‘Snapchat Dysmorphia’: Is the Stress of Social Media Driving Teens to Plastic Surgery?
Plastic surgeons are seeing more patients walk through their doors asking to look like their selfies. Is this actually a growing mental health problem?
You’ve never looked better: Your skin is poreless, your nose looks small, your lips look plump, and you’re doe-eyed. You’re ready to hit "post" for the world to see. Cue the likes.
Problem is: Is this really you?
With filters on social media like Instagram and Snapchat, flattering lighting, perfect poses, and editing apps that can make you look like a thinner version of yourself (with perfect skin, to boot), we’ve entered into the era of selfie perfection. But, some experts say, all this social media flawlessness is seeping from our phones and invading our real lives. More people are thinking: I want to look like that — and going to great lengths to get there.
The trend, what some people are calling “Snapchat dysmorphia,” is real — and getting more potent every year. According to 2017 data from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), 55 percent of fascial plastic surgeons say patients have requested cosmetic procedures to look better on social media — an increase of 13 percent from the year before.
A?paper published in August 2018 in the journal?JAMA Facial Plastic Surgery noted that airbrushing used to be just for celebs. People saw how perfect they looked on the covers of magazines but knew it took a village to get them there. That certainly made its own impact on society’s standards of beauty, but things have taken a different turn today. Filters, lighting, and other social media tricks have introduced this drive for perfection to the masses: “A quick share on Instagram, and the likes and comments start rolling in. These filters and edits have become the norm, altering people’s perception of beauty worldwide,” the authors write.
The Possible Connection Between Stress and Social Media Use
While seeing your own imperfections in the mirror is nothing new, having the knowledge about what you could look like without them is. “The more time people spend on social media, the more their brains are being affected by the content they are exposing themselves to. For some, this means it encourages them to view their own, natural appearance as being unacceptable,” says Patrick J. Byrne, MD, board member of the AAFPRS and professor and director of the division of facial plastic and reconstructive surgery at The Johns Hopkins University School of Medicine in Baltimore. (Indeed, for Everyday Health’s United States of Stress story, when asked whether they felt bad about their appearance for any reason, the majority reported with a resounding "yes." About 22 percent of respondents said they felt bad about themselves on a daily basis.)
Adding to the problem: There’s a desire to repetitively view your social media accounts throughout the day, as they update constantly. In Everyday Health’s stress survey, 57 percent of respondents, including baby boomers and those among Generation Z, reported looking at their social media accounts daily.
This “constant checker”— as dubbed by?the American Psychological Association, which represents 86 percent of people according to their?2017 Stress in America report — experiences more daily stress than someone who looks at it less often. In fact, 42 percent say they worry about the negative impact social media has on their health; only 27 percent of non-regular checkers say the same. Add to it aesthetic pressures, and you have a recipe for stress, anxiety, and mood problems.
Plastic surgeons are seeing this play out in their offices regularly. Typically, when patients come in for a consult, they hold a mirror and, using a Q-tip, point to the areas they’d like to change. Today, these “flaws” may only be seen in a selfie — not a mirror. “[Patients] find it far easier to show me with photos on their phone. They point out imperfections — the nasal tip is too big, the nose is crooked, they have a double chin — that in some cases are next to impossible to see in person,” says Dr. Byrne. This may be an inevitable result of spending a good chunk of time looking at your own photos, he says.
Dwelling on those perceived imperfections or flaws can make anyone feel terrible. “This habit can trigger a sense of insecurity, which can lead to a stress response in the body,” says Sari Shepphird, PhD, a body image specialist and psychologist in Los Angeles.This can lead to a cyclical pattern of negative thoughts. You’re stressed about a flaw, feel as if you need to change your appearance, then spend time and resources doing so, which can create more stress, she says.
The desire to “fix” these imperfections may hit young women the hardest, says?Mark Schwartz, MD, a plastic surgeon in New York City, who adds that this group often asks for injectable fillers and Botox, as well as breast augmentation and liposuction to appear like the celebrities they see on social media. “They have grown accustomed to seeing themselves in a somewhat distorted way: on a tiny screen and in photos that have been edited to remove imperfections and take advantage of lighting tricks,” he says.
Sam Rizk, MD, a facial plastic surgeon in New York City, also agrees that it’s millennials who are hyperfocused on how they appear on Instagram and Snapchat. “Selfies taken with a ring light and using editing apps and filters can distort [someone’s] self-image. The Kardashians practically invented this phenomenon,” he says.
