H ealth I BODY IMAGE

Im m ersed in Perfection
Cosmetic surgeons are prime witnesses to the assault o f photo-editing on body image and self-esteem.

By A bigail Fagan

H EN MAYA * FIRST downloaded Insta- anxious and insecure: Did her nose look small enough? Was her

W gram, at age 18, she felt confident in her ap­

pearance both on and off screen. “I wouldn’t
think twice before posting a selfie,” she recalls.
chin defined? Why didn’t she look like those effortlessly beauti­
ful influencers? “I kept ruminating over the same things,” Maya
says. “It ran me down.”
ISTOCKPHOTO(3)

As she spent more time on the platform, she watchedToboth salvage her self-esteem, she downloaded the popular
trendy influencers and friends at university post perfect photo photo-editing app FaceTune. With a pinch of her fingers she
after perfect photo. The pristine images began to make her feel plumped her top lip, shrunk the tip of her nose, and sharpened

" Maya’s name has been changed to respect her privacy.

28 I Psychology Today I January/February 2020

her jawline. But not too much. She didn’t
w ant the doctored photos to diverge too
far from her real appearance. “You feel
kind of stupid if you don’t look like your
Instagram in your real life—so you try to
achieve in real life how you look in your
Instagram ,” M aya explains.
To bridge th a t gap, she explored
cosmetic surgery. She also looked into
dermal fillers, injections that plump fea­
tures and smooth wrinkles. Five days be­
fore her 21st birthday, she w alked into
her doctor’s office armed with edited self-
ies, and had her lips and chin injected
with fillers. W hen she turned to the mir­
ror, she was thrilled. “It was amazing. It
was kind of like I had a filter on my face,”
Maya says. “ I felt completely confident. ”
At her birthday p arty a few days later,
she snapped photos of the celebration to
share. “I didn’t edit any of my photos,”
she says. “There was no need to .”
NEW BEAUTY STANDARDS
Physicians who work at the aesthetic
edge are witnessing a shift: Photo-editing
is driving clients to redesign themselves.
People historically came to cosmetic sur­
geons w ith photos of celebrities whose
features they hoped to em ulate. Now,
they’re coming with edited selfies. They
w ant to bring to life the version of them ­
selves that they curate through apps like
FaceTune and Snapchat.
T hat’s coming to pass in the doctor’s
office. “ People can take a photo of them ­
selves and, in an instant, m anipulate it.
T hat makes a change feel more real and
attainable,” says Boston University cos­
metic surgeon Neelam Vashi.
Cosmetic enhancement has surged
in recent years. T he num ber of m ini­
mally invasive procedures tripled be­
tween 2000 and 2018, according to the
A merican Society of Plastic Surgeons.
Nearly 18 million surgical or minimally
invasive procedures were done in 2018,
up from 15 million in 2013. In 20 1 5 ,4 2
percent of cosmetic surgeons reported
seeing clients whose goal was to improve
their appearance in selfies. In 2017, that
number rose to 55 percent.
British plastic surgeon Tijion Esho
dubbed it “Snapchat D ysm orphia,” and
the term to o k off w hen Vashi and her
colleagues declared in JAMA Plastic
Facial Surgery th a t selfies an d p h o to ­
editing had instilled new beauty stan-
Photo-editing
is driving
clients to
redesign
themselves in
real life.
dards. “It can be argued th a t these apps
are m aking us lose touch w ith reality
because we expect to look perfectly
prim ped and filtered in real life,” the
authors wrote.
A nd k n o w in g th a t an im age is
doctored doesn’t stop your brain from
engaging in co m p ariso n . It h appens
au to m atically , says Renee Engeln, a
psychology professor at N orthw estern
University and the author of Beauty Sick:
H ealth I b o o t im u .r
How the Cultural Obsession with Ap­
pearance Hurts Girls and 'Women.
Society an d sc h o lars have been
g ra p p lin g w ith u n re a lis tic b e a u ty
id eals forever. W h a t m akes p h o to ­
ed itin g different? In th e p ast, those
ideals w ere prop ag ated by celebrities.
We can grasp th a t those standards are
u n attain ab le because o f the colossal
distance betw een stars an d everyday
people; celebrity, after all, is defined by
a p ro fessio n al co m m itm en t
to appearance th ro u g h reg i­
m ented exercise, co n tro lled
diet, and a team of m akeup,
hair, and fashion experts.
But now th a t gap is n ar­
rowing, if not outright disap­
pearing. FaceTune and other
ed itin g ap p lic a tio n s are so
widely available th at unrealis­
tic beauty ideals are invoked by
classmates, coworkers, neigh­
bors, and friends.
The endless reel of flaw­
less faces can consum e tim e
and energy. It can erode self­
esteem . A nd it can d riv e a
wedge between the self posted
online and the self reflected in
the m irro r— o n e’s ideal an d
one’s real self. “It’s devastating
when those tw o versions don’t
line u p,” Engeln says.
A study published in the
International Journal o f Eat­
ing Disorders found th a t the more ado ­
lescent girls engaged in photo-editing,
the more they w orried about their body
and dieting. A nother found th a t more
selfie-viewing was associated with nega­
