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With filters on Snapchat and Instagram, people are creative in how they modify images. Some play around with adjustments, others remove skin imperfections or changing the shape of a nose.

A recent JAMA Facial Plastic Surgery article highlighted “Snapchat dysmorphia” where the desire for perfection crossed the line from playing with a filter for fun to believing plastic surgery is needed as users experience symptoms of Body Dysmorphic Disorder (BDD).  

With forty years of experience in the cosmetic surgery field, John Satino, with New Hair Laser, sees cases of body image discomfort. "In hair transplants, this usually manifests when patients want unusually low hairlines that look totally unnatural. In some cases, young males come into the clinic seeking hair restoration surgery when no hair loss is apparent. We now see an additive trend of wanting fillers to the point of disfigurement. As these procedures become more common, and with [filtered] social media photos, this consumes our youth with a passion,” says Satino. He even sees it reaching the preteen market.

Inessa Fishman, MD, also see this with younger patients who have, “selfie dysmorphia, or very unrealistic expectations of appearance, bred within the Snapchat-filtered, Photoshopped, and Instagrammable culture of today.” Some patients believe cosmetic surgery should result in an appearance with zero flaws. Fishman reports that they "expect absolutely no wrinkles in their neck and the completely poreless and flawless skin we see in airbrushed magazine ads and polished Instagram posts. These patients tend not to be great surgical or treatment candidates, as their expectations are not in line with reality--or the treatment results I provide." Although not a counselor, Fishman is in tune with warning signs about an individual's reason for surgery and expected outcomes.

Dr. Ariane Machin, a psychologist with the Conscious Coaching Collective  points out that cropping and filtering everything is something anyone can do now. As a result, people no longer see reality and instead compare themselves to what they see online. Machin notes, "This has led to increased body image dissatisfaction, and a potential increase in disordered eating patterns to reduce the discrepancy of what we think we look like to what we should look like according to the images we see online each day."

Bill Prasad, a licensed counselor sees this in his practice as well. "Society has always put pressure on women to be a certain weight and look a certain way. Now, there is the pressure of having a social media community to compete with. This can lead to heightened anxiety and depression." In the past, clients would bring pictures to their doctors of actors they want to emulate. Now Prasad says, “they bring in doctored photos from social media.” Looking like a celebrity is no longer good enough. Now people aspire to become a computerized image.

Zachary Farris, MD, FACS has the same issue with some patients. “They show their photo to me and want to look like an idealized version of themselves created by filters." As this becomes more common in today’s culture, Farris believes "plastic surgeons need to be vigilant in spotting the signs of BDD and ensuring that their patients have the maturity to make a decision to go under the knife."

Emmy Brunner, a psychotherapist, sums up these issues with a comment on our modern culture. "We live in a society that profits from our insecurities, and because we’re consistently told that we can look better or prettier, we buy into it. Couple this with the power of social media which focus on physical features, the advertisements we see and the inescapable scrutiny upon our bodies, it’s hard for anyone to see that they can identify themselves by anything other than their appearance.”

Yet, Brunner believes social media could still be used for good instead of evil. "Ultimately, the more people show of their real lives and the more they publish of what they would want to see (coming from a compassionate, “well voice” rather than an unwell place),” advocates Brunner, "the more they can develop a nurtured and nurturing community - because it’s that authenticity that will resonate most.” Until then, plastic surgeons need to stay vigilant and have referrals available for mental health professionals when warranted.