‘The Substance’ Shines Light on Society’s Obsession with Longevity

New body horror film "The Substance" may be an extreme and unrealistic depiction of aesthetic medicine, but it’s also a very real critique of society’s fixation on youth, beauty, and longevity.

Can Botox and filler turn you into a grotesque, deformed monster with more than one spine and countless misplaced body parts? Not likely, but they can be a slippery slope on a futile, neverending quest for youth, physical perfection, and unattainable beauty that may leave you feeling forever unsatisfied with what you see in the mirror.

At least, that’s the takeaway from the body horror film "The Substance," which won the Best Screenplay award at the 2024 Cannes Film Festival and earned actor Demi Moore a Golden Globe for her portrayal of Elizabeth Sparkle, the film’s main character.

The movie follows Sparkle, a celebrity who is ousted from Hollywood at the age of 50 and left with little to show for her career but a fancy apartment and old clips of her jazzercise videos. So when she’s informed of a mysterious substance that promises to “create a younger, more beautiful, more perfect” version of herself, she immediately signs on without concern for potential side effects or consequences.

And thus, Sue (Margaret Qualley) is born through a gruesome process that involves self-injections and the splitting of Elizabeth’s spine from which the younger, prettier clone emerges. What follows is a graphic, bone-chilling tale of the dangers of prioritizing beauty and youth at all costs — including your own health, wellbeing, and life.

While the specific events of the film may be far-fetched (and scientifically impossible), the pressures and insecurities Elizabeth faces — and the extreme lengths to which she’s willing to go to measure up to society’s standards — are all too real in a world that is indisputably obsessed with appearance and staying young.

A fictional film, a real societal issue

The beauty standards and ageism highlighted in "The Substance" are something Lia, a 33-year-old from North Carolina who asked that her last name be kept private, often feels in her own life.

Lia tells Healthnews that she “feels anxious about looking older” and constantly "slathers her skin with creams" that promise to preserve her youth. While she herself hasn’t turned to injections, she concedes that she’s lost track of what normal aging even looks like due to all the so-called “solutions” being peddled by companies and used by her peers.

Facetune can smooth all your lines away and whiten your smile, and Botox gets rid of any trace of a line. It's hard to know what a 33-year-old face is meant to look like.

- Lia

Meanwhile, real-life stories of individuals going to extreme lengths to look young consistently fill news headlines: Tech mogul and infamous biohacker Bryan Johnson, who has made it his mission to reverse aging and live forever, recently shared that an attempted anti-aging procedure that involved injecting a donor’s fat into his face ended with a major reaction in which his face swelled up dramatically.

Social media influencers, meanwhile, share their extreme body modifications online, normalizing undergoing countless surgeries to achieve a certain appearance.

What 'The Substance' teaches us, according to plastic surgeons

As a Royal College-certified plastic surgeon with extensive experience in aesthetic medicine and a deep understanding of the societal and psychological factors driving the pursuit of youth, Steve Hanna, M.D., tells Healthnews that he found the themes explored in "The Substance" quite compelling. That’s because, according to Hanna, our culture's preoccupation with youth has never been more pronounced.

“The longevity industry — spanning cosmetic treatments, anti-aging skincare, and regenerative medicine — is rapidly growing,” he explains. “This pursuit of youth is often fueled by a combination of social media-fueled beauty standards and deeply ingrained societal beliefs that equate youth with value, productivity, and self-worth.”

According to the American Society of Plastic Surgeons 2023 report, there were 4,715,716 procedures using botulinum toxin type A (including Botox, Dysport and Xeomin) in the U.S. in 2023, reflecting an increase of 6% from the previous year. Dermal fillers have also become more popular, with 3,441,534 procedures performed last year, up 4% from 2022.

The report also found that Gen Z showed interest in facial surgeries typically associated with older demographics, such as facelifts, facial fat grafting, and forehead lifts. The 30-39 age group, made up predominantly of Millennials, meanwhile saw the highest year-over-year increase in hyaluronic acid fillers, with an 8.93% rise, according to the report.

Hanna says he sees firsthand in his work how certain procedures become highly in demand among specific demographics as part of a rotating trend cycle that is often influenced by celebrities and social media.

According to Dennis Schimpf, M.D., a board-certified plastic surgeon at Sweetgrass, in addition to Botox and fillers, some of the latest aesthetic trends he’s witnessed in his work include fox-eye surgery, lip flips, buccal fat removal, and jawline contouring.

He’s also witnessed some alarming, riskier trends, such as at-home filler and Botox, which are dangerous because they lack professional hygiene standards, increasing the risk of infections, nerve damage, and uneven results.

"Bone-smashing" for facial structure, which involves repeatedly hitting one’s face in hopes of reshaping bone structure, often aiming for a sharper jawline or cheekbones, has also gained popularity. Schimpf warns that this is ineffective and painful and can result in fractures, long-term injuries, or misalignment.

At-home chemical peels, waist training with corsets, sunburn tanning, saline injections for lip filler, IV drip therapy for skincare, and silicone injections are additional alarming trends on the rise, according to Schimpf, and they can also potentially result in negative health outcomes.

"The Substance" offers a satirical yet chilling commentary on how the fixation on youth and beauty can distort priorities, leading people to go to extreme measures with sometimes dire results, Hanna says.

From my perspective, the story reflects the darker side of aesthetic medicine — where the desire for transformation can overshadow considerations of mental and physical health.

- Hanna

A mental health expert's takeaway

Veronica West, MPH, a psychologist and the founder of My Thriving Mind, says the film reads like a twisted beauty ad gone horribly wrong, ultimately shining a light on a societal obsession that seems to know no bounds.

“Between wrinkle-free influencers and billion-dollar longevity industries promising us immortality — or at least 20 more years without gray hair — the pressure is real,” West tells Healthnews. “‘The Substance’ holds a warped mirror up to our society, asking, ‘How far would you go for a youthful glow? And at what cost? Your face? Your soul? Your sanity?’"

Although the film's plot is somewhat ridiculous and downright terrifying, West says it effectively parodies how ridiculous our standards of beauty can be.

In a sense, it’s a kind of PSA, she adds: “If you keep focusing on youth, you run the risk of being the main character in your own horror story.”

West says the film is ultimately a cautionary tale about the dangers of seeking youth and beauty at all costs. The lesson baked within it is to embrace life's natural process — wrinkles and all — despite the external pressures placed on everyone, but particularly older women.

Admittedly, this is easier said than done in a society that teaches women their value lies in their appearance, but the film teaches that breaking free of these shackles is the key to living an authentic, fulfilling life.

Of course, whether to undergo an aesthetic procedure is and should always remain a personal choice that individuals are empowered to make. What must change, as argued by both the film and experts, is the pressure people feel to look a certain way in order to receive acknowledgement, acceptance, and love.

“Sure, anti-aging creams are fine, but maybe we should also focus on aging gracefully, laughing at ourselves, and remembering that a good personality beats a perfect jawline any day,” West says. “If someone offers you a ‘miracle serum,’ maybe stick to sunscreen instead.”