tive self-esteem. Yet another revealed a
link between photo-editing and accep­
tan ce of cosm etic surgery. “It m akes
sense th a t p latfo rm s w here en h an ce­
ments are so easy could make you more
in terested in en h an cem en ts th a t are
January/February 2020 I Psychology Today 129
Health I body image
perm anent,” says Engeln, w ho was not
involved with the research.
2-D CHANGES IN A 3-D WORLD
M ichael R eilly, a cosm etic and
re c o n stru c tiv e su rg eo n a t M e d S ta r
G eorgetow n U niversity H ospital, has
observed shifts in his practice. Whereas
past clients were often concerned about
flattening the bump on the ridge of their
nose, current clients focus on symmetry
and making the nose smaller, Reilly says.
Patients also ask for wider eyes, a more
angular chin, and even skin tone. Vashi
has noted the same trends.
The countless tiny tweaks possible
on editing apps are difficult to replicate
in practice. Plumping lips, arching eye­
brows, widening eyes, whitening teeth,
an d evening skin tone— they create a
completely different face. “When people
take their image and, for lack of a better
w ord, ‘zhuzh it u p ,’ those often aren ’t
things I can do surgically,” Reilly says.
A S ta n fo rd c o m p u te r sc ie n tist
team ed up w ith plastic surgeons at R ut­
gers to quantify one difference between
the virtual w orld and the real w orld.
Selfies taken a foot aw ay increase the
perceived size of the nose by ab o u t 30
p ercent, they re p o rt in J AMA Facial
Plastic Surgery. Says Reilly: “You can
make yourself look better in a selfie and
then the real thing is like ‘w hoa, w hat
happened?” ’
For both clients and cosmetic sur­
geons, it’s crucial to understand how en­
hancements influence perceptions in real
life, n ot just on social media, Reilly says.
His research shows that procedures have
the potential to change how personality
is perceived. “Life isn’t 2-D,” Reilly says.
“N o t everyone cares w hether you look
younger. They care abo ut if they w ant
to engage w ith you. D o you look like
someone they’d w ant to w ork with? To
be their child’s teacher? These things are
30 I Psychology Today I January/ February 2020
more about the hum an experience and as well as genetic factors, may contribute
less about internal self-esteem issues.” to the development of the disorder— and
exposure to images filtered to perfection.
WARPED PERCEPTION “A lot of factors are w orking together,
For many, cosmetic surgery can be but social media may play a role in m ak­
incredibly empowering. Altering a single ing people more vulnerable,” Weingar­
feature that has perpetually plagued one’s den believes.
self-esteem can relieve insecurity and instill People with BDD represent 2.4 per­
confidence that benefits careers, friend­ cent of the population but 13 percent of
ships, and rom antic relationships. But cosmetic surgery patients. They may not
photo-editing may exacerbate disordered be the rig h t patien ts for a procedure.
body image in vulnerable individuals. “Because BDD is a body image disorder,
People with body dysmorphic dis­ cosmetic treatm ents aren’t very likely to
order (BDD) are preoccupied w ith an fix the problem .” Weingarden says.
imagined or real physical flaw th a t an M a y a d o e s n ’t e d it h e r p h o to s
observer m ight n o t even notice. They anym ore. But she adm its th a t she still
constantly m onitor and try to fix or hide scrutinizes others’ photos and compares
the perceived flaw. They may check the herself to them. She’s m ore aw are of all
m irror or seek reassurance dozens of of the behind-the-scenes procedures,
times a day, says Hilary W eingarden, a w hich m akes her feel fru stra te d and
body dysm orphia expert a t M assachu­ angry. H er solution has been to unfol­
setts General Hospital. low her stable of influencers and spend
Does photo-editing cause BDD? “I less tim e on th e p latfo rm . “ Being on
don’t think we know th a t,” Weingarden Instagram 24/7 w asn’t good for me. So
says. Certain personality traits, such as I stopped feeding my o b sessio n ,” she
rejection sensitivity and perfectionism, says. “But I still go for fillers.”
H o w to B olster Your Body Im ag e
la Educate yourself about unrealistic beauty Ideals, Remember the many
steps taken to create the beautiful images you see every day.
2 a Retrain how you look a t yourself In the mirror. Those with BDD zoom in on
one feature, which can further warp their perception. Stand a reasonable distance
from the mirror, allocate attention across your whole body, and note the features
you like, too. Try to observe your reflection objectively and avoid harsh or judgmental
words like disgusting.
3 aDeploy cognitive behavioral skills, such as identifying unhelpful
thought patterns. One such pattern that pertains to body image is all-or-nothing
thinking. People may believe they look either perfect or terrible. Challenge those
extremes.
4a Take tim e away from social media. If an indefinite break feels daunting,
avoid social media for 48 hours. By logging off, we offer ourselves the opportunity to
devote mental energy to what we find most meaningful.
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