek structure that is predominantly Native American and Middle Eastern”. (It reminds me of Victorian colonial explorers raiding new lands and bringing home skulls.) Nothing to do with ageing.
“It’s all about using apps,” says Fetto. “They take a selfie, then Facetune their face until they get the look they want, take a screenshot and take it into a clinic. With millennials that’s a huge thing, and it’s not any particular race. There’s a dysmorphia, a generally warped idea of what we look like, but also what we should look like. Lots of talk about loving yourself and celebrating your body, but a huge rise in tweakments.”
Michael Saul is a lawyer for TJL Solicitors in Manchester, a practice that specialises in cosmetic surgery negligence cases. He usually handles cases that involve “invasive surgery” (nose jobs, boob jobs, butt lifts, liposuction) which, when they go wrong, can have catastrophic results. Tweakments, being less invasive, risk less serious complications, though he has seen some “significant problems”. The most serious was occlusion of an artery. He won a case for a client who lost their sight in one eye when dermal filler was injected into their central retinal artery. And he recalls a couple of times when Botox was injected into the jawline and neck, resulting in problems with swallowing and, in one awful case, an emergency tracheotomy, because the patient couldn’t breathe.
The majority of his cases, says Saul, involve nonqualified practitioners. His practice has been trying to encourage better regulation of this growing industry for years. But the government has only been “paying lip service”; they have promised regulation, but haven’t really done anything about it. Since clients are getting this work for aesthetic, rather than medical reasons, the general attitude is, he feels, tough luck: “You brought it on yourself.” But he’s seen how awful it is for people when things go wrong. Lumpy lips, “contour deformity”, infection, new fillers injected into areas where old fillers remained, clients left with abscesses, and “asymmetry”.
I mention a recent Woman’s Hour interview with a mother whose 17-year-old ran up £15,000 on her credit card on fillers and a nose job. You should be 18 to have rhinoplasty, but no one asked for ID. “That is rare, but the younger generation is very vulnerable,” says Saul. “Social media puts a pressure on their appearance already, and they think surgery or a treatment will be a panacea. So if it goes wrong, and they’re left with an even bigger problem, then this is doubly devastating. The psychological effects can be terrible.”
How are my psychological effects? Not terrible, by any means. My face looks fine. My life continues. I’m rational enough to know that I haven’t fundamentally changed – you don’t erase a lifetime with a needle, as any decent practitioner will tell you – but that initial clench in my stomach takes a while to disappear. I feel as if I’ve stepped over a line. I’ve become someone else. Who? One of those people. If you believe yourself to be feminist and essentially secure, then messing with the contours of your face will mess with your idea of yourself. I am not me. I am embarrassed. So I don’t tell anyone, and instead silently challenge the world to play a game with me: someone has to spot that my face is a new face, that I am frozen and filled. Unfortunately, no one notices. Not my husband, not my kids, not my mum, not any of my friends. Perhaps people are too busy to look at each other closely, too polite to say anything if they spot something strange. It’s like getting a new haircut that your family ignores. I notice though. Are my eyebrows too far apart? Why do my cheeks plump up like I’m 25 when I smile? I check myself in the mirror a lot more than usual. I take selfies of me trying to frown. I don’t think this is helpful.
The only time anyone says anything is when I interview a footballer and a rap star. The photographer, whom I work with a lot, says, “You look well, Miranda.” She has the eye, she sees the new contours. But I still don’t tell her what I’ve done. We talk about my gold trainers instead, about sourcing cool secondhand jeans – just as vain, really, but the stuff of vanity that suits my self-image.
This is, apparently, me acting my age. Everyone I talk to says people in their 20s and 30s are far more open and relaxed about getting work done. They’re used to sharing, or haven’t reached an age where they feel the need to lie.
I talk to Tom, a man in his early 30s who’s had a bit of work. “Oh God, I told everybody,” he laughs. “I’m an oversharer.” In his 20s he was concerned about his eye wrinkles, and a beauty editor advised him to try Plexr, a nonsurgical treatment where the practitioner “stabs loads of holes in the skin so they lift up that area”. But he was unsatisfied with the results, so last year he had proper surgery, the kind you need to be knocked out for. He’s happy with the decision. It cost him a lot of money but now, he says, when he’s out late at a club, and he steps into “those strip-lit toilets and I catch sight of myself in the mirror, I feel it’s definitely worth it. Before, that would wreck my night. If that five grand has brought me five or 10 years without that feeling, it’s worth it.”
He admits that he, too, has been affected by social media, by how his selfies look. “You can laugh,” he says, “but I’ve been a Jennifer Lopez fan since I was 10. Obviously I follow her on Instagram, and she is not ageing. Somewhere deep inside me I think: why is she not ageing and I am?”
In previous eras, if you were a Jennifer Lopez fan, or – like me – a Madonna fan, you would tape TV shows, buy magazines, go to concerts. Your sense of what Madonna looked like would shift only when a new photo session was released. Now, if you’re a fan of any celebrity, it’s like they’re part of your family. They post on Instagram, tease clips on Twitter, release tunes to TikTok. They are more exposed, so of course they get tweakments to make their faces look better on social media. Madonna doesn’t disguise the work she has had done, but others are more subtle. They look fresh, they look dewy. They don’t appear to grow older.
And as our eyes become even more accustomed to this non-ageing, this rubbing out of character and past life from every famous face, we normalise it. Because the new tweakees still have expressions: modern fillers mean they can crinkle their smile lines, raise their eyebrows. They’re not frozen, that’s not what’s weird. What’s weird is that they all look the same. Lovely. Happy. Smooth between the eyebrows, with beautiful bone structure, glowing skin. No slack necks, no weak chins. Nothing unseemly.
Perhaps the younger, Botox-in-your-20s generation will age like celebrities. As ever, it will be money that divides. Richer people will pay experienced doctors to work on them; those with less money will go to less qualified people, or not bother at all. And aside from celebrities, with every podcast, book and website on the subject, tweakments are further normalised. It’s like taking drugs: once you realise how many people are doing them, they don’t seem so bad. Now I’m a tweakee, tweakments don’t seem scary. Expensive, yes, and a faff (like drugs!): but not scary. I’m not sure if I’d get Botox again – I like my laughter lines, the grooves around my mouth – but having better skin has been nice. “People get more tweakments,” says Karnovitch, “because they see what happens when they wear off.”
How do you stop? Or when? For some, their face becomes an ongoing project, like those people who never finish getting their house redecorated. And once one house in the road has been done up, then all the others feel the pressure to gentrify. To gentrify, but magically, with silent builders, that no one sees. Because to talk about it is mortifying. The worst part of my tweakments, for me, was admitting that I had it done. Still, that’s changing. L’Oréal recently added “Filler” and “Laser Renew” to its long-standing Revitalift skincare range, put them in packaging that looks like tweakment instruments.
When Tom went home for Christmas, his family were impressed with the results of his eye procedure. His sister said to her husband, “Your lip dips down in the middle, maybe you should do something about that.” Her husband isn’t on Instagram. He’s a roofer.
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