CoverStory By Denise Mann

In the era of #selfies and selfie-absorption, facial plastic surgeons are increasingly finding themselves as the vanguards of a new type of vanity.

And while there are some clear benefits associated with the trend, not all facial plastic surgeons like what they are seeing or what selfies and social media are doing to the practice of facial plastic surgery as a whole.

“It has certainly had an impact on our specialty. There is no doubt about that,” says facial plastic surgeon Edwin Williams, MD, of Williams Center Plastic Surgery Specialists in Latham, NY, and the incoming president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)—a group that represents more than 2,700 facial plastic and reconstructive surgeons throughout the world.

“It’s not just selfies. It’s social media, including Facebook, Snapchat, WhatsApp, Twitter, Instagram, and anywhere else that people can see their photos,” he says. “We no longer have control of our photos and where they show up—and it breeds insecurity where it may not have in the past.”

As a result, patients are looking to facial plastic surgery en masse. Fully one in three facial plastic surgeons surveyed saw an increase in requests for procedures due to their patients being more aware of their looks on social media channels, the AAFPRS reports.

“We are in the business of helping people who are bothered by their appearance, but we don’t want to foster insecurity, and this can mean we walk the fine line,” Williams says.

The New Me Generation

About one million selfies are taken each day, and 36% of people admit they have altered theirs with this filter or that one, according to a survey by Samsung. Selfies comprise almost one-third of all photos taken by people aged 18 to 24, and celebs are all over this trend. (Kim Kardashian has an all-selfie book aptly titled Selfish on the market.)

Even First Lady Michele Obama and Pope Francis have posted selfies. Some selfie-lovers also travel with their own props—namely, selfie sticks or “narcisticks,” the seemingly ubiquitous extendable monopods that allow for better and wider selfie angles. These are so popular and distracting that they have actually been banned from music festivals like Coachella and Lollapalooza, and now from Disney World and Disneyland.

“By taking so many selfies, we are much more aware of any perceived or actual defect or weakness,” Williams says.

With all this snapping, posting, and chatting, it’s no great surprise that facial plastic surgeons saw a 10% increase in rhinoplasty, a 7% increase in hair transplants, and a 6% increase in eyelid surgery as a direct result of social media. “If you take five or 10 selfies a day, you will see these things more,” he says.

It’s a perfect storm, says Pamela Rutledge, PhD, MBA, the director of the Media Psychology Research Center and faculty in the media psychology program at Fielding Graduate University in Santa Barbara, Calif.

“On one hand, plastic surgery is much more available and much less expensive. There are all kinds of new techniques that are less aggressive, so there is a whole new menu with much lower price points,” she says. “The Internet and the ability to communicate with visuals has made us all more visually aware of how we look in relation to others.”

And social media also has that funhouse-mirror effect in that a photo is seen over and over again, and then just when you think it is buried, it shows up for a #TBT event or via Facebook’s “On This Day” feature, where you are served up photos taken on this day in any given year.

“Years ago, if there was a bad or unflattering photo, you ripped it up and threw it away. Now, you can look at a photo and say, ‘ugh, my nose looks horrible,’ and the picture will end up on someone else’s feed again and again.” Williams says.

As such, scrolling through selfies and other images on social media has become a big part of consultations, he says. “Patients will show me their photos and say things like, ‘I saw this on my nose the other day,’?” he says.

“Selfies are not portraits, they are moments in time,” Rutledge cautions. “Anyone can take one where the nose looks too big. It’s just where you hold the camera,” she says.

That’s not to say that a selfie can’t serve as a critical “before” image in some cases, Williams says. Apps like Perfect365, FaceTune, and Pictr can also help doctor selfies, whether zapping zits, smoothing frown lines, whitening teeth, or brightening eyes. “You can try on cosmetic surgery, in a way, with these apps, and that can be a positive experience for some prospective patients,” he says.

Social media has also sired innovation and entrepreneurship among plastic surgeons and marketers. For example, a Northern Va-based plastic surgeon coined the term “FaceTime facelift” for a procedure that improves how a person looks when FaceTiming on an iPad. (The incision is hidden behind the ears, so it is not visible under the chin when you chat.)

And the new double-chin-dissolving injectable, Kybella, also has a built-in target audience as a result of selfies and social media. “They are going after submental fullness, which is the area that can be prominent when video-chatting or when taking selfies from a certain angle,” Williams says.

The Teen Seen

Facial plastic surgery patients are skewing younger as a result of all this technology and digital exposure. More than half of facial plastic surgeons surveyed found an increase in cosmetic surgery or injectables in people under age 30, the AAFPRS reports, and social media is clearly fueling this uptick.

“I fix a lot of noses on 18-year-old women, but kids have enough to deal with before they start to tinker with their body image,” Williams says. “If a mom and a daughter come in and the mom wants a rhinoplasty, but the child has mixed feelings, I say, ‘come back when the kid wants it,’?” says the father of four (including three girls).

Not liking how a nose or another facial feature looks on Instagram is not a reason for plastic surgery in its own right, he says. These images can, however, help a teen illustrate what they don’t like about their appearance and want fixed with surgery.

Yes, all this social media exposure and self-criticism is good for business, but it also puts facial plastic surgeons in the sometimes awkward position of having to say no to patients with unrealistic selfie-based expectations—knowing full well that the medspa or clinic down the street will be all too happy to oblige.

“If you look around, you will find someone who will do what you want, but it may not be in the patient’s best interests,” he says.

First, Do No Harm

Oftentimes, Williams and others find themselves talking patients down instead of trying to upsell them on a facial plastic surgery procedure.

Immediate past president of the AAFPRS, Stephen S. Park, MD, FACS, agrees. “Today, facial plastic surgeons must spend a fair amount of time re-educating patients about what is fact and what is fiction, and many people are going far down the unmonitored road and getting hurt and coming back with complications,” says Park, the director of the Division of Facial Plastic and Reconstructive Surgery at the University of Virginia Medical Center in Charlottesville.

Many facial plastic surgeons must walk a fine line between patient well-being and paying the bills.

“With the Affordable Care Act and declining reimbursements, many non-core physicians are entering into aesthetic medicine, and our biggest challenge is how can we differentiate ourselves yet not commoditize what we are doing,” he says.

It’s a challenge and one that starts with cleaning up the aesthetic landscape.

“Medspas are popping up all over, and sometimes there isn’t a licensed medical director to be found,” Williams says. “Federal and state budgets are lean, and they are busy dealing with the podiatrist who is filling narcotics prescriptions, not medspas that treat patients with Botox and fillers without a director on-site.”

The onus is on facial plastic surgeons to report these to the proper authorities, he says. “If you are going to make a formal complaint against a medspa, then you better be sure you follow the letter of the law to the T yourself. You can’t go throwing stones if your house isn’t clean.

“As facial plastic surgeons, we need to set the bar high,” Williams adds.

We can all expect him to lead by example in the coming year.

Denise Mann is the editor of Plastic Surgery Practice. She can be reached at [email protected].