Reviewed by Brunilda Nazario, MD on August 10, 2018
From the WebMD Archives

Aug. 10, 2018 -- The days of wanting to look like a celebrity are over, say plastic surgeons around the world. Now, more and more people want to look like themselves -- a phone-edited version of themselves, that is.

The number of people taking selfies has skyrocketed in recent years. In 2016, Google Photos announced that its 200 million users had posted 24 billion selfies to the app. As of this month, the “selfie” hashtag on Instagram has more than 355 million posts. And with the inclusion of front-facing cameras on smartphones that come with photo apps like Snapchat, Instagram, and Facetune, users now have Photoshop-like power at their fingertips.

Last year, in an annual survey, plastic surgeons reported that 55% of their patients said their main reason for getting surgery was to make themselves look better in selfies.

According to a recent editorial in the medical journal JAMA, researchers at Boston University School of Medicine’s dermatology department report that people go to plastic surgeons requesting “fuller lips, bigger eyes, or a thinner nose” that they see in photo filters. The trend, called “Snapchat dysmorphia,” was first identified in 2015 and is now raising alarm among some plastic surgeons.

Cosmetic Surgery Up For the Under-30 Set

These looks are often unattainable, say the authors, and blur the line of reality and fantasy for patients.

Neelam Vashi, MD, is the director of the Cosmetic and Laser Center at Boston University and co-wrote the editorial. As a cosmetic dermatologist, she says that the trend seems most common in people aged 20 to 40.

“People want to look beautiful. That’s a natural part of living in our society,” says Vashi. “However, I really do believe that social media is propagating and accentuating these unrealistic expectations of beauty.”

Statistics from the American Academy of Facial Plastic and Reconstructive Surgery reflect the desire for good looks. According to a recent report, more than half of the responding surgeons saw an increase in cosmetic or injectable procedures in patients under 30 years old last year. More than 80% were strictly for appearance.

Despite the concerns, many plastic surgeons don’t view Snapchat dysmorphia as a totally negative trend.

Daniel Maman, MD, is a board-certified plastic surgeon in New York City. He says that even though Snapchat dysmorphia can have negative effects, starting with a selfie can be a good thing.

Maman sees at least one patient a day who brings in an edited selfie as a reference for possible surgery. He says the key to success in his field is delivering promised results by screening patients to ensure the work they want done is appropriate and even possible.

“In our field, we’re used to people bringing in a photo of Angelina Jolie or Jennifer Aniston and saying, ‘Hey, I wanna look like that,’ when they physically look nothing like that celebrity,” he says. “With an edited photo of themselves, at least we’re starting with a foundation that’s realistic.”

Vashi says patients often complain about the appearance of their facial features from certain selfie angles, not the way they look in a standard portrait photograph. She says she explains to patients that different angles affect proportions in different ways.

“Some people want a nose that a specific angle and Snapchat filter gives them. Giving them the nose they want in a manipulated selfie would mean giving them a really small and weird-looking nose in real life,” she says. “I have to tell them that having a nose that small would probably give them breathing issues.”

Filtered Faces Aren't Reality

What we see in selfies isn’t what others see in real life, say researchers from Rutgers Medical School and Stanford University.

In a recent JAMA study, researchers calculated facial distortion in selfies by experimenting with different camera angles. Testing what they dubbed “the selfie effect,” when taking a selfie while holding the camera 12 inches away, a man’s nose appeared 30% larger, while a woman’s appeared 29% larger. It wasn’t until reaching 5 feet away that facial features were proportional in a photograph to a real-life scale.

“You can imagine that this might fuel some body image dissatisfaction,” says Katharine Phillips, MD, a professor of psychiatry at Weill Cornell Medical College. “For people who are already unhappy with how they look, taking a lot of selfies can exacerbate the dissatisfaction.”

Obsessing over the way one looks is a red flag for plastic surgeons and psychiatrists alike. To these experts, the greatest danger of Snapchat dysmorphia is that it can trigger body dysmorphic disorder (BDD).

BDD involves thinking too much about something you believe is wrong with your appearance. “Body dysmorphic disorder is … closely related to OCD [obsessive-compulsive disorder]. All the rituals, like mirror-checking, constant comparing, and selfie-taking are toxic behaviors. They keep the obsession going,” says Phillips.

She says that two-thirds of BDD cases start before the age of 18, with the majority beginning by 12 or 13 years old.

“It affects people who feel like they don’t belong, people who’ve experienced ridicule about their appearance, and often children who experience bullying. It usually comes up among teens and tweens trying to fit in,” says Funda Yilmaz Marra, a licensed professional counselor who specializes in stress disorders, including BDD.

For people with BDD, social media can often worsen their symptoms. She says that while social media makes it easier for us to compare ourselves with others, BDD can take it to a level of compulsion.

“It’s kind of like living a fantasy. You’re creating this perfect image of yourself. That’s common in people with body dysmorphic disorder, but it’s never perfect for them. They feel like they have to work much harder,” says Marra.

Show Sources

Neelam Vashi, MD, assistant professor of dermatology, Boston University School of Medicine; director, Cosmetic and Laser Center, Boston University School of Medicine.

Daniel Maman, MD, plastic surgeon, 740 Park Plastic Surgery, New York City.

Katharine Phillips, MD, professor of psychiatry, Weill Cornell Medical College; attending psychiatrist, New York-Presbyterian Hospital, New York City.

Funda Yilmaz Marra, licensed professional counselor, Georgia Psychological Treatment Center.

JAMA Facial Plastic Surgery: “Selfies -- Living in the Era of Filtered Photographs.”

JAMA Facial Plastic Surgery: “Nasal Distortion in Short-Distance Photographs: The Selfie Effect."

International Journal of Eating Disorders: “Photoshopping the selfie: Self photo editing and photo investment are associated with body dissatisfaction in adolescent girls.”

Clinics in Dermatology: “Obsession with perfection: body dysmorphia.”

American Academy of Facial Plastic and Reconstructive Surgery: “Statistics: Social Media Makes Lasting Impact on Industry -- Becomes Cultural Force, Not Fad.”

Google’s The Keyword: “Google Photos: One year, 200 million users, and whole lot of selfies.”

Instagram: “#selfie.”

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