Both things can be very accurate. Romi Rain has mentioned her body dysmorphia a few times in the past, and while she’s clearly had work done, she looks amazing because she did it early/pre career and (at the time of typing this) knew when to stop. Then you have Bridgette B who had personal issues (abuse/divorce) and chose to get work done coming out of those situations, only to get butchered by her surgeon.