Is Social Media Driving Cosmetic Surgery Among Millennials?

Edwin F. Williams III, MD


March 14, 2016

Editor's Note:
In 2015, roughly two thirds (64%) of facial plastic surgeons saw an increase from the previous year in patients under 30 requesting cosmetic surgery or injectables, according to a survey conducted by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).

AAFPRS President Edwin F. Williams III, MD, recently spoke with Medscape about what he sees as an alarming trend: social media influencing plastic surgery choices among young patients. Check out the interview below and then tell us in the comments section what your experience has been with younger patients asking for cosmetic procedures.

Medscape: What might be motivating younger patients to seek facial plastic surgery or injectables?

Dr Williams: People come in and say, "I saw this pic on my friend's Facebook and, like, my nose..." They see their photos in ways they haven't before. It used to be that you have a picture of the family and it sits over in a corner. But now people are snapping photos all the time, of everything, and they are sending them around.

I am very conservative and I have mixed feelings about the whole thing because I also have three daughters, from 16 on up to 25. You really don't develop your judgment until you are about 23 or 24.

Medscape: Could you go into more detail about how social media might influence someone to seek plastic surgery?

Dr Williams: What's happening is that people no longer have control of their photos. For example, a photo will be taken and posted either on Facebook or elsewhere. At that point, folks no longer have control of their photos, and it brings to light some of the things that are bothering them—for example, if someone has a poorly balanced nose or a nose that has a large bump, [and a photo taken at an unflattering angle] shows up somewhere unexpectedly.

Medscape: Is it just about looking at photos? What about the way people interact with those photos, such as with comments and "likes"?

Dr Williams: Both. Unfortunately, people are not kind, and sometimes comments are made. It's hard for us to quantify that, but it's something we hear on a regular basis from people seeking aesthetic surgery.

Medscape: Is there a way to counteract the unrealistic portrayals of beauty circulating on social media?

Dr Williams: Not really, in this day and age, because things are sensationalized. It is the responsibility of a reputable doctor to put things in perspective when seeing a patient. By the way, most patients are usually reasonable and realistic; it's really the rare patient who overreacts.

It is the responsibility of a reputable doctor to put things in perspective when seeing a patient.

Medscape: How has social media changed the way plastic surgeons interact with patients?

Dr Williams: It has changed the way doctors interact mainly by making sure that we are compulsive about managing expectations. Typically, a reputable surgeon will ask enough questions to get to the bottom of what is motivating a patient to seek aesthetic surgery. For example, patients who come in to get the lips or nose of a certain celebrity are less desirable patients because they're fixated on a particular feature that may not be realistic. It's the doctor's responsibility to do a good job of educating the patient.

Medscape: What is the gender breakdown of these patients?

Dr Williams: Ninety percent end up being women—that really hasn't changed.

Medscape: What are they looking to have done?

Dr Williams: Rhinoplasty. Otoplasty is a much smaller number. We are also seeing women in their 20s asking for fillers and lip augmentation.

Medscape: How should younger patients be counseled differently from patients age 30 or above?

Dr Williams: There is a difference between 28 and 22. If someone is 28 and is saying, "I am thinking about Botox," I would say, "Here is how it works: It's something that, if you want it, is going to need to be maintained, and these are the economics."

If it is a 22-year-old, I would just dissuade them. I would not be comfortable injecting a 22-year-old with Botox. I think I would just say, "Listen, I know it is hard for you to believe, because when you are 22 you think you are an adult; but these are really adult decisions, and your body image is not fully developed yet."

Medscape: Have you had to dissuade many young patients from seeking plastic surgery, and is that difficult?

Dr Williams: On occasion. It's not like we have young patients flocking to us as a result of social media, but I would say that most physicians who perform plastic surgery have experienced a few folks asking for things for which they may not be good candidates. But if they feel that the expectations are unreasonable or that they're motivated by the wrong thing, most reputable surgeons will not take the next step of accepting the patient or performing surgery.

Medscape: Is there a message you would like to get across to your plastic surgery colleagues about this trend in younger patients?

Dr Williams: Do a good history and find out what is motivating the patient. Make sure that his or her expectations are reasonable and realistic.

What has your experience been with patients under 30 who are asking for cosmetic procedures? Tell us in the comments section.


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