899664 JOO Journal of Orthodontics

Scientific Section

Journal of Orthodontics

The effect of viewing idealised smile 2020, Vol. 47(1) 55­–64

https://doi.org/10.1177/1465312519899664
DOI: 10.1177/1465312519899664
© The Author(s) 2020
images versus nature images via social Article reuse guidelines:
sagepub.com/journals-permissions
media on immediate facial satisfaction journals.sagepub.com/home/joo

in young adults: A randomised

controlled trial

Ariane Sampson1 , Huw G Jeremiah2, Manoharan Andiappan3

and J Tim Newton4

Abstract
Introduction: The objective of this randomised controlled trial (RCT) is to investigate the effect of a social networking site
(SNS) on body dissatisfaction, facial and smile dissatisfaction, and face-related discrepancy, and whether these effects differ
from the use of appearance-neutral Instagram images. We also aimed to investigate whether there are trends in increased self-
reported use of social media and increased body dissatisfaction, facial and smile dissatisfaction, and face-related discrepancy.
Methods: Undergraduate students were randomly allocated to an experimental group with idealised smile images or to
a control group with neutral nature images. They completed pre-exposure questionnaires, then perused for 5 min their
allocated images on individual Apple iPads via the Instagram application. Participants then completed the post-exposure
surveys. The main outcome was facial dissatisfaction. Body dissatisfaction and total facial and body dissatisfaction were
secondary outcomes. Simple randomisation was achieved with a computerised random number generator. Data were
analysed using repeated measures ANOVA and multivariate regression analyses.
Results: A total of 132 participants (mean age = 20.50 ± 2.21 years) were randomised to either the experimental
group with idealised smile images (n=71) or the control group with neutral nature images (n=61). Baseline characteristics
were similar between groups and no participants were lost. Exposure to ‘ideal’ facial images on social media decreases
facial satisfaction (95% confidence interval [CI] = 0.85–1.05; P < 0.0001). Individuals with high baseline self-discrepancy
scores are less satisfied with their facial features and body appearance (95% CI = 0.04–1.16; P = 0.036).
Conclusion: This study shows that viewing SNSs with high visual media reduces satisfaction with facial appearance in
the short term in men and women. This effect is greater in those with high self-discrepancy scores. Increased media
usage was not correlated with increased dissatisfaction. Wearing braces or having had braces was shown not to influence
post-exposure dissatisfaction.

Keywords
facial satisfaction, facial dissatisfaction, body satisfaction, body dissatisfaction, social media, Instagram, self-discrepancy,
internalisation

Date received: 29 March 2019; revised: 21 November 2019; accepted: 18 December 2019

