“If you could change anything about your face, what would it be?”
It’s 2011, and I’m sitting at a round, faux-wooden table in the middle of my high school cafeteria. Slowly, I tear off a hunk of a fresh-baked plain bagel before dipping it in cream cheese, popping it in my mouth, and swallowing a wash of strawberry-flavored Crystal Light. The question had been prompted by one of my friends. “I really hate my chin,” I respond.
“Really?” she reacted. “I would never notice.”
Fast-forward seven years, a college education, two jobs, countless relationships, and one cross-country move later. “If you could change anything about your face, what would it be?” A wash of déjà vu just as tart as the 16-ounce bottles of Crystal Light I used to love in high school comes over me. Although this time, the question is prompted by a registered nurse and self-proclaimed “celebrity rejuvenation specialist.” And instead of my high school cafeteria, I've plopped on top of a sterile leather recliner in a West Hollywood–based dermatology office. “I’ve always hated my chin,” I say.
“Really?” the specialist frowns. “I think it’s pretty.”
That being said, in a day and age when a morning selfie feels more natural than a steaming cup of coffee, and an accompaniment of self-scrutinization more common than cream and sugar, her opinion doesn’t really matter, does it? After years of despising my chin (or what I deemed a lack thereof), I got a subtle hit of filler injected into my chin earlier this year. And I felt satisfied—for a bit. You see, back in middle school and high school when I first decided I didn’t like my chin, I (ironically) had little exposure to it. I would cringe when I saw myself in photographs or recordings of my dance competitions, but when you consider my friends and I spent way more time prank-calling cute boys and taking silly photo shoots in pleather bikinis and crazy makeup on our Canon digital cameras, the intensity of that aforementioned cringe lacked edge. Or at least, an edge I would act on.
But as social media became increasingly prevalent, and selfie became a household noun, the edge intensified. I became fixated on the roundness of my chin, felt hurt when my friends would compliment the “cherub-like” shape of my face, and was borderline terrorized when my jaw was edited to look thinner in photographs. So when said appointment with said specialist presented itself a couple of months back, I didn’t miss a beat. And perhaps not so shockingly, I am far from alone. “Selfie surgery” is officially a thing—to the extent that it’s been coined as such by The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).
“For better or worse, ‘selfie awareness’ is more than a fad. In 2017, 55% of facial plastic surgeons saw patients who want to look better in their selfies within their practice,” a stat that a survey from the Academy says has increased a whopping 13% from even just one and a half years ago. The trend was first recognized three years ago, and it’s only continued to gain steam, simultaneously changing the pulse of the facial plastic surgery industry. According to the same report, Botox, Dysport, and Xeomin remain the most prevalent minimally invasive procedures for both women and men, followed closely by fillers and fancy skincare treatments. "As for surgical trends," cites AAFPRS, "rhinoplasty leads the way year after year (performed by 97% of surgeons in 2017) followed by blepharoplasty (95%) and facelifts (88%)."
This locomotive increase isn’t lost on us as editors in the beauty industry. In addition to having an inbox riddled daily with cosmetic and surgical stats (if you’re intrigued, read this), we’re simultaneously deluged with products and pitches now pegged toward flawless, filter-like results for our selfies, which, as I said, are now as routine and necessary as our smoky morning drip.
“To be honest, yes,” a fellow beauty editor responded when I asked if selfies have influenced any cosmetic or surgical procedures she’s received. “I definitely feel like how parts of my face and body look in pictures makes a difference in how I decide to do things. For example, I don’t notice my Botox in real life but more so when I look at pictures and no longer feel the need to edit any expression lines. It’s like having good lighting, but forever. Or I’ve also considered chin filler because I thought it would make my jaw look more snatched.”
Interestingly, what followed our conversation wasn’t more dish regarding our procedural daydreams. It was the anxiety, compulsion, and obsessiveness that’s been heightened since we became immersed so completely into the beauty realm and throes of social media. Of course, we both love our jobs (and social media), but more so than ever, picking apart one’s appearance and examining ourselves in photographs has become the ultimate double-edged sword. Ritual. Fun. But also influential AF. Aka “The Power of Prejuvenation,” another spot-on phrase coined by members of AAFPRS.
“In our youth-based culture, it’s become all about slowing down the clock,” the Academy cites. “The number of patients under 30 seeking cosmetic tweaks continues to grow. 51% of AAFPRS members agree that more patients now emphasize early maintenance with increasing numbers of men and women in their 20s and 30s opting for preventive measures to forestall bigger procedures and surgery. In fact, more than half of facial plastic surgeons saw an increase in 2016 in cosmetic surgery or injectables with patients under 30.” The commonly reported influences: the impact of social media and the desire to remain competitive in the workforce. In other words, there’s an ever-increasing pressure to preserve oneself as forever ageless.
