A recent RealSelf survey revealed that one in five women plan—at some point—to pursue plastic surgery, and more than one-third of U.S. adults are considering a cosmetic procedure in 2019. I was surprised when I first read those numbers; I’m one of those women who’d always sworn she’d never do either—but that was before my neck started falling. And before cosmetic procedures began to lose their social stigma.

I’m still not sure I’ll consider surgery, given the cost, the recovery time, and let’s face it, the pain. But since coming to work at RealSelf, I’ve clued in to the countless nonsurgical procedures promising to give me (and my faltering neck) a new lease on life. Still, I keep circling around the same questions: which treatments are worth the time and expense? Which will require a weeklong hideout? Which will make me look too “done?” And most importantly: which can actually deliver on the familiar promise of “still you, but better?”

For the first time, RealSelf is answering the question of which procedures are truly Worth It, based on ratings from thousands of reviews posted on RealSelf in the past year. Our “Most Worth It” procedures of 2019 are ranked by their RealSelf Worth It (or Not Worth It) ratings: a thumbs up or down from real people, based on their experience with cost, downtime, recovery, and results.

Breast procedures come out on top

This year’s Most Worth It surgical procedure—according to RealSelf reviewers—is breast implant removal. After getting rid of implants that felt too heavy, unnatural, risky, or simply posed an ongoing wardrobe challenge, many of the past year’s reviewers say they love the feeling of going natural. Jessbreath, a 36-year-old runner, says her implants just felt too large. At 62, Zenful feels “loads lighter, younger, and thinner” without them. And after 35 years of having implants, Seroma’s “excited to be all me again.”

These choices aren’t so surprising, given rising trends in body positivity and the “you do you” feminism fighting hard to topple the one-fantasy-fits-all ideal of decades past.

That said, surgeries involving implants also receive stellar RealSelf Worth It ratings. In fact, eleven breast-related procedures—including those that increase or decrease cup size, lift, or reconstruct your breasts—had Worth It ratings high enough to land them near the top of the Most Worth It list. About half include implants: a crucial element for women like Boobsafterbc, who says breast reconstruction gave her back what cancer stole. “I feel like I am 5 weeks away from having my life back 100%, including a femininity that I have missed deeply.”

Before and after weight loss or pregnancy

Surgeries related to weight loss also earned top Most Worth It rankings. Sleeve gastrectomy placed second overall, with a 99% Worth It rating from people like Dawn, who no longer worries that her weight will keep her from fully participating in her daughter’s life; and Katey, who says, “this feels like the first step, and the right step on that journey to rediscovering my self-worth and happiness.”

Body lifts placed 6th overall with a 99% consumer Worth It rating—despite their average cost of $15,000. This procedure combines surgeries like a butt lift, thigh lift, tummy tuck, panniculectomy, arm lift, or breast lift to remove excess skin and tissue after massive weight loss. Reviewers said it was the final step in revealing the outward results of their life-changing weight loss journey.

Tummy tucks also placed in the top ten, earning a 97% Worth It rating, and while they’re often done after major weight loss, that’s not always the case. They’re also overwhelmingly Worth It for women who, post pregnancy, want to lose excess skin and tighten the underlying muscle. Many say they look and feel as good (if not better) than they did before giving birth.

Vaginal rejuvenation? 100% yes

On the Most Worth It nonsurgical procedures list, the chart-topping diVa Vaginal Therapy boasts a 100% Worth It rating—more evidence of taboos going out the window. Women of all ages, with or without kids, are feeling freer (and taking advantage of better avenues) to prioritize their sexual health. diVa laser treatments, for instance, firm and tighten vaginal tissue, increase lubrication, and reduce stress incontinence, a trifecta that gets a full-throated hallelujah from women wanting to get their groove (and bladder control) back after childbirth or menopause.

Ikeda70’s, review says she feels “fully like a new woman” after diVa. Nolasmiles says she used to have slight incontinence, but now can laugh and sneeze in public. “I have never had any major problems with lubrication but I definitely welcome the improvement!” Two other vaginal rejuvenation treatments, MonaLisa Touch and ThermiVa, also made the Most Worth It list. All of this is hopeful news for women (like me) who are unwilling to accept that sexual discomfort, urinary embarrassment, or lackluster orgasms are inevitable, and “just part of the aging process.”

Injectable fillers + toxins = the 2019 power couple

More than a quarter of this year’s Most Worth It nonsurgical treatments are facial fillers or toxins, including top-ten ranked Restylane Lyft, Volbella, Dysport, and Botox. And while they all have individual benefits, RealSelf reviewers also rave about their combined results. Together, they can create a “liquid facelift,” something I’d consider far in advance of a surgical facelift. (I might even be thinking about it right now.) Millennials are also jumping onboard the fillers and toxins train, using injectables as preventative measures—just more proof that the stigma around cosmetic procedures simply doesn’t exist the way it did ten, or even five years ago.