Introduction
Much research has studied the effect of traditional media
such as television and fashion publications on body image.
The exponential rise in Internet use has driven researchers
to study Internet sites, which have shown the immediate
negative effect of social media on body image, particularly
in young women (Brown and Tiggemann, 2016; Fardouly
and Vartanian, 2015; Fardouly et al., 2015; Groesz et al.,
2001; Haferkamp and Kramer, 2011; Tiggemann and
1
F aculty of Dentistry, Oral & Craniofacial Sciences, King’s College
London, London, UK
2
Orthodontic Department, Addenbrooke’s Hospital, Cambridge
University Hospital NHS Foundation Trust, Cambridge, UK
3
Biostatistics and Research Methods Centre, Faculty of Dentistry, Oral
& Craniofacial Sciences, King’s College London, London, UK
4
Department of Population and Patient Health, Faculty of Dentistry,
Oral & Craniofacial Sciences, King’s College London, London, UK
Corresponding author:
Ariane Sampson, Faculty of Dentistry, Oral & Craniofacial Sciences,
King’s College London, London, UK.
Email: ariane_sampson@hotmail.com
56 Journal of Orthodontics 47(1)
Miller, 2010; Tiggemann et al., 2009). It was found that
most post-Facebook-exposure body dissatisfaction was
related to the photographic function of Facebook rather
than total time spent on it (Cohen et al., 2017; Meier and
Gray, 2014). A recent systematic review on the effect of
social networking sites (SNSs) on body image (Holland
and Tiggemann, 2016) showed that the current pool of
research overwhelmingly links the use of social media with
body image.
With 2.62 billion active users (eMarketer, 2018), social
media use is inescapable and accelerating exponentially.
Instagram, an SNS high in visual media, is a unique photo-
sharing form of social media boasting upwards of 48,611
photographs posted per minute (Instagram, 2018) and the
highest rate of social engagement per post compared to all
other social media platforms (Leone, 2018). This platform
can engage users in appearance-related social comparisons.
With Instagram users able to interact equally with peers
and celebrities, this creates an opportunity for regular expo-
sure to idealised images. Viewing fitness inspiration (‘fit-
spiration’) images (Tiggemann and Zaccardo, 2015) or
celebrity and peer images (Brown and Tiggemann, 2016)
on Instagram increases negative mood and body image
compared to neutral images in young women.
Some research indicates that young men are also suscep-
tible to increased body dissatisfaction, particularly in terms
of muscular ideals (Cafri et al., 2005). Despite these find-
ings, few studies have been done on the role of social com-
parison in men as a mediator of idealised male media
images and body dissatisfaction.
To date, there have been three meta-analyses investigat-
ing these associations. There was significantly increased
negative body image after viewing thin ideal media images.
Effects are stronger in women and are inversely related to
age (Grabe et al., 2008; Groesz et al., 2002; Myers and
Crowther, 2009).
Festinger’s Social Comparison Theory outlines the natu-
ral human desire to compare themselves to others (Festinger,
1954). This theory helps explain the negative effects of
media exposure on body image so often found in many
studies (Keery et al., 2004; Myers and Crowther, 2009; van
den Berg et al., 2007; Vartanian and Dey, 2013). This is
particularly rife when women are able to compare them-
selves to those most similar to them, such as their peers
(Heinberg and Thompson, 1995). The greater the tendency
to compare, the higher the level of body dissatisfaction
(Keery et al., 2004; Myers and Crowther, 2009; van den
Berg et al., 2002, 2007; Vartanian and Dey, 2013) which
may lead to the development of negative behaviours such
as disordered eating habits (Saunders and Eaton, 2018) and
orthorexia (Turner and Lefevre, 2017).
One type of self-discrepancy (Freud, 1923; Higgins
et al., 1985) is when a person’s ‘actual’ self does not match
their ‘ideal’ self. Those who are high on this type of dis-
crepancy level are more likely to draw social comparisons,
are more susceptible to triggers that result in dejection-
related emotions such as depression (Cattell, 1973) and
have lower self-esteem (Rosenberg, 1979).
There is currently no theoretically driven experiment on
the effect of Instagram, or indeed any other SNS high in
visual media, on smile and facial dissatisfaction, and no
research to this effect in dental specialties such as ortho-
dontics. The orthodontic patient base is made up predomi-
nantly of teenagers and young adults, a cohort most likely
to be large users of SNSs high in visual media. This research
would help us understand the effects of SNSs high in visual
media on mental wellbeing, smile satisfaction, perceived
treatment need, motivations for treatment, patient ideals
and patient triggers.
The main aim of the present study was to investigate the
immediate effect of an SNS high in visual media on body
dissatisfaction, facial and smile dissatisfaction, and face-
related discrepancy (the extent of which one wants to
change specific aspects of their facial features), and whether
