“I Need a Touch-Up!” America’s Most High-Maintenance States Revealed

Botox? Booked. Mani-pedi? Already in the diary. Hair transplant? Why not!

While some people pride themselves on being low-maintenance, others… not so much. Whether it’s weekly massages, a strict haircare routine, or a never-ending rotation of dental tweaks and injectables, staying picture-perfect is a full-time commitment.

But which U.S. states are leading the charge when it comes to all thing's beauty and body upkeep?

At Textla, we work with thousands of small cosmetic businesses across the country, from salons and spas to cosmetic dentists and independent beauticians, helping them keep in touch with clients through SMS marketing. So we know how busy the beauty calendar can get and we were curious: where are Americans the most committed to keeping up appearances?

Method Behind the Maintenance

We crunched the numbers from all 50 states to uncover which ones have the highest concentration of: Plastic surgeons, dental implant specialists, hair transplant clinics, manicurists and pedicurists, hairdressers, stylists & cosmetologists, and massage therapists. We adjusted these figures per 100,000 people to account for population, gave each state an index score out of 100 in each category, and added those up to calculate a total High Maintenance Score out of 600.

The result? A data-led peek into the most beauty-obsessed corners of America.

The 5 Most High-Maintenance States in America

1. New York

With a High Maintenance Score of 454.10, New York takes the top spot, and frankly, we’re not surprised.

This is the state where looking good isn’t optional; it’s an expectation.  

And if you’re looking for a quick glow-up before a meeting? No problem. With nearly 950 manicurists and pedicurists per 100,000 people, you’re never far from a fresh set, a blow-dry, or a lunchtime facial.

Looking good here isn’t just about vanity, it’s about keeping up. In a place where everything moves fast and first impressions matter, New Yorkers have turned maintenance into a form of momentum

• Plastic surgeons? 42 per 100,000 people — the highest in the nation.

• Hair transplants? 13 specialists per 100,000 — again, #1.

• Dental implants? New Yorkers have access to the most per capita.

• Manicurists and pedicurists? Over 18,000 in the state , you’re never far from a fresh set.

From the high fashion runways of Manhattan to upstate med spas and beauty salons, New York’s beauty industry is booming.

2. New Jersey

Just across the Hudson, New Jersey is giving serious competition with a score of 386.95.

Coming in hot at number two, New Jersey proves it’s not just about pizza and parkways — it's full-on polish. With the highest number of hairdressers and cosmetologists per capita and nearly 1,000 manicurists per 100,000, this state is serving up fresh fades and French tips like nobody’s business.

• Nearly 1,000 manicurists per 100,000 people - one of the highest rates in the country.

• Plastic surgeons and hair transplant clinics abound - perfect for the glow-up culture thriving from Hoboken to the Shore.

• Jersey ranks #1 for hairstylists and cosmetologists per capita.

With easy access to NYC trends but its own beauty culture, New Jersey takes pride in its presentation.

3. Delaware

Delaware may be tiny, but when it comes to pampering, it pulls out all the stops, scoring 352.05.

It might not be the first state you think of when it comes to maintenance, but it’s clearly putting in the work.  

Clocking in at third place, it punches way above its weight, thanks mostly to a sky-high number of massage therapists.

• Massage therapists: Over 4,200 per 100,000 people, second only to New Hampshire.

• Hair transplant specialists (10 per 100,000) and manicurists & pedicurists (673 per 100,000) are in solid supply.

Delaware performs consistently well across all categories, making it a surprise high scorer.

4. California

It may be a bit of a shock that California doesn’t top the list, but at 326.98, it still proves it's a powerhouse in the beauty business.

With over 1,100 plastic surgeons and nearly 40,000 manicurists, California is bursting with beauty professionals. The only reason it’s not higher? Population. The sheer number of people spreads out the stats — but make no mistake: the demand is intense.

• Plastic surgeons: 29 per 100,000 (1,163 total).

• 38,450 manicurists and 20,000+ hairdressers, stylists and cosmetologists make it a beauty behemoth.

5. Connecticut

Don’t sleep on Connecticut as the New England gem rounds out the top five with a High Maintenance Score of 326.64.

Quiet, preppy, and perfectly polished, this state secures its place in the top five with more than 1,000 manicurists per 100,000 people - the highest in the nation. That’s a lot of shellac.

It’s got 30 plastic surgeons per 100,000, tons of stylists, and a seriously solid dental game, because apparently, perfection is part of the zip code.

• Leads the nation in manicurists & pedicurists per capita — over 1,000 for every 100,000 people.

• Strong showings in plastic surgery, hairstyling and cosmetology, and dental implants.

Think upscale med spas in Greenwich, stylish hair salons in New Haven, and cozy massage boutiques all over.

Top 5 States by Beauty Category

Want to know which states dominate specific areas of the self-care space? Here's the glow-up breakdown:

Dental Divas – Most Dental Implant Specialists (per 100k)

1. New York – 19

2. Washington – 17

3. California – 15

4. New Jersey – 13

5. Nevada – 13

Nail Nation – Most Manicurists & Pedicurists (per 100k)

1. Connecticut – 1,023

2. New Jersey – 982

3. California – 975

4. New York – 948

5. Massachusetts – 780

Hair Today – Most Hair Transplants (per 100k)

1. New York – 13

2. Delaware – 10

3. Louisiana – 10

4. Florida – 9

5. California – 9

Rubdown Royalty – Most Massage Therapists (per 100k)

1. New Hampshire – 6,361

2. Delaware – 4,212

3. Rhode Island – 3,601

4. Nebraska – 2,429

5. Massachusetts – 2,115

Snatched States – Most Plastic Surgeons (per 100k)

1. New York – 42

2. Florida – 33

3. Connecticut – 30

4. California – 29

5. West Virginia – 28

So, What Does It All Mean?

Looking good may be subjective, but based on hard numbers, some states are working overtime to stay polished, prepped, and photo-ready. Whether it’s the influence of social media, career competition, or just plain personal pride, Americans in these states are keeping beauty professionals very busy.

And at Textla, we’re here for it. We power the SMS marketing behind thousands of small beauty businesses, keeping appointment books full and loyal clients coming back for more.

Methodology

Textla analyzed the number of professionals in six beauty-related categories across all 50 states using a combination of data from Realself, a platform of board-level registered cosmetic specialists, and US and data from the U.S. Bureau of Labour Statistics. We normalized these counts by each state’s population (per 100,000 people), gave them an index score out of 100 in each category, and summed those scores to create a “High Maintenance Score.”