Plastic Surgeons Ask If Selfie Editing Is Related To A Desire For Plastic Surgery

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New data gathered by researchers at Johns Hopkins University School of Medicine is piling on what we already know about the connections between social media use and an increasing desire for plastic surgery. But it’s the first study to measure the association between the use of photo editing software and filters on social media and attitudes towards these procedures.

The study’s lead author, Lisa E. Ishii, MD, sought to assess whether self-esteem and the use of photo editing applications for use in social media are associated with attitudes towards cosmetic surgery. After all, 2017 ‘s annual American Academy of Facial Plastic and Reconstructive Surgery survey found that 55% of surgeons reported seeing patients who requested surgery to improve their appearance in selfies.

But if selfies are technically pictures of…well, yourself, how could you want to look more like them?

Late last year we were introduced to the phrase “Snapchat dysmorphia” in a piece by researchers from the Department of Dermatology at Boston University’s School of Medicine. In JAMA Facial Plastic Surgery, they described the ability of Snapchat and FaceTune filters to smooth out skin and make teeth look whiter and lips look fuller as a gateway to seeing oneself in a whole new way – a way users wanted to replicate in real life.

While no one is walking into cosmetic surgeons’ offices asking for puppy dog ears (yet), Dr. Neelam Vashi, a co-author of the piece and the director of Boston University's Ethnic Skin Center, suggested that apps like this could focus a user’s attention on their perceived flaws. And the obsession with eradicating those “flaws” - along with a desire to see in the mirror what one sees in a filtered photo - has been leading more and more young women to seek out plastic surgeons.

In fact, the American Academy of Facial Plastic and Reconstructive Surgery said that 55% of clinicians reported that their patients “wanted to look better in their selfies” in 2017 — up from 42% the previous year. And the patients are getting younger as well - 72% of facial plastic surgeons reported an increase in cosmetic surgery or injectables in patients under the age of 30.

Dr. Vashi told the website Inverse that these photo-editing apps provided a glimpse of perfection that’s difficult not to chase, explaining that "it becomes a trigger for people to become very preoccupied with how they look.”

We’ve long associated perfect symmetry with beauty – even hypothesizing that symmetry is an evolutionary indicator of health and an ability to seduce (all of which is, at the very least, still up for debate). Facial asymmetry is one of the things these filters excel in “correcting.” And Dr. Vashi said that her own patients have come in asking for procedures that will change the proportions of the face in what Inverse’s Emma Beutel reported is “similar to what you might see in the butterfly filter or the flower crown filter” on Snapchat.

Just a few months ago, Dr. Patrick Byrne, director of facial plastic and reconstructive surgery at John Hopkins Medicine, told CBS News that his younger patients would be unable to hold a mirror up to their faces and describe what they wanted “fixed.” Instead, they would take out their phones and find their best photo as a reference.

What he called “a little insane” is a testament to how much digital photography has come to dominate the way we think of ourselves. And while some plastic surgeons are selling “prejuvenation” procedures designed to maintain youth rather than reverse the signs of aging (raking in millions of dollars with the promise of eternal beauty and the assurance that it’s never too early for Botox), others are turning away patients who are too young to have a single wrinkle – after all, you can’t smooth out something that isn’t there.

Our obsession with our digital selves isn’t all in our heads, however. Peers and employers have access to these images and put value on them. We’re lying to ourselves if we pretend there’s no pressure or value in looking our best in an image that could potentially be online forever.

Dr. Ishii’s team, which just published their study in JAMA Facial Plastic Surgery, asked 252 English-speaking adults in the U.S. (the majority of whom were white women, it’s important to note) to answer some questions about their use of social media and photo-editing tools, as well as their attitudes about cosmetic surgery.

They were asked to self-report how much time they spent on various platforms, which ones they used, the types of software or filters they used to edit photos of themselves that they posted online, as well as how many photos of themselves they had posted and how many of those were enhanced. Subjects also reported just how long they spent altering photos before posting them as well as whether or not they had ever untagged or removed a photo because it “was not digitally enhanced or edited to their liking.”

Participants’ self-esteem was assessed using two common psychological questionnaires and they were asked if they would consider having cosmetic surgery as well as what their motivations would be for undergoing the procedures. The statistical analysis of all this data showed a few interesting results that are worthy of further discussion - and most certainly further research.

First, participants who used more social media applications were, in fact, more likely to consider surgery – but that’s nothing new. But while 65.87% of participants reported using photo editing applications to make changes in photo lighting, only 5.16% reported using them to make changes in body or face shape.

While behaviors such as removing photos that weren’t enhanced to their liking or using Instagram filters or the photo editing app VSCO were tied to increased consideration of cosmetic surgery, the statistical analysis found no significant correlation overall between photo editing and attitudes towards plastic surgery.

Sure, the researchers were able to replicate some other findings – the social media engagement can worsen body image concerns because of the ability to constantly compare oneself with peers -  but the unexpected results (that is, not finding a statistically significant correlation) mean that more work needs to be done to explain the connections between social media photo editing and a desire for plastic surgery.

Part of the problem is that a wide variety of photo editing was considered. There’s a big difference between making changes in lighting and FaceTune-ing yourself into oblivion. The researchers did note that while photo editing features to make lighting changes had no significant association with cosmetic surgery attitudes, “the use of photo editing features to alter facial features was associated with increased consideration of surgery.”

But on the whole, they couldn’t make a compelling enough case with the data gathered. And it’s important to publish these studies. It doesn’t mean there’s nothing there, only that an experiment set up with those parameters did not yield a convincing correlation.

That means it’s up to another team to look at more specific uses of digital manipulation and its relationship to plastic surgery. We know something is going on with women under 30, but we need to look more closely at just how many are changing their faces and bodies in photos and whether or not that makes them more likely to want to follow through with the alterations “IRL.”

In the meantime, it’s worth keeping the conversation going about plastic surgery motivations – and plastic surgeons themselves should be the ones to lead the way with their young patients in order to keep expectations realistic.

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