these effects differ from the use of appearance-neutral
images. We also aim to investigate whether there are trends
in increased self-reported use of social media and increased
body dissatisfaction, facial and smile dissatisfaction, and
face-related discrepancy. The null hypothesis assumes that
the use of SNSs high in visual media does not result in
greater body dissatisfaction, greater facial and smile dis-
satisfaction, or greater face-related discrepancy, and that
the effects of SNSs high in visual media is not linked to
increased self-reported use of media and technology, not
greater in women than in men, not less in those with a his-
tory of orthodontic treatment and not greater compared to
exposure to neutral images.
Methods
A randomised controlled trial (RCT) was used to investi-
gate the effect of SNS image type (Instagram user images
versus Instagram appearance-neutral images) on dependent
variables of negative body, facial and smile dissatisfaction,
and face-related discrepancy. After trial commencement,
no changes to the methods occurred.
The sample size calculation was carried out using a
medium effect size of 0.5 to detect the significant differ-
ence in facial satisfaction scores between experimental and
control groups with 80% power using a two-tailed test
(Norman et al., 2012). It showed that a sample of 128 par-
ticipants would be sufficient to detect a significant differ-
ence, and there was slight over-recruitment due to subjects
being approached simultaneously. The final sample of 132
had sufficient power to perform all the other analyses car-
ried out in the study.
Participants (n = 132) were male and female undergrad-
uate students from the university campus, recruited between
September 2017 and January 2018, for what they were told
was a study on social media. Students of Dentistry or
Sampson et al. 57
Psychology were excluded from the study. Participants
were aged 18–35 years as 90% of Instagram users are aged
18–35 years (Jin Yea Jang, 2016).
Two sets of images were compiled for the study: the
experimental group with 60 Instagram user images of
attractive smiles; and the control group with 60 appearance-
neutral Instagram images of nature. All the images were
chosen from public Instagram images.
A preliminary study was carried out to choose images for
the experimental group. The first author shortlisted 100 con-
secutive public photographs of people with full, attractive
smiles and well-aligned teeth with the ‘#smile’ hashtag on
Instagram. The photographs featured an equal proportion of
celebrity and non-celebrity (< 1000 followers) faces and
men and women of a similar age group to those who would
be participating in the study (18–35 years). All five male
and female independent raters who were Orthodontic
Consultants, Specialist Orthodontic Practitioners or final
year Orthodontic postgraduate students from the hospital’s
own Orthodontic Department were asked to rate the 100
facial images on a series of 5-point Likert scales.
Orthodontists were chosen to carry out the preliminary
study as they are known to be the most discerning critics of
what constitutes an ideal smile and ideal teeth (Kokich et al.,
1999; Witt and Flores-Mir, 2011). The images were judged
based on attractiveness of the smile and teeth (1 = very
attractive, 5 = very unattractive), general appeal (1 = very
appealing, 5 = not at all appealing), image quality (1 =
good quality, 5 = not good quality) and enjoyment (1 =
very enjoyable, 5 = not at all enjoyable). The top scoring 60
images were selected for the experimental group. The
repeatability of the participants’ ratings was not assessed in
line with previous research in this area using this methodol-
ogy (Brown and Tiggemann, 2016).
The neutral images for the control group were chosen
from the top 60 consecutive images with the ‘#nature’
hashtag on Instagram. These images featured only nature
and had no people in them. The choice of nature was based
on the stimuli used in previous research using this method-
ology (Brown and Tiggemann, 2016; Tiggemann and
Zaccardo, 2015).
Body and facial dissatisfaction were measured using the
Body Satisfaction Scale (BSS) (Slade et al., 1990) and the
Facial Satisfaction Scale (FSS) component within the BSS
(1 = very satisfied, 7 = very dissatisfied; range = 1–7),
amounting to two questions. The BSS was scored as out-
lined in the original psychometric validation of the measure
(Slade et al., 1990). A question was included as a visual
analogue scale asking participants how they felt about their
smile at that precise moment in time (0 = very happy, 100
= not happy at all).
The State Appearance Comparison Scale (Tiggemann
and McGill, 2004) was used to determine on three 7-point
Likert Scales whether individuals thought about their own
appearance (1 = no thought about appearance, 7 = a lot of
thought about appearance), compared their overall appear-
ance to the photographs (1 = no comparison, 7 = a lot of
comparison) and compared specific body parts / teeth or
smile to photographs (1 = no comparison, 7 = a lot of
comparison). Scores were averaged to give a total score for
state appearance comparison. This scale was shown to have
sound inter-correlation (Tiggemann and McGill, 2004).