The difference today is the fixation on the small things that people may not have bothered to become consumed with before. “Patients are more obsessed about small imperfections. They like the way they look after they experiment with filters and editing apps. Their tolerance for a bump on their nose, acne breakouts, a little thigh bulge, or thin lips seems to be a little lower than previous generations,” says Dr. Schwartz.
RELATED: How to Maintain a Healthy Body Image
Can Snapchat Trigger Body Dysmorphic Disorder?
Many people are concerned that relying on these filters and projecting a heavily edited image of yourself to the world can not only severely impact users’ self-esteem but their mental health, too. As the authors of the JAMA Facial Plastic Surgery paper wrote: “The pervasiveness of these filtered images can take a toll on one’s self-esteem, make one feel inadequate for not looking a certain way in the real world, and may even act as a trigger and lead to body dysmorphic disorder.”
Body dysmorphic disorder (BDD) is a mental illness that can lead affected individuals to have frequent thoughts about their appearance; seek constant reassurance from others that they look okay; check their appearance in the mirror or other reflective surfaces repeatedly; avoid social situations to prevent others from seeing them; and use hats, scarves, and makeup to conceal the perceived flaw, according to the International OCD Foundation (IOCDF). People with BDD also often seek cosmetic surgeries to “fix” their perceived imperfections.
IOCDF notes that while typically everyone has at least one part of their appearance that they don’t like, BDD goes beyond seeing (and even being bothered by) physical imperfections. Those who have BDD are consumed by thoughts about their flaws, which “may cause severe emotional distress and interfere with daily functioning,” according to the Anxiety and Depression Association of America (ADAA). It’s something that affects about 1 in 50 people, mostly young, and women and men in equal amounts, the ADAA says. Someone with BDD is likely to respond to social media images in a far more intense way, says Dr. Shepphird. “The idea that one is being shamed for their appearance and doesn’t match the standard of perfection can increase the risk of depression, [and cause] elevated levels of anxiety and a general distortion of their perception of themselves,” she says.
Yet the development of BDD is multifactorial; genetics and brain chemistry can play a role, for instance. It often co-occurs with other conditions, like depression, eating disorders, and obsessive-compulsive disorder (OCD). In fact, BDD is considered an obsessive-compulsive-related disorder, notes the International OCD Foundation. Both BDD and OCD are marked by obsession; in people with BDD, this obsession is body focused.
Previous?research published in the journal?JAMA Psychiatry analyzed brain scans of 12 people with BDD and concluded that these patients do indeed process others’ faces differently compared with control subjects. But that clearly was before the era of selfies. A more recent study, published in July 2015 in the journal?Psychological Medicine, found that both those suffering from anorexia nervosa or BDD have abnormal activity in areas of the brain that process images as a whole — they may be wired to home in on the “flawed” details rather than the overall picture.
So, it’s easy to see why social media can be so damaging for people with BDD. Whether Snapchat is a trigger is up for debate, but it’s likely not the only driving factor. “I don’t think in of itself social media causes BDD, but rather exacerbates [existing] BDD,” says Talia Wiesel, PhD, a psychologist and assistant professor of psychiatry in the OCD and related disorders program at the Icahn School of Medicine at Mount Sinai in New York City.
Social media can prompt repetitive behaviors in someone with BDD, like making comparisons with others. This can make people worry more about how they look, says Katharine Phillips, MD, psychiatrist at NewYork-Presbyterian and Weill Cornell Medicine in New York City, who adds that many of her patients report that social media images are a source of stress for them. While what happens in the brain of those with BDD when viewing social media hasn’t been studied, she says, “it’s possible that that activity increases in parts of the brain known as the orbitofrontal cortex and caudate, areas that tend to be hyperactive in people with BDD, which probably reflects obsessional thoughts.”
For these people, habits like taking excessive selfies and analyzing them for flaws can be damaging. “They often make people feel worse and can fuel more BDD repetitive preoccupations,” says Dr. Phillips. “Because there are so many gorgeous celebrities to compare oneself with — it isn't surprising that people with BDD (and those without BDD, too) often feel worse after they compare themselves with these images. In addition, people with BDD not only underestimate their own attractiveness but also tend to overestimate the attractiveness of others, which makes this problem even worse,” she says.