Apparently, even more surgeons than last year (42% in total) said patients sought cosmetic procedures to look better in selfies, Instagram, Snapchat, Facebook Live, and other social media platforms. Among the most requested procedures were eyelid procedures (“to look less tired”), cosmetic procedures to remedy grievances with their profile (a stat that personally hits close to home for me), and last but not least, patients hoping to “get their cheekbones back.” Additionally, “combined” non-surgical procedures reign supreme, as 66% of facial plastic surgeons reported these types of treatments as the topmost trend in their practices. And get this—that was two years ago.
“The focus has shifted from correction to prevention,” says Fred G. Fedok, MD, FACS, the immediate past president of the AAFPRS. “Now, even before the first signs of sagging, lines, or volume loss, we are seeing patients adamant about stalling the aging process.” Additionally, the rate at which we’re snapping selfies can also impact our perspective on treatments we may never have considered before.
“I’d never considered getting fillers, since I always associated fillers with adding volume, and with Asian features, that’s never really been an issue for me,” explains another beauty editor I consulted. “Instead, I’d become obsessed with a more sculpted complexion, specifically around my jawline. I’d use Snapchat’s ‘pretty filter,’ which chiseled my chin and elongated my neck, and (only half-jokingly) lament that I wish my jawline could be that snatched in real life.
“Then, I happened to meet Lauren from GoodSkin Los Angeles at an event, and when we discussed the types of treatments she could do for me, she mentioned filler along my jawline. I never knew until that moment that filler wasn’t just used for adding volume but for adding definition, too. She was super straightforward, and I respected that, and with visions of a sculpted jawline dancing in my head, I went into her office the next day. And honestly, I’m so obsessed with the results. I think people assume that you need to do more invasive treatments like Kybella or liposuction to get more definition along your jawline or chin, and now I’ve learned that’s simply not the case. Did Snapchat and Facetune influence my decision to get filler? No, but also, not no. They allowed me to realize what a big difference in your overall appearance a slightly more sculpted jaw and chin can make, and I feel so much more confident now that I have that IRL.”
Intrigued by the various reports and research I’ve come across—in addition to my personal experience and the close-at-hand testaments of co-workers and friends—I decided to reach out to some of the best cosmetic and plastic surgeons in the business. Keeping reading for our Q&A on the increasing prevalence of selfie-influenced surgery and treatments.
Have you noticed the "selfie surgery" phenomenon within your practice?
"Of course," replies Melissa Doft, MD, of Doft Plastic Surgery. "Due to the rise of social media, we are all being photographed more. Second, to the ubiquitous use of filters, almost no one is represented naturally. This has changed our perception of what is normal and what is attainable through surgery."
Furthermore, Doft explains this may become problematic because a selfie can actually distort the way we look (exaggerating a chin if we're looking down or widening our nose if we're too close to the camera), creating an illusion of a perceived issue that wouldn't necessarily be noticed—or even exist—in real life.
And Franziska Huettner, MD, Ph.D., FACA, of Plastic Surgery Group of NYC agrees. "Absolutely—patients now frequently show selfie pictures of themselves during the consultation in order to point out what they don't like about their face, neck, or profile."
How have self-standards among patients shifted since the introduction of social media?
"Selfie filters are creating a severe discrepancy between what a person sees and posts in socially shared photos versus what they are seeing in the mirror," explains Nancy Samolitis, MD, co-founder of Facile Dermatology + Boutique. "It is well-established that celebrity photos in print have long been photoshopped, but the advent of social media is allowing anybody the opportunity to create a false sense of reality and achievable expectations."
"People are more critical of their appearance and more focused on it," agrees Doft. "Before, we would look in the mirror when getting dressed and perhaps a few times throughout the day. But what with the pressure to be posting all the time, we're now constantly evaluating our looks. And due to camera angles, there is an increase in questions and concerns regarding drooping or sagging under patients' necks and noses. Lips have also become a focus."
How do you react if or when someone brings in an edited selfie as their inspiration pre-treatment?