The state variant of the Self-Discrepancy Index (SDI)
(Dittmar et al., 1996; Higgins, 1985) was used to measure
appearance discrepancy. Participants were asked to write
out up to five aspects of their physical appearance that they
would like to change, to rate how different they would like
to be from what they currently are (1 = a little different, 6
= extremely different) and how significant this difference
would be to them (1 = a little important, 6 = extremely
important).
Questions were asked to assess participants’ media and
technology usage using the Media and Technology Usage
and Attitudes Scale MTUAS (Rosen et al., 2013). The 46
questions included frequency of use of e-mail, web
­browsing, photo-taking, video-watching, gaming, calling,
texting, sharing files and engagement on social media
sites (1 = never, 10 = all the time). Adjustments were
made to this questionnaire to include specific information
on Instagram use, including number of followers, number
of personal friends followed, number of celebrities
­followed and number of people regularly interacted with
(1 = 0, 2 = 1–50, 3 = 51–100, 4 = 101–175, 5 = 176–
250, 6 = 251–375, 7 = 376–500, 8 = 501–750, 9 = >
751). Participants could then be divided into low media
users or high media users.
Following exposure to images, participants were asked
their age, gender, ethnicity (Office for National Statistics,
2015) and history of orthodontic treatment (yes or no).
The primary outcome was facial dissatisfaction. The
secondary outcomes were body dissatisfaction and total
overall body and facial dissatisfaction. After trial com-
mencement, no changes to outcome measures occurred.
Participants were invited to read the introduction and
information sheets, after which they provided informed
consent and completed pre-exposure surveys. Participants
were then randomly divided into one of two conditions
(experimental group versus control group) by simple com-
puterized list randomisation (Haahr, 2018) and asked to
browse their allocated page for 5 min.
It was impossible to blind participants or operator to
their group allocation as they were immediately aware of
the type of images they were viewing. There was mild
deception in terms of the objectives of the research as par-
ticipants were not told the true purpose of the study until
after completing the task. Participants were told at recruit-
ment that this was simply a study on social media.
The Instagram pages were presented to participants by
the first author on individual Apple iPads via the Instagram
Application, a real-time social media platform. This
58 Journal of Orthodontics 47(1)
Figure 1.  CONSORT participant flow diagram.
replicates the most natural method of browsing SNSs.
After perusing the Instagram page, participants completed
the post-exposure surveys. The protocol had not been
published before trial commencement. This study was
approved by Kings College London’s ethics committee
(LRU-16/17-4241).
Statistical analysis
Descriptive statistics summarised the BSS, FSS and total
scores at two time points. The association between demo-
graphic variables and the groups were compared using the
Chi-square test. Before carrying out the parametric tests,
the normality assumption was tested by plotting residual
values using histograms, Shapiro–Wilk test, Kolmogorov–
Smirnov test and box plots (P = 0.12). As the data satis-
fied normality assumptions, parametric tests were carried
out. Repeated measures ANOVA was used to compare
BSS, FSS and total scores separately between groups
(experimental group versus control group), time points
(pre-exposure and post-exposure) and the interaction
between groups and time points. Sphericity was tested
while using repeated measures ANOVA. As the interac-
tions were significant the linear combinations were tested
using the Least Significant Difference (LSD) test to han-
dle multiple comparisons.
Multivariate regression analyses were carried out to
find out the significant predictors of BSS, FSS and total
scores. Before carrying out the multiple regression, the
normality assumption of the outcomes was tested using
the methods described above. Separate regression analy-
ses for each of the outcome measures, namely BSS, FSS
and total scores, were carried out by treating the outcome
measure as dependent variables of time, gender, group,
braces, media use, SDI and the interaction of group X
media use as the predictor variables. As all the predictors
have only two categories and the interactions were not
significant, no multiple comparisons were carried out.
Statistical significance was assumed at a level of 0.05.
The analyses were carried out using the Statistical Package
for Social Sciences (Release 24.0.0, SPSS Inc., IBM
Corp., Chicago, IL, USA) and Stata 13 (Stata Corp,
College Station, TX, USA).
Results
A total of 132 participants took part in this study, out of
which 80 (60.6%) were women and 52 (39.4%) were men.
The mean age of the participants was 20.5 years (SD 2.21).
Participants identified as White (n = 62, 47%), Asian
(n = 34, 25.8%), Mixed (n = 15, 11.3%), Black (n = 4,
3%) and Other (n = 17, 12.9%). Of the participants, 53%
Sampson et al. 59

