Looksmaxxing tier list checked against the evidence

Key points

• The list (@Hoostethics, 2026-10-22) ranks 33 items. It states no criteria, so the tiers are an opinion, not a finding [49].
• It disagrees most with the evidence on hair loss: finasteride and topical minoxidil sit in D, though both are approved and tested in randomized trials, while topical dutasteride sits in S with no approved product [18][21][22][26].
• Melanotan is in S. The unapproved “tanning shots” have no trials for tanning and case reports of melanoma; the approved relative, afamelanotide, is for one rare disease [1][2][4].
• For most procedures (rhinoplasty, hair transplant, fat grafting, philtrum reduction) the evidence is observational, so a tier cannot be defended from trial data [27][31][34][36].
• It agrees with the evidence on bone smashing, mewing and the unapproved growth-hormone fragment: low tiers, nothing to support them.

What a tier list is, and is not

A tier list is one person’s ranking. It does not say whether S means “works”, “safe”, “cheap” or “worth the risk”, for whom, or over what time, and it puts drugs, surgery, supplements and habits in one grid. The post had 15,121 likes and 3.3M views when we fetched it [49].

We transcribed the image. Below, “agrees” means the evidence supports a tier at least that high; “disagrees” means it does not. Status is for the US unless another regulator is named. “No controlled studies found” means a PubMed search on 2026-11-08 [48].

S tier

Item	What it is	Status	Evidence	Src
Tazarotene / tretinoin creams	Topical retinoids	Prescription. Tazorac cream labelled for psoriasis and acne; contraindicated in pregnancy. Tretinoin 0.02% labelled as adjunct for fine facial wrinkles	Partly agrees. Tretinoin label says it “DOES NOT ELIMINATE WRINKLES” and that many vehicle-group patients also improved	[10][11]
Melanotan (“Melanotan-1” vial)	Unapproved synthetic hormone analogue sold for tanning	No approval. Only afamelanotide (Scenesse) is approved: EPP implant, FDA 2019, EU 22 Dec 2014. FDA says tanning shots are not approved	Disagrees. A 2017 review found 4 case reports of melanoma arising in moles; causation unproven. FDA notes case reports of melanoma with melanotan II. Scenesse label recommends twice-yearly skin exams	[1][2][3][4][5]
Teeth whitening (strips)	Peroxide strips	Consumer or dentist products; category not checked	Partly agrees. Cochrane 2018: 71 RCTs, whitening beat placebo for 2 weeks to 6 months; certainty low to very low; sensitivity mild	[28]
Rhinoplasty	Nose surgery	Surgeon-performed	Thin. A 2025 review of 12 RCTs (743 patients, mean follow-up 9.1 months) found no standardized, validated outcome measure	[31]
Hair transplant	Surgical graft of hair	Surgeon-performed	Thin. 45 papers (24 case reports, 21 observational) on complications. No randomized trial against no treatment found	[27][48]
Topical hair serum	A minoxidil-type serum; a “topical dutasteride” spray	Minoxidil 5% is over the counter for men. No topical dutasteride product found in DailyMed; oral dutasteride is approved for BPH and used off-label for hair	Split. Minoxidil: see D. Topical dutasteride: reviews call it still in development	[21][26]

A tier

Item	What it is	Status	Evidence	Src
Lumify	Brimonidine 0.025% eye drops	Over the counter “redness reliever” for minor eye irritation	Partly agrees. Four company-linked studies: redness below vehicle, no tachyphylaxis to day 29, rebound rare	[29][30]
Topical GHK-Cu	Copper-peptide serum	No drug approval found	Thin. A 2026 review (64 records kept) says human trials are mostly small, on cosmetic creams	[39]
Korean SPF	Sunscreen	US sunscreens are OTC drugs. FDA added bemotrizinol, sold in Europe for years, on 9 June 2026	Agrees for sunscreen generally. Nambour RCT (1,621 adults): skin aging 24% less with daily use; melanoma HR 0.50 (95% CI 0.24-1.02). No brand comparison found	[40][41][42][48]
Low-dose testosterone	Testosterone enanthate	Prescription. Approved for men with low or absent testosterone plus a condition; age-related limitation kept (Feb 2025); all products raise blood pressure	Disagrees. TRAVERSE (5,246 men aged 45-80 with hypogonadism and cardiovascular risk, 33 months): no excess major cardiac events, more atrial fibrillation, kidney injury, pulmonary embolism. No trial in men with normal levels found	[12][13][14][48]
Osteotomy	Jaw surgery (we assume)	Surgeon-performed	Thin for cosmetic use. 12 observational studies in people with dentofacial deformity: quality of life improved	[32]
Isotretinoin (“delete acne (caution)”)	Oral retinoid	Prescription, severe nodular acne only. Boxed warning for birth defects; US iPLEDGE; UK consultant-led team plus Pregnancy Prevention Programme (2020 notice)	Agrees on acne efficacy. Cochrane: 31 RCTs, 3,836 people, most at high risk of bias. Label also warns of psychiatric disorders and others	[7][8][9]
Botox	Botulinum toxin	Prescription. Botox Cosmetic labelled for temporary improvement of lines in adults; boxed warning on distant spread	Thin for “prevention”: no randomized prevention trial found	[38][48]

