Where Ageism Runs High, So Does the Appetite for Plastic Surgery

In a culture that worships youth, the scalpel has become one of the most visible instruments of our collective anxiety about growing older. Now a new study offers the first empirical evidence that this anxiety has a geography. Research published in Current Psychology by Stewart J. H. McCann of Cape Breton University shows that American states with higher levels of ambient ageism also display measurably greater interest in plastic surgery, a relationship that holds even after statistically accounting for a battery of demographic and economic factors. The finding, drawn from data across the 48 contiguous states for 2015, suggests that attitudes toward aging may shape not only how individuals think but how entire communities behave, from the searches they type into Google to the density of plastic surgeons practicing within their borders.

The study rests on a deceptively simple hypothesis: if ageism, the prejudice and stereotyping directed at people because of their age, fuels a desire to escape the visible markers of aging, then places where ageist attitudes are more widespread should also be places where residents show more interest in cosmetic procedures. Testing that idea at the state level required two things: a reliable measure of ambient ageism for each state, and an equally reliable gauge of how interested each state’s residents are in plastic surgery. McCann turned to large, publicly available datasets to construct both.

Interest in plastic surgery was captured in two complementary ways. The first was Google Trends search data, which reflects how often residents of each state searched for information related to plastic surgery relative to other search activity. Search behavior offers a remarkably candid window into private intentions; people who would never discuss a facelift with a neighbor may still type the query into a search engine at midnight. The second measure was the density of plastic surgeons per capita in each state, an indicator that captures the supply side of the market. Surgeons, after all, tend to establish practices where demand is strong, so a state with more plastic surgeons per resident is plausibly a state with greater appetite for their services. Encouragingly, both measures behaved similarly in the analyses, strengthening confidence that they were tapping the same underlying phenomenon.

The measure of ageism drew on the accumulated evidence of geographical psychology, a field that studies how psychological traits and attitudes cluster across regions. Previous work had already shown that implicit age bias varies meaningfully from state to state and that these variations correlate with state-level health outcomes, including the prevalence of Alzheimer’s disease among older adults. Using state-level indices of ageist attitudes, McCann computed Pearson correlations between ageism and each of the two plastic surgery interest measures. Both correlations came out positive and statistically significant: the more ageist a state, the greater its residents’ interest in plastic surgery and the higher its concentration of plastic surgeons.

Correlation alone, however, is never enough, particularly in state-level research where a handful of demographic variables can masquerade as psychological ones. Wealthier states might both hold less ageist attitudes and afford more cosmetic procedures. States with older populations might be more ageist simply because age groups are in closer proximity, or less ageist because of greater intergenerational contact. To rule out such confounds, McCann employed multiple regression and partial correlation analyses with six statistical controls: state socioeconomic status, the percentage of White residents, the percentage of urban residents, the percentage of female residents, median age, and the obesity rate. The pattern of results survived intact. Even after stripping away the variance attributable to these six characteristics, the association between ageism and plastic surgery interest remained positive and significant for both outcome measures.

The study also attended to two technical threats that can undermine regional analyses of this kind. Multicollinearity, the problem of predictor variables being so tightly intercorrelated that their individual contributions become indistinguishable, showed no evidence of distorting the regression results. Spatial autocorrelation, the tendency of neighboring geographic units to share characteristics in ways that violate the independence assumptions of ordinary statistics, was likewise assessed and not found to be a problem. These diagnostics matter because state-level findings that ignore spatial dependence can dramatically overstate the reliability of an effect. Their absence here lends the central result a solidity that many ecological studies lack.

What does the association mean? McCann offers two main interpretations, both framed carefully as speculations rather than conclusions. The first is an aggregation account: the state-level relationship may simply reflect the accumulation of individual-level relationships. If, as a substantial body of laboratory and survey research suggests, people who hold more ageist attitudes or greater aging anxiety are individually more drawn to cosmetic procedures, then states composed of more such individuals should show higher aggregate interest. This interpretation is consistent with prior findings that aging anxiety predicts favorable attitudes toward cosmetic surgery, particularly among middle-aged women, and that fear of aging and fear of death are intertwined in ways that make the pursuit of a youthful appearance psychologically meaningful.

The second interpretation is bolder: the correlation is consistent with a causal link in which ambient ageism, the ageist climate of a community, actively promotes interest in plastic surgery among its residents. Terror management theory provides one theoretical scaffold for this idea. From that perspective, awareness of mortality is buffered by cultural worldviews and symbolic immortality, and the aging body is a potent reminder of death. Anti-aging cosmetic procedures can function as an existential defense, a way of denying the body’s trajectory. A community steeped in ageist stereotypes may amplify this defense, making surgical intervention feel more necessary and more normative. Yet the study’s cross-sectional, correlational design explicitly precludes causal inference. The data were collected for a single year, 2015, and cannot establish whether ageism drives surgery interest, whether surgery-seeking communities develop more ageist climates, or whether both are downstream of some unmeasured cultural factor.

The ecological nature of the analysis also demands caution in a different way. State-level correlations cannot be automatically applied to individuals, a pitfall known since the classic work on ecological correlation in the 1950s. The finding that ageist states have more plastic surgery interest does not mean that every ageist individual wants a nose job, nor that every surgery patient is prejudiced against older people. What it does suggest is that psychological climates, the shared attitudinal atmospheres of places, are associated with consequential patterns of behavior and market activity. This aligns with a growing literature in geographical psychology showing that personality traits, implicit biases, and social attitudes are not randomly distributed across the map but cluster in stable, predictable patterns that relate to health, politics, and economics.

The practical implications are hard to ignore. The American Society of Plastic Surgeons reports millions of cosmetic procedures performed annually, and international surveys confirm that aesthetic surgery is a vast and growing global industry. If ageist climates contribute to that demand, then the stakes of ageism extend beyond the well-documented harms to older adults themselves, including worse health outcomes and increased mortality risk documented in prior research. Ageism, this study implies, may also be written onto younger bodies in the form of Botox, fillers, and facelifts, as people internalize the message that aging is something to be fought. The author notes that this is the first study to empirically demonstrate the association between ambient ageism in a geographic area and residents’ interest in plastic surgery, and the data are openly available for other researchers to scrutinize and extend. Future work with longitudinal designs, individual-level data, and measures that track both attitudes and procedures over time will be needed to determine whether the arrow of influence points from prejudice to the operating table, from the operating table back to prejudice, or in both directions at once. For now, the study stands as a striking reminder that our attitudes toward aging may be inscribed not only in policy and healthcare but in the very geography of the beauty industry.

Subject of Research: The association between state-level ageism and interest in plastic surgery across the contiguous United States

Article Title: U.S. state levels of ageism and interest in plastic surgery

Article References: McCann, S. J. H. (2026). U.S. state levels of ageism and interest in plastic surgery. Current Psychology, 45(18), Article 1521. https://doi.org/10.1007/s12144-026-10025-8

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10025-8

Keywords: ageism, plastic surgery, cosmetic surgery, aging anxiety, geographical psychology, Google Trends, age stereotypes, U.S. states, Current Psychology, state-level analysis, terror management theory, ecological correlation