Table 1.  Demographic characteristics of study sample.

Experimental group Control group Overall χ2 P

Gender Male 27 (38) 25 (41) 52 (39) 0.12 0.73

  Female 44 (62) 36 (59) 80 (61)  

Age Mean ± SD 20.51 ± 2.34 20.49 ± 2.07 20.50 ± 2.21  

  Median (range) 20 (18–30) 20 (18–27) 20.0 (18–30)  

Ethnicity 7.5 0.73

White English 20 11 31  

  Irish 0 0 0  
  Gypsy 0 0 0  
  Other 16 15 31  

Mixed White + Black Caribbean 0 1 1  

  White + Black African 1 1 2  

  White + Asian 3 3 6  

  White + Other 3 3 6  

Asian Indian 8 9 17  
  Pakistani 3 1 4  
  Bangladeshi 0 1 1  
  Chinese 2 4 6  
  Other 3 3 6  

Black African 1 2 3  
  Caribbean 0 0 0  
  Other 1 0 1  

Other Arab 6 4 10  

  Other 4 3 7  

Braces Yes 39 31 70 0.22 0.64

  No 32 30 62  

said that they had had orthodontic braces. No patients were
lost (Figure 1).
Comparison of the two groups confirmed no statistically
significant differences between groups on variables of age,
gender, ethnicity or history of braces (Table 1), thus ran-
dom allocation was successful.
Values are given as n (%), mean ± SD or median (range).
Descriptive statistics summarised BSS, FSS and total
scores. The estimated marginal means based on the repeated
measures ANOVA are given in Table 2. Repeated measures
ANOVA compared BSS, FSS and total scores separately
between groups (experimental and control groups), time
points (pre- and post-exposure) and the interaction between
groups and time points. The results of the comparison are
given in Table 3.
All the dissatisfaction scores (BSS, FSS and total scores)
increased in the post-exposure period for the experimental
group whereas for the control group it showed a declining
trend (Figure 2).
Multivariate regression analyses were carried out to find
out the significant predictors of BSS, FSS and total scores.
The results of the multivariate regression are summarized
for each of the outcome measures in Table 4.
The dissatisfaction scores are not influenced by gen-
der (P > 005). The FSS and the total scores differed sig-
nificantly between groups. A history of braces and
increased use of media have no effect on dissatisfaction
scores.
In line with CONSORT reporting requirements, adverse
events were monitored and none were reported.
60 Journal of Orthodontics 47(1)

Table 2.  Estimated marginal means for Body Satisfaction Scale (BSS), Facial Satisfaction Scale (FSS) and total scores according to
group and time.