B tier

Item	What it is	Status	Evidence	Src
Antioxidants (acerola, vitamin E)	Supplements	No appearance indication	Thin. No controlled study of either alone on appearance found. Nambour: beta-carotene had no overall effect on skin aging	[40][48]
Debloating (potassium chloride powder)	Potassium salt	Potassium chloride is labelled as a medicine for low potassium (Klor-Con)	Disagrees. No controlled studies found. Label: potentially fatal hyperkalaemia if excretion is impaired or intake too fast; often symptomless until late; interacts with ACE inhibitors, ARBs, NSAIDs, potassium-sparing diuretics	[44][48]
Fat grafting	Own fat moved to the face	Surgeon-performed	Thin. 2022 review: complication rates 1.5%-81.4% across papers; true rate unknown, RCTs needed	[34]
Filler	Injected gel	FDA-approved devices for adults 22+, set areas. Vessel injection can cause blindness, necrosis, stroke	Partly agrees. Approved uses are narrow; FDA calls vessel injection “the most concerning risk”	[35]
Philtrum reduction	Lip lift	Surgeon-performed	Thin. One review: 6 studies, 361 patients, all combined with rhinoplasty. No randomized trial found	[36][48]
Mastic gum	Chewed resin	None	No controlled studies found on jaw or face. Reviews cover heart, bowel and oral health	[48]

C tier

Item	What it is	Status	Evidence	Src
Mewing	Tongue-posture habit	None	Agrees. Searching “mewing” returns commentaries (2019, 2026) and no trial; we could not read their full text	[48]
Injected GHK-Cu	Injectable copper peptide	No approved injectable. FDA lists it among withdrawn compounding nominations: limited human data, immunogenicity concern	Agrees. Human literature described as “thin and fragmented”	[4][39]
BB cream	Tinted cosmetic	Cosmetic	Thin. In a lab test of 21 products, 70% matched labelled SPF; the rest were 2 to 10 times lower	[43]
Limb lengthening	Cosmetic stature surgery	Surgeon-performed	Partly agrees. 7 studies, 489 patients: no deaths, high satisfaction, but 56% “problems” with external frames versus 37% with nails	[37]
HGH fragment 176-191	AOD9604, per a 2026 review	Unapproved. FDA: immunogenicity risk and serious adverse events, causality unclear	Agrees. Authors’ summary of six placebo-controlled trials: no IGF-1 effect, no related serious events. Fat data are from mice and human fat tissue in vitro. No published efficacy result found	[4][15][16][17]
Fake tan	Dihydroxyacetone (DHA) lotions	DHA approved for external use only	Disagrees with order. Colours skin; minimal sun protection; contact dermatitis reported	[5][6]
Oral minoxidil	Tablet for hair loss	Tablets labelled only for severe hypertension; hair use is off-label. Label warns of pericardial effusion and angina	Roughly agrees. 4 RCTs (279 patients): similar hair density to topical, more hypertrichosis; a 90-man RCT (68 completed) found no significant difference at 24 weeks	[23][24][25]

D tier

Item	What it is	Status	Evidence	Src
Bone smashing	Self-inflicted facial trauma	None	Agrees. No evidence it works. It is dangerous: a surgeon cites airway bleeding, blindness and nerve damage	[46]
Finasteride	5-alpha-reductase inhibitor	Prescription; 1 mg approved for male hair loss. UK (May 2026): warnings on depression, suicidal ideation, lasting sexual dysfunction	Disagrees on efficacy. Label trials: 48% vs 7% improved at 12 months (blinded photo panel); year-1 sexual effects 3.8% vs 2.1%. A meta-analysis of observational studies found no suicide link (HR 1.07, CI 0.76-1.51)	[18][19][20]
“Starvmaxxing (with meth)”	Not assessed	Methamphetamine is Schedule II	Not assessed; it is dangerous and, outside a prescription, illegal	[47]
Topical minoxidil	Scalp solution or foam	Over the counter; 5% label is for men, crown only	Disagrees. 48-week RCT, 393 men: 5% beat 2% and placebo; itching and irritation more common	[21][22]
Gua sha	Scraping massage	None	Thin. 8-week RCT, 34 women, gua sha vs facial roller, no untreated group	[45]
Buccal fat removal	Cheek-fat surgery	Surgeon-performed	Partly agrees. Meta-analysis, 308 patients: 25% had complications (CI 4%-46%); authors advise caution	[33]
Thumb pulling	Named without explanation	None	No controlled studies found	[48]

Where the list and the evidence disagree

1. Hair-loss drugs are upside down. Finasteride and topical minoxidil are in D. Both have regulator approval and randomized data; finasteride’s label shows a clear benefit on a blinded photo panel [18][22]. Topical dutasteride is in S, with no approved product and reviews describing the delivery problem as unsolved [26]. The D placement is not baseless for finasteride: the UK regulator logged 170 reports of suicidal ideation, 19 of them fatal suicides, from 1994 to May 2025, with the caveat that reports do not prove causation [19].