"Patients have often brought in photos of celebrities as inspiration, and now, they'll bring in edited photos of themselves as well," Samolitis tells me. "I have had patients who scroll through endless pages of selfies trying to find how they liked the way their lips or cheeks looked on a certain day or in certain lighting. It is the cosmetic physician's job to set realistic expectations prior to performing a procedure. In my field where we provide non-surgical procedures, significantly altering someone's appearance is not always possible. I typically will gently suggest not looking at photos but looking at a mirror during the consultation, and we discuss in a straightforward manner what the treatment options are. In most cases, this approach works well and patients are very understanding and appreciative. In some cases, I refer to a plastic surgeon, and in rare cases of true body dysmorphia, I refer for psychiatric evaluation and treatment."
However, as Doft points out from a surgical standpoint, edited photos can actually be helpful to a certain extent. "Sometimes filtered or edited photos can be very helpful. It can be a useful tool to help understand the goals of the patient and their expectations. Facetune, Photoshop, and plastic surgery are obviously very separate methods of altering one's appearance, but Photoshop can be a useful tool in a discussion about surgery."
What demographics seem to be most susceptible?
"The 'millennial' females are most influenced by the altered reality that is portrayed on social media, including standards of beauty that are extremely altered with makeup and filters," Samolitis points out. "That being said, anyone who has a smartphone—including men and older patients—have had the experience of taking an unflattering selfie that may make them notice some age-related change that they don't like (e.g. the 'tech neck')."
Doft agrees, citing women falling in the 18- to 35-year-old range as most susceptible.
Is there concern about "selfie surgery" within the industry?
"I think some professionals find it very concerning, and others will capitalize on the trend," admits Anita Patel, MD, FACS. "As a physician, I feel I have a duty to my patients to use my judgment, offer guidance, and make recommendations based on their best interests rather than the bottom dollar. When a patient comes in with reasonable requests and realistic expectations, treatments can be very gratifying to the patient. However, when patients come in requesting to alter their features severely, it can definitely be concerning and a much bigger challenge to communicate the reasons I will not provide that treatment. The concern or danger here stems from when a patient is seeking a treatment in order to gain outside validation—which is common due to the prevalence of social media."
"Patients can have very specific requests on how they would like to look," agrees Huettner. "It is for the surgeon to decide if this particular look would actually be aesthetically pleasing for this particular person. The face and body are harmonious structures, with different proportions. One person's lips might be very aesthetically pleasing for them, but re-creating the exact same look might not be as aesthetically pleasing in a different person who has a different facial structure. It's like a symphony; it all has to come together harmoniously and proportionally."
What are the most common procedural requests?
From a cosmetics perspective, Samolitis explains she and the other practitioners at Facile often see selfies brought in with changes made to the shape and size of the lips and contour of the cheeks and jawline.
"Injectable fillers can enhance these features, but trying to change those features more significantly can often lead to an artificial look," she tells me. "Smoothing wrinkles and blotting out acne and discoloration are another way of filtering photos, but in dermatology, we know that this can be a more achievable look with diligent skincare, sun protection, and skin-rejuvenating procedures. Even in cases where someone has altered their features to unrecognizable proportions, I encourage good skincare because healthy, glowing skin always improves self-esteem!"
From a plastic-surgery standpoint, Huettner cites the lips, nose, eyes, breasts, belly, and buttocks as the most common places of concern among her patients.
Of course, the topic of "selfie surgery" is indeed intriguing, but the prevalence of social media and the perhaps unrealistic standards filters and editing apps can incur can lead to legitimate issues crossing the boundary of concern and phenomena—scarily posing the possibility of serious health risks, especially pertaining to instances of body dysmorphia.
"Body dysmorphia is a very real phenomenon, and it's not always easy to recognize when it starts," warns Patel. "If this is an issue, patients won't be satisfied with the treatment they requested since their perception of the result is so different from the reality."
Of course, pursuing treatments influenced by social media and selfies doesn't necessarily mean someone is suffering from body dysmophia—far from it—but it does present a dynamic and thought/behavior pattern that professionals want us to be aware of. "Selfie surgery itself does not indicate the person has body dysmorphia," confirms William H. Truswell, MD, president of AAFPRS. "BD is an obsessive-compulsive disorder which often stems from an undercurrent of low self-confidence. Patients with BD disorder will sometimes seek plastic surgery for problems they see but are not truly there and might have unrealistic expectations in terms of outcome which can lead to a repetitive cycle of surgery."
If you or someone you know may be suffering from BDD, treatment options include psychologic or psychiatric interventions and possibly medications. If you have any concerns, please don't hesitate to reach out to your general practitioner or another health professional you trust.
Next up: how one beauty editor's job and American beauty standards impacted her anxiety.