Variable Mean (95% CI)

  FSS BSS Total score

Group
Experimental group 18.29 (16.57–20.01) 19.24 (17.58–20.90) 37.53 (34.51–40.55)
Control group 15.86 (14.01–17.72) 16.41 (14.62–18.20) 32.27 (29.02–35.53)

Time
Pre-exposure 16.57 (15.33–17.81) 17.69 (16.42–18.97) 34.26 (32.05–36.47)
Post-exposure 17.58 (16.22–18.94) 17.94 (16.73–19.18) 35.54 (33.23–37.84)

Group X time
1 Pre-exposure 17.06 (15.37–18.74) 18.83 (17.10–20.56) 35.89 (32.88–38.89)
  Post-exposure 19.52 (17.67–21.38) 19.65 (17.99–21.31) 39.17 (36.03–42.31)
2 Pre-exposure 16.08 (14.26–17.90) 16.56 (14.69–18.42) 32.64 (29.40–35.88)
  Post-exposure 15.64 (13.64–17.64) 16.26 (14.47–18.06) 31.90 (28.52–35.29)

CI, confidence interval.

Table 3.  Comparison of Body Satisfaction Scale (BSS), Facial Satisfaction Scale (FSS) and total scores between group and time.

Variable P value

  FSS BSS Total score

Time [pre-exposure vs. post-exposure] (p) 0.002* 0.293 0.004*

F (df) 10.08 (1–130) 1.11 (1–130) 8.84 (1–130)

Group [Control group vs. Experimental group] 0.06 0.026* < 0.0001*

F (df) 3.61 (1–130) 5.24 (1–130) 22.06 (1–130)

Interaction [Group X Time] < 0.0001* 0.024* 0.021*

F (df) 20.83 (1–130) 5.06 (1–130) 5.49 (1–130)

*Statistically significant.

Discussion Participants expressed greater facial and smile dissatis-

The present study aimed to examine the relationship
between exposure to ‘ideal’ facial images on social
media with facial and smile dissatisfaction. So far,
research has shown significant correlation between
exposure to idealised images on social media and body
dissatisfaction (Holland and Tiggemann, 2016). Our
study shows a statistically significant increase in facial
and smile dissatisfaction following exposure to ‘ideal’
facial images, but not body dissatisfaction. This is likely
to be because the chosen user images for the experimen-
tal group were concentrated on the face, with the ‘ideal’
smile being the central focus of the images. There were
no images showing the whole body, so individuals were
unaffected in terms of their body satisfaction. This result
was apparent in both men and women.
faction after exposure to the idealised facial images com-
pared to those exposed to neutral images, which is
consistent with previous research (Fardouly et al., 2015).
Another important finding in our study was that facial,
body and total dissatisfaction reduced in the control group.
This suggests that viewing neutral nature images helped
improve participants’ mood and appearance-related satis-
faction. This supports findings that recommend targeting
specific SNS photo activities and to view more appear-
ance-neutral images to prevent body image concerns
(Cohen et al., 2017).
Overall, the present study agreed with the findings of
Meier and Gray (2014) and Cohen et al. (2018) that post-
exposure body dissatisfaction was more related to viewing
photographs on social media than the total time spent on
Sampson et al. 61
Figure 2.  Graph to show relationship between Facial Satisfaction Score (FSS) and Body Satisfaction Score (BSS) before and after
exposure in the experimental (smile images) group vs. the control (neutral nature images) group.
social media. There was no correlation between increased
use of social media and greater smile or facial dissatisfac-
tion in men and women, suggesting that any use of social
media, not just increased use, can have an impact on facial
and body dissatisfaction.
Studies have shown that adults who have had orthodon-
tic treatment have improved self-esteem and quality of life
(de Couto Nascimento et al., 2016; Imani et al., 2018). This
purported increase in self-esteem was shown in our study
not to correlate in resistance to post-exposure facial or body
dissatisfaction. Wearing braces or having had braces was
shown not to influence post-exposure facial or body
dissatisfaction.
Most studies on social media effects on body dissatisfac-
tion are targeted at women. The present study shows that
gender has no influence on the effect of social media on
facial or body satisfaction. Both genders are equally sus-
ceptible to the effects of social media. This contrasts with
other findings (Haferkamp and Kramer, 2011) but could be
explained by evolving attitudes towards personal appear-
ance and social comparison across genders, as found by
Tamplin et al. (2018).
Individuals with higher self-discrepancy scores have
been found to be more vulnerable to the adverse effects of
social media on body, smile and facial dissatisfaction and
have greater propensity to make appearance-related social
comparisons. Our study shows that individuals with high
self-discrepancy scores are less satisfied with their facial
features and body appearance.
With the growing use of social media, clinicians must be
made aware of the impact this may have on patients. This
information may help develop a better understanding of
patients’ motivations to seek treatment (to gain confidence
following comparisons on social media) and the impact on
their mental wellbeing (depressive states as a result of
social media).
Limitations
Our study focused on one SNS with one of the highest lev-
els of visual media. There are, however, a number of other
SNSs that could be incorporated into future research, par-
ticularly when 73% of Americans actively use more than
one SNS (Smith and Anderson, 2018).
Research shows distinct patterns in socioeconomic sta-
tus and choice of SNS (Lenhart, 2015). Users from less
affluent families (< $30,000 per annum) are twice as likely
to regularly use Facebook than wealthier peers (> $75,000
per annum), who prefer Instagram and Snapchat (SNSs
higher in visual media).
Differences in education were not taken into considera-
tion in this study, as all participants were university stu-
dents. Smith and Anderson (2018) showed that college
graduates are more likely to use Instagram than those with
an education level of ‘high school or less’. These differ-
ences in socioeconomic and educational backgrounds may
have relevance for future research for a truer representative
sample of young adults.
Generalisability
The study cohort was representative of a young UK-based
student population, a population likely to be using SNSs
high in visual media.
62 Journal of Orthodontics 47(1)

