New York wears the injectables crown.
According to a new report, Empire State residents are ceaseless in their desire for creaselessness.
Using metrics including demand, provider and clinic density, and search interest, the Botox Obsession Index ranks all 50 states by the intensity of their Botox fixation.
Botox, a botulinum toxin meant to reduce the appearance and worsening of fine lines and wrinkles, remains the country’s most popular cosmetic enhancement procedure according to the American Society of Plastic Surgeons (ASPS), which estimates that 9.9 million treatments happened in 2025.An estimated
An estimated 800,000 of them occur in New York.
This latest study, conducted by Avinity Health, found that New Yorkers conduct an estimated 202 Botox searches per month per 100,000 residents, the highest rate of any state.
“New Yorkers are officially the most Botox-obsessed people in America,” Emily Dawson, co-founder and Clinical Director of Avinity Health, told The Post.
“What pushed New York to No. 1 was demand. New Yorkers search for Botox more often per capita than people in any other state.”
Providers have an interesting explanation for what is driving that demand.
“New York is filled with discerning, highly educated people who want the best, which is what makes us receptive to advances in medicine and aesthetics,” NYC-based plastic surgeon Dr. Laura Devgan told the Post.
Further, Devgan notes that the efficacy of Botox matches the general pace of the Empire State
“New York is incredibly busy and fast-moving, and in the right hands, Botox is a high gratification procedure with minimal downtime.”
However, the race for #1 proved incredibly close, as surprise second-place dark horse Colorado was edged out by NY by a mere 0.07 points.
“New York beat Colorado by just seven-hundredths of a point — the tightest margin anywhere in the top 10. New York essentially won the Botox crown by a wrinkle,” deadpanned Dawson.
California, Florida, and Massachusetts rounded out the top five for Botox obsession, while New Jersey took eighth place.
According to Devgan, New York is not only leading the charge with Botox obsession but directly influencing how it is applied.
“New York is always 10 years ahead of the rest of the country when it comes to beauty, style, and aesthetics; New Yorkers are driving the American zeitgeist toward a Botox look that is polished, understated, and natural,” said Devgan.
Interestingly, while New York ranks #1 in search interest, it ranks only #7 in Botox providers and clinics per resident, the widest gap between interest and availability of any state.
“Attention and access do not sit in the same places,” said Dawson.
“New York generates more estimated Botox searches per resident than any other state while ranking seventh for providers and clinics per resident, the widest gap in the index where searching runs ahead of supply.”
However, Botox providers say the gap reflects refinement rather than absence.
“A Botox appointment takes minutes, but developing the expertise behind it takes years, explained Devgan.
Indeed, in New York, as in most other states, Botox administration is classified as a medical procedure that only healthcare professionals can perform, including doctors, nurses, nurse practitioners, and physician assistants.
“Patients who value that depth of anatomical knowledge can create substantial demand for particular specialists. I suspect this is part of the gap between high patient interest and the number of providers available,” she added.
Moreover, Devgan notes that rigorous regulation is a necessary measure for proper care.
“If you are putting a sharp object into someone’s face, the bar should be high,” she underscored.
“New York’s licensing and scope-of-practice requirements are essential safeguards designed to protect patients.”
According to the study, other states where supply has allegedly yet to meet demand include Virginia, Illinois, and Washington.
While NY is the most Botox-hungry state in the US, Florida is the most saturated with providers, followed by Idaho and Arizona.
In terms of states where smoothness isn’t top of mind or in the search bar, Mississippi, West Virginia, Iowa, Arkansas, and Indiana are the least obsessed with Botox.
The study authors shared that although many view Botox as a luxury treatment, high income does not guarantee a high ranking, as some of America’s wealthiest states were far from the top.
In effect, Maryland has the third-highest median household income but ranks 18th for Botox obsession, while Alaska, eleventh for income, ranks 41st.
While wealth may not be a key indicator, regionality might be, as nine of America’s ten most Botox-obsessed states are in the West or Northeast.
The study also noted a spike in site-specific Botox searches.
US residents searched for masseter, or jaw, Botox 74,020 times a month, making it the second most searched term in the study after the word Botox itself.
“The single most surprising number in the study is masseter Botox. That tells you what people are curious about, and it is not foreheads,” said Dawson.
Masseter Botox can help people who suffer from temporomandibular joint disorders as it relaxes the jaw muscle. It can also manage teeth grinding and headaches, according to Healthline.
While masseter Botox can offer relief, it isn’t without complications; the most serious side effects include an asymmetric smile or visible bulging in a small area of the masseter muscle if the Botox doesn’t reach the muscle’s deepest fibers.
According to Devgan, masseter Botox is one among myriad applications for the injectable.
“Botox is so much more than a wrinkle smoother; it is increasingly used for neck contouring, brow lift, gummy smile correction, trapezius debulking, and even reduction of armpit sweating.”
