Editing Selfies Linked to Plastic Surgery Acceptance

Ricki Lewis, PhD

July 01, 2019

Increased acceptance of cosmetic facial surgery is associated with the use of certain social media and photo editing applications, according to findings of an online survey study published in JAMA Facial Plastic Surgery.

Photo messaging apps such as YouTube, WhatsApp, and Tinder enable users to post selfies that have been altered using online editing ("digital enhancement") and filtering tools such as Photoshop, Snapchat, VSCO, and Instagram. A user can erase wrinkles; enlarge eyes; alter lip shape; swap facial parts with those of a celebrity, monster, pet, or even a gingerbread man; add a crown of flowers; or embed a meme, such as vomiting rainbows.

More seriously, the ability to alter one's public face enables users to envision alterations that facial plastic surgery could make a reality. The past few annual surveys from the 2500+ members of the American Academy of Facial Plastic and Reconstructive Surgery have revealed a steady increase in the percentage of surgeons who report seeing patients who requested surgery specifically to improve their appearance in selfies.

Cosmetic surgeons have adopted the term "snapchat dysmorphia" to describe patients who come in with their desired "after" images displayed on their phones, such as a face with Angelina Jolie's lips and Jennifer Lopez's nose.

The apparent increasing incidence of snapchat dysmorphia inspired Jonlin Chen, BS, a medical student at Johns Hopkins University, Baltimore, Maryland, and colleagues to investigate the strength of the association between the use of photo messaging apps that alter images with perceptions of the use of facial plastic surgery. "The rising trend of pursuing cosmetic surgery based on social media inspiration highlights the need to better understand patients' motivations to seek cosmetic surgery," they write.

The researchers measured self-esteem and acceptance of cosmetic surgery attitudes among 252 participants who were recruited from university e-mail lists and posts on Reddit, Facebook, and Instagram in 2018. They used the Rosenberg Self-esteem Scale, the Contingencies of Self-worth Scale, and the Acceptance of Cosmetic Surgery Scale.

The sample was skewed with respect to female sex, white race, and young age: 184 (73.0%) were women, 134 (53.2%) were white, and the mean age was 24.7 years (range, 18 – 55 years). None of the participants had had plastic surgery; they did report using social media or photo editing apps. The mean number of social media apps used was seven, and the mean number of photo editing apps was two.

The researchers report finding lower self-esteem scores among participants who used YouTube (difference in scores, −1.56; 95% confidence interval [CI], −3.01 to −0.10), WhatsApp (difference in scores, −1.47; 95% CI, −2.78 to −0.17), VSCO (difference in scores, −3.20; 95% CI, −4.98 to −1.42), and Photoshop (difference in scores, −2.92; 95% CI, −5.65 to −0.19). No significant differences for self-esteem emerged with respect to the other social media and photo editing apps. Participants could write in apps or social media that were not listed.

The investigators found increased consideration of cosmetic surgery, but not overall acceptance of surgery, in users of VSCO (difference in means, 0.84; 95% CI, 0.32 – 1.35) and Instagram photo filters (difference in means, 0.38; 95% CI, 0.01 – 0.76) compared with nonusers of these apps.

The apps that were associated with a higher overall score on the Acceptance of Cosmetic Surgery Scale were Tinder (difference in means, 0.79; 95% CI, 0.34 – 1.23), Snapchat (difference in means, 0.39; 95% CI, 0.07 – 0.71), and/or Snapchat with photo filters (difference in means, 0.44; 95% CI, 0.16 – 0.72).

Participants who reported untagging or removing a selfie "because it was not digitally edited or enhanced to your liking" also had higher facial surgery acceptance scores.

If the findings can be validated in larger samples, physicians might be able to better assess a patient's perception of facial plastic surgery by knowing that lower self-esteem is associated with use of YouTube, WhatsApp, VSCO, or Photoshop and that higher overall acceptance of cosmetic surgery increases with use of Tinder, Snapchat, and Snapchat filters.

The authors point out, however, that the association revealed in the study was in regard to the changing of facial features using photo editing, not with the use of other features of the apps, such as altering lighting.

A limitation of the study is that it is unlikely that the participants represented patients who seek cosmetic surgery, who are older.

The researchers have disclosed no relevant financial relationships.

JAMA Facial Plast Surg. Published online July 1, 2019. Full text

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