Friday is National Selfie Day and with the rise of social media usage, it should come as no surprise that our society has become obsessed with physical perfection. Social media has played a major role in creating an unrealistic expectation of beauty — and users on those platforms run the risk of losing touch with reality. On average, Millennials will spend an hour a week on selfies and are expected to take 25,700 selfies in their lifetime. With those selfies, they will then spend hours self-critiquing and picking apart each imperfection that they see in the image. This process creates a sense of low self-esteem and a rise in depression among U.S young adults aged 19 to 32, according to the U.S. National Library of Medicine.

This downside to social media and selfies is due to the heavy use of photoshop and facial filters, which alter a person’s natural appearance to emulate the “ideal” body or facial features. Surgeons have experienced a steady increase in patients wanting to recreate their filtered selves with flawless wrinkle-free skin, symmetrically contoured face, larger eyes, plumper lips, and a slimmer face. 

The majority of individuals requesting these revisions are Millennials aged between 22-37 years old. The American Academy of Plastic and Reconstructive Surgery’s 2018 annual survey revealed that the number of cosmetic procedures has gone up 47 percent since 2013. Experts are breaking down the influence that selfies and social media have over users, and are explaining the correlation between the increase of selfies and plastic surgery.

Dr. Pablo Prichard, chief of plastic surgery at John C. Lincoln Hospital in Phoenix, has some interesting insight on these current plastic surgery trends due to the rise of the selfie and social media, and the impact they have on today’s beauty standards.

Pablo Prichard, MD, is the chief of plastic surgery at John C. Lincoln Hospital in Phoenix.

AZ Big Media: How does the changing social media landscape impact people’s perceptions of their appearance?

Pablo Prichard: I think there’s two layers to that. The first layer is because of social media and how prevalent it is. People are taking massive amounts of selfies and because one generation ago, or even a couple years ago, people didn’t have phones that took photos. Or the photos that were on the phones were very poor quality so you really couldn’t see a whole lot of detail. Now we’ve got these phones that take these HD quality photos and we’re constantly taking these photos of ourselves we are noticing every flaw in our faces and our bodies. That’s one layer; the massive amount of photos were taking of ourselves, and then self-critiquing.

The other layer is all of the enhancements that are available through Snapchat or other photo editing software like Photoshop. You’ve got filters that make your nose and face slimmer, reduces a double neck or chin, that perfect the skin so that the skin is completely flawless. You also have all these Instagram “models,” who also Photoshop their bodies to make their waist look slimmer, and project their breasts and their butts. All of these different things make the average social media consumer really look at themselves and they see anything that they could change, they want to change.

ABM: What kind of requests are you now getting due to these enhancements that are being shown via social media, and in what frequency?

PP: The most popular ones are easy– fuller lips, enhanced facial features, change in the eye shape, smoother nose– all of which can be done in the office. Nowadays fillers can be an in and out procedure, patients are totally awake with just a little bit of numbing. You can get fuller lips, that’s obviously one of the common things, but you can also enhance the face. You can get a fuller cheek, or reduce the bag underneath the eye to make you look more vibrant. There is actually filler that can make your nose look better. You can’t make anything smaller with filler because you are just adding material, but you can proportionally make things more in line with facial harmony.

In addition to that, more permanent changes that are requested like rhinoplasty (a nose job), or in the body. The face is probably the most common thing, but in the body getting “mommy makeovers” with a thinner waist, larger breasts, injections in the buttock area to make that curvier. All those enhancements or requests are things that people see on social media. Or get filtered in themselves and want that change later on.

ABM: Have you noticed that after a patient receives these procedures that it could actually negatively impact their self-esteem?

PP: It totally depends on the reason why they are making the changes. Whenever I see somebody come in and request a change I try to decipher, “Ok what is the reason they want the change?” If it is something to do with “My boyfriend wants this done,” “My friends think I should have this done,” “I think it will save my marriage or my relationship,” or something like that, then that is the wrong reason for doing any kind of change.

If it’s just something that somebody has lived with, like a large nose and it just kind of bothered them and they want to change it for themselves then I think that is an appropriate reason to change something. I always tell patients never change something because somebody else wants you to do it, or even worse because it’s some kind of trend. If you see a social media trend and something is a fad, and is just in right now, that’s another thing I think is the wrong reason to change something. I think it really has to come from within.

ABM: Do you feel like some of these trends are leading people into trying to achieve unrealistic beauty standards?

PP: Oh absolutely! The reason why some of these trends make people think they can attain something that’s really not possible is because of how highly Photoshopped some of the Instagram models are. They get unrealistic looking waistlines, and then huge butt areas to maximize an hourglass shape; which is totally unrealistic. They see that and they don’t understand that some of these images are Photoshopped. I can’t say that all of them are of course, but a lot of them are, and if they are buying into this is “natural” then they can have unrealistic expectations in themselves.

When they don’t achieve those expectations then they can be depressed about it, or unhappy about it. So I also always go over with patients what their expectations are and make sure that I can actually achieve that expectation if we are doing surgery. I make sure that it is a realistic expectation, and if it is an unrealistic expectation then I don’t do surgery because nothing is going to make that patient happy, and why put that patient under that surgical procedure when it’s not going to make them happy.

ABM: How would you describe your average patient?

PP: I work with patients who want something done, have wanted it done for years, and saved up for the procedure. It’s not a spur of the moment reaction of, “Today I woke up and I want something.” These people think about what they want, and it’s something for themselves only.

ABM: What are some statistics you can share regarding average patient age?

PP: Ages vary quite a bit, but it depends on what people are having done. I notice a lot of small, what we call, “tweaks” to the face in general tends to be the younger millennials. So it tends to be people in their 20s who again have massive amounts of filtered images that they are looking at. They are constantly looking at one small spot on their face that they really dislike. A small amount of filler can go a long way, and then they never have to think about that spot again.

Somebody after kids who is in their 30s- 40s, tend to be the “mommy makeovers.” Where their bodies have changed after pregnancy and they don’t like those changes. Maybe some black skin in their belly or breasts that aren’t as perky as they were when they were 20; those things tend to come in their 30s and 40s. Then the crowd in the 50s and up tends to be more of facelifts and eyelid lifts.

ABM: What do you recommend to patients who reveal social media and the selfie culture contributed to wanting a certain procedure?

PP: I think it’s really important for a plastic surgeon to be completely honest with a patient. If they say they want something done and I feel like it’s going to negatively impact their face, or if they feel like there is a defect and I don’t see that defect, that’s what we call body dysmorphic disorder. Where there is something that the patient imagines is there, but is not really there. I let the patient know my honest opinion about what I feel like is something that is actually there, or not. If it’s something that I don’t see, then I don’t offer any kind of services. It has to be something that I actually observe. Then if they say that “This is because of some photos that I have taken,” that itself is kind of common because it is amazing to me that when we look at ourselves in the mirror our brain changes our perception of ourselves because we know that we are looking at ourselves.

Our brains kind of make us look better. A lot of people will say, “I’m not photogenic. I don’t take good pictures.” Part of that, not all of it, is when they are looking at themselves in the mirror, the brain gives them the best image of themselves. When they look at themselves in a photo, all of a sudden, they become more objective about their face or their body, and they can actually see things in the photo that they couldn’t actually see in the mirror. And so just because they see something in a photo it definitely doesn’t amount to doing a procedure.