Every procedure on RealSelf comes with a Worth It Rating, a proprietary consumer-satisfaction score showing the percentage of real patients, with firsthand experience, who thought the procedure was “Worth It.” 

We have announced the 2021 Most Worth It Ranking—a list of the 20 top-rated cosmetic procedures of the year, as determined by Worth It Ratings from RealSelf members. In our Most Worth It series, we’re highlighting the trends revealed by this year’s ranking and the procedures to watch this year, to help you make smart, confident decisions. 

Sleeve gastrectomy is the Most Worth It procedure

With a 100% Worth It Rating (based on 63 reviews from RealSelf members over the past year), sleeve gastrectomy lands the top spot on the list this year. This surgical procedure shrinks the size of the stomach by 85–90%, dramatically reducing the amount of food the patient can eat and typically leading to significant weight loss. 

Many doctors recommend sleeve gastrectomy (also called gastric sleeve surgery) over gastric bypass, since the former is less invasive; has a lower complication rate and shorter recovery time; and, unlike gastric bypass, doesn’t require lifetime abstinence from NSAIDs and reliance on nutritional supplements. 

One RealSelf community member wrote that sleeve gastrectomy “literally saved and revolutionized my life.” Another said it allowed her to be more active and get endorphins through exercise—which helped her finally feel healthy, “mentally and physically.”   

Breast surgeries are as popular as ever

Six breast-related surgeries were included in the top 20. Breast implant removal and breast reduction came in ahead of breast implantsaugmentation, and reconstruction, suggesting a trend toward a smaller, more natural look. 

Dr. Melissa Doft, a board-certified plastic surgeon in New York City, credits the increase in breast reductions at her practice to COVID-19 and stay-at-home orders. “It may be due to COVID-19–related weight gain, but I also think it’s due to women being at home and realizing they’re not happy with their shape and finally having the time to look into a solution,” she says. “I’m also seeing a trend of women wanting smaller breasts in general. Prior to COVID-19, most women wanted a C or D cup—now they want a B or C cup. I think this is because they’re home more and want to be braless and, therefore, have a smaller cup size.”   

Men’s favorites: gynecomastia surgery and hair restoration

Gynecomastia surgery, also called male breast reduction, and two hair transplant procedures (performed in higher numbers on men) earned Most Worth It distinctions this year. Many RealSelf members who underwent these surgeries called their results “life-changing” and reported newfound confidence. 

One gynecomastia surgery reviewer wrote, “I didn’t want to wear T-shirts or go to the beach/swimming pool. I am extremely happy with the results of my surgery and the way my chest looks now. The surgery has helped me mentally by increasing my confidence and self-esteem.” 

Wrinkle-reducing crowd pleasers: Dysport and Botox

Two neurotoxins commonly used to smooth fine lines, wrinkles, and frown lines—Dysport (96% Worth It Rating) and Botox (94% Worth It Rating)—came out ahead of all the other injectable options. 

The two are similar, but Dysport has a lower molecular mass than Botox, which gives it a higher diffusion rate. For this reason, some doctors feel it’s better for larger areas, like the forehead, while Botox is ideal for more concentrated areas, like the crow’s-feet. 
Anecdotal evidence suggests Dysport may also kick in a few days sooner than Botox, which takes between 7 and 14 days. It’s worth nothing that everybody metabolizes the various forms of botulinum toxin differently, so the longest-lasting treatment for other people might not be your favorite. Your provider can help you select the best wrinkle reducer for your needs.

RealSelf 2021 Most Worth It Ranking Honorees

RankProcedureWorth It Rating1
Eligible Reviews
(min. 50+)
1.Sleeve Gastrectomy100%63Weight Loss
2.Gynecomastia Surgery99%108Male Body Enhancement
3.Breast Implant Removal98%383Breast Enhancement
4.Breast Reduction98%626Breast Enhancement
5.Breast Implants97%622Breast Enhancement
6.Arm Lift97%70Skin Tightening
7.FUE Hair Transplant97%124Hair Restoration
8.Breast Augmentation97%1,770Breast Enhancement
9.Natrelle Breast Implants97%59Breast Enhancement
10.Mommy Makeover96%776Breast Enhancement, Body Contouring, Skin Tightening
11.Lip Augmentation96%151Lip Enhancement
12.Lower Facelift96%120Face & Neck Lifts
13.Dysport96%71Fillers & Other Injectables
14.Tummy Tuck96%1,353Skin Tightening
15.Septoplasty95%65Nose Enhancement
16.Breast Reconstruction95%95Breast Enhancement
17.Eyelid Surgery95%382Eye Enhancement
18.Botox94%497Fillers & Other Injectables
19.Hair Transplant94%234Hair Restoration
20.Facelift94%357Face & Neck Lifts

Source: RealSelf, Jan. 1, 2020–Dec. 31, 2020.
1Worth It Ratings shown as rounded percentages; official ranking determined by several decimal places.

See more about the 2021 Most Worth It Ranking.


To be recognized as a 2021 Most Worth It procedure, a treatment must receive more than 50 reviews from RealSelf members between January 1, 2020, and December 31, 2020, and have earned a minimum cumulative Worth It Rating of at least 90% during the same time period. A total of 20 procedures (a mix of nonsurgical and surgical) earned a 2021 Most Worth It designation. While Worth It Ratings in the 2021 Most Worth It Ranking are shown as rounded percentages, the actual ranking is determined to several decimal places. 

Alix Tunell is the Deputy Editor at RealSelf. A former beauty editor at Allure, Harper’s Bazaar, and Refinery29, she now investigates the latest in aesthetic trends and treatments. She lives in New York City.