2. Melanotan against fake tan. Melanotan is S, fake tan is C. The only approved relative, afamelanotide, is an implant for adults with EPP, with a label that flags darkening of moles [2]. The evidence on unapproved melanotan is case reports; the review places its use within a “tanning culture” [1]. The only listed tanning method with a regulatory status for cosmetic use is DHA [5].

3. Prescription drugs treated as tools. Low-dose testosterone is A and isotretinoin is A. Testosterone labels cover men with a deficiency; the large trial was in men with symptoms and low levels, and tells us little about use in men with normal levels [12][14]. The testosterone label has a section on abuse and misuse [13]. Isotretinoin works for severe acne, but the label adds a boxed warning and an access programme [7][8].

4. Procedures ranked without trial data. Rhinoplasty and hair transplant are S; osteotomy is A. The reviews describe thin outcome literature: no validated measure, case reports, observational studies [27][31][32]. Buccal fat removal in D is the one surgical call that fits the data: one in four patients had a complication [33].

What an evidence ranking would look like

A ranking built from evidence would score two things separately: how well an effect has been shown, and how large the documented harms are. For the first axis, from strongest to weakest: a regulator decision with trial data in a label, a systematic review of randomized trials, a single randomized trial, observational studies, case reports, then anecdote and social posts.

On that scale, finasteride, topical minoxidil and isotretinoin would rank near the top for effect: approved, with randomized data. Teeth whitening has 71 trials, yet only two had low risk of bias, so even a Cochrane review ends at “low to very low certainty” [28]. Surgery would sit in the middle, on observational data. Melanotan, injected GHK-Cu, the growth-hormone fragment, mewing and thumb pulling would sit at the bottom: unapproved, or untested in people for the claimed effect.

Approval is also narrow: Scenesse, Lumify and testosterone are approved for specific uses, not for appearance in healthy people [2][12][29].

Risks and unknowns

• We ranked nothing ourselves. The sources report average effects in trial populations, not individuals.
• We could not read the full text of the 2019 and 2026 mewing commentaries [48]. The UK isotretinoin notice we opened is from 2020 and has since been superseded.
• A June 2026 press report of a proposed US change to the testosterone age limitation was not opened or verified.
• We did not verify the cosmetic or device status of whitening strips, fat grafting, BB cream or GHK-Cu serum, nor UK or German status for most items.
• A reported negative phase 2b obesity trial for AOD9604 appears only in secondary summaries; we could not verify it and left it out.

Frequently asked questions

Is the tier list based on evidence? It states no criteria. Several placements match the evidence (bone smashing, mewing, injected GHK-Cu, the growth-hormone fragment); several do not, notably finasteride, topical minoxidil, melanotan and topical dutasteride [49].

Is melanotan the same as the approved drug Scenesse? No. Scenesse (afamelanotide) is approved for adults with erythropoietic protoporphyria in the US and EU. Melanotan products sold for tanning are unapproved and have no trials for that use [2][3][4].

Has mewing been tested in a trial? We found none. A PubMed search on 2026-11-08 returned commentaries and no trial of mewing [48].

Is potassium chloride “debloating” safe? We found no controlled study of it for that purpose. The drug label describes potentially fatal hyperkalaemia when the kidneys cannot clear potassium or intake is too fast [44][48].

Sources

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5. American Cancer Society, “Is It Safe to Get a Fake (Sunless) Tan?” (revised 1 Sep 2026). https://www.cancer.org/cancer/risk-prevention/sun-and-uv/tanning-pills-and-products.html
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48. PubMed searches run 2026-11-08 (terms: mewing; orthotropics; mastic gum; acerola; thumb pulling; debloating; hair transplantation randomized; prejuvenation botulinum toxin; Korean sunscreen randomized; testosterone eugonadal men randomized; philtrum/lip lift). https://pubmed.ncbi.nlm.nih.gov/
49. @Hoostethics, “ranking looksmaxxing techniques” (X post, 22 Oct 2026; image transcribed in the project’s source file). https://x.com/Hoostethics/status/2113302148750758106

This article is information, not medical advice.