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This research concerns the effectiveness of social media influencers as endorsers of dermal filler treatment to ameliorate the facial signs of ageing, for UK-resident Generation X women. Influencers have emerged as contemporary opinion leaders with the ability to shape the choices of like-minded followers with whom they are in direct digital contact. Whereas previous studies have largely focused on influencer characteristics, this research examined the role of salient attitudes and beliefs held by followers as determinants of endorsement effectiveness. A two-phase research design was used. The first, qualitative phase of 19 semi-structured interviews explored Youth-Ideal, a novel appearance ideal that encourages women to maintain a youthful appearance into midlife and confirmed the inclusion of Youth-Ideal Internalisation as a latent variable in the subsequent, quantitative phase. This second phase of the research analysed data from 733 participants using structural equation modelling (SEM) to test a conceptual model, based on the Theory of Reasoned Action, made up of twenty hypothesised relationships between four follower characteristics, identified as either emergent attitudes to the influencer (perceived similarity, attitude congruence) or pre-existing perspectives concerning the endorsed product (attitude to the behaviour and Youth-Ideal internalisation) and four discrete measures of endorsement effectiveness (perceived credibility, acceptance of information, comparison behaviour and booking intention). The findings reveal that both followers' emergent attitudes to the influencer and their pre-existing attitudes and beliefs affect the performance of an influencer-led endorsement. However, the power and timing of those effects vary, hence, a communication cascade is proposed spanning from receipt of endorsement content to behavioural intention, where emergent attitudes, those directed towards the influencer, have the greatest impact on the formation of perceptions of credibility and acceptance of information and pre-existing attitudes and beliefs stemming from the nature of the endorsed product have more influence on followers' intended behaviour. This evaluation of the impact of both emergent and pre-existing attitudes and beliefs held by followers on the effectiveness of an influencer-led endorsement helps fill gaps in existing influencer marketing knowledge by uncovering how the object of the endorsement can impact both followers' perceptions of the influencer and their behavioural intention. By demonstrating the importance of salient aspects of followers' attitudinal profiles, this research can also guide marketing professionals in their identification of an appropriate influencer. Further, understanding the nature, direction and magnitude of the target consumer's attitude toward the endorsed product will help in the development of communication strategy and messaging.