Dr. Wiesel points out that research, published in December 2015 in the?International Journal of Eating Disorders, showed that social media is correlated with body dissatisfaction and the desire to change one’s appearance, but this alone doesn’t mean someone has BDD. For those who do have BDD, social media use may go hand-in-hand with obsessive comparisons with celebrities or friends who, too, may be spending hours curating, enhancing, and retouching their photos. “BDD can lead these patients to engage in another compulsion — seeking plastic surgery,” Wiesel says. Problem is, as Shepphird adds, “we found plastic surgery doesn’t make BDD go away, but it intensifies it.”
It’s tempting to call your filtered photos the “best version of yourself,” but what is that really saying? “It’s the extent to which we are bothered by our flaws that determines if this is problematic,” says Wiesel. Those with BDD may be so consumed by their appearance that it impacts their relationships, work, and social life.
But even if someone doesn’t develop BDD, the desire to airbrush your flaws away remains damaging. The trend “may be encouraging young people to put far too much emphasis on their own personal appearance than they should,” says Byrne. “Granted, this has always been a concern in our society. But this obsession for which we are biologically predisposed can be perversely incentivized by the pernicious effect of ‘likes’ and ‘followers’ on one’s behavior and priorities,” he adds.
Indeed, a?study published in September 2018 in the journal Body Image on undergraduate collage women found that those who placed more emphasis on Instagram likes were more likely to compare their appearance with others and be dissatisfied with their facial features. Beyond BDD, research published in June 2018 in the journal?Cyberpsychology, Behavior, and Social Networking found that platforms like Instagram and Snapchat were linked to a hyperfocus on one’s body appearance and eating disorders.?
How Plastic Surgeons Are Screening Patients for BDD
Even before Snapchat filters were a thing, plastic surgeons were aware of the need to screen patients for BDD. Byrne coauthored?a?study published in the March-April 2015 issue of the journal?JAMA Facial Plastic Surgery that emphasized the need for these patients to be identified before undergoing surgery. Plastic surgery is not a treatment for BDD, but can exacerbate it.
If you are seeking plastic surgery and using a selfie as a reference point, a good plastic surgeon should provide a realistic idea of achievable results. “I prefer to have a discussion about how all human beings have facial imperfections, and most are simply irrelevant. The existence of an imperfection is not an indication for an intervention,” says Byrne.
“Aesthetic plastic surgeons today need to be part surgeon and part therapist,” adds Schwartz. He says that surgical consultations should last at least an hour, to talk about realistic goals. “If I don’t think their requests are reasonable, I’ll always tell patients that up front. Surgery is serious business that comes with some risks. There is never a guarantee, as it’s not a perfect science. It isn’t something that should be considered lightly,” he says.
If a patient shows signs of BDD, Dr. Rizk says he won’t operate, and instead may consider referring them to therapy. The desire to look like an airbrushed photo of yourself is not realistic, experts say. “We are surgeons, not magicians,” says Rizk.
How to Change Your Social Media Habits for a Better Self-Image
If you think you may have BDD, seek help from a mental health professional. But even if you don’t have BDD and feel like your social media presence is making you hyperaware of perceived flaws, you can take steps to develop a better relationship with your social media use. Here’s how:
Be realistic. You’re not going to give up all of your social media accounts. Instead, “think about your screen use. How can you be mindful and intentional when you’re on?” says Wiesel. Rather than automatically grabbing your phone during moments of downtime, ask yourself why you’re opening up that app and what you need to accomplish.
Inventory your self-worth. This takes some introspection, but ultimately it’s worth it. “Take stock of the major areas of your life that make up who you are. Reminding yourself in an image-obsessed world that you’re more than your appearance sounds cheesy, but it’s important,” says Wiesel.
Give yourself a break. “Some of the things we’d say to ourselves are things we’d never say to another person,” says Wiesel. She suggests practicing mindfulness for one to two minutes a day. Focus on the thoughts and feelings that pop into your head criticizing your appearance. Notice them, but don’t judge or criticize yourself for having them. “Part of being human is being imperfect,” she says.
Don’t go there. If you haven’t started using filters or editing apps, don’t even start, says Wiesel.
Consider curating your feed. It’s impossible to get away from messages about society’s standards of beauty, and you shouldn’t aim to avoid them at all costs either. The ultimate goal is to be able to see these messages and not compare yourself with them, says Wiesel. But if your social media feed is overrun by people who make you feel bad about yourself, ask yourself why you continue to follow them. You might consider following other accounts that reinforce positivity and are not image focused.