Table 4.  Results of multiple regression for Body Satisfaction Scale (BSS), Facial Satisfaction Scale (FSS) and total scores.

Predictors Compared with Effect 95% CI P value

FSS
  Baseline 0.95 0.85–1.05 < 0.0001*
  Gender  
   Female Male –0.52 –1.98 to 0.95 0.49
  Group  
    Control group Experimental group –2.39 –4.32 to –0.46 0.016*
  Braces  
    Braces – No Braces – Yes 0.63 –0.76 to 2.01 0.37
  Media use  
   High Low 1.15 –0.71 to 3.02 0.22
  SDI 0.60 0.04–1.16 0.036*
  Group X Media use –0.59 –3.37 to 2.19 0.67
BSS
  Baseline 0.47 0.32–0.62 < 0.0001*
  Gender  
   Female Male 0.98 –1.24 to 3.21 0.38
  Group  
    Control group Experimental group –2.74 –5.66 to 0.19 0.07
  Braces  
    Braces – No Braces – Yes –0.40 –2.50 to 1.71 0.71
  Media use  
   High Low 0.29 –2.53 to 3.12 0.84
  SDI 0.97 0.12–1.82 0.025*
  Group X Media use –0.51 –4.73 to 3.71 0.81
Total scores
  Baseline 0.94 0.86–1.01 < 0.0001*
  Gender  
   Female Male 0.27 –1.70 to 2.24 0.78
  Group  
    Control group Experimental group –3.49 –6.10 to –0.87 0.009*
  Braces  
    Braces – No Braces – Yes 0.58 –1.28 to 2.44 0.54
  Media use  
   High Low 1.08 –1.43 to 3.58 0.40
  SDI 0.63 –0.14 to 1.39 0.11
  Group X Media use –1.04 –4.78 to 2.69 0.58

*Statistically significant.
CI, confidence interval.

Conclusion this trial, viewing SNSs with high visual media signifi-
cantly reduces satisfaction with facial appearance in the
This study adds to the growing body of evidence showing short term. Individuals with high levels of self-discrepancy
the detrimental effects of SNSs on self-image. Based on have a more profound effect.
Sampson et al. 63
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iD
Ariane Sampson https://orcid.org/0000-0002-5559-6185
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