Faking it: how selfie dysmorphia is driving people toseek surgery

Elle Hunt

Filters have never been more prevalent � and it’s leading some people to have fillers, Botox andother procedures. What’s behind the obsessive pursuit of a flawless look?

Wed 23 Jan 2019 06.00 GMT

P eople used to call Anika the Snap Queen. Between the ages of 19 and 21, she was“obsessed with Snapchat, to the point where I had 4,000 followers”. At the peak ofher “tragic” behaviour, she reckons now – a year after quitting the image-sharing app– she was taking 25 selfies a day.

She liked the sense of having a platform, she says, with the average selfie getting 300 replies.“It was like, ‘Oh my God, I’m so popular – I’ve gotta show my face.’” But the filters were alsopart of the appeal. The Londoner had long been insecure about the slight bump in her nose.Snapchat’s fun effects, which let you embellish your selfies with dog ears, flower crowns andthe like, would also erase the bump entirely. “I’d think, ‘I’d like to look how I look with thisfilter that makes my nose look slimmer.’”

Socialising in the real world, she would choose her seat to avoid being seen in profile. Sherecognises that this was irrational – “but it happens. I feel like we’re in a world where a lot ofpeople are seen to be perfect, and so we try and reach that peak.”

Sometimes her followers would suggest meeting in person. “Then it would be like, ‘I have tolook like my selfie.’” It was around this time, the height of her Snapchat obsession, that Anikastarted contacting cosmetic doctors on Instagram.

The phenomenon of people requesting procedures to resemble their digital image has beenreferred to – sometimes flippantly, sometimes as a harbinger of end times – as “Snapchatdysmorphia”. The term was coined by the cosmetic doctor Tijion Esho, founder of the Eshoclinics in London and Newcastle. He had noticed that where patients had once brought inpictures of celebrities with their ideal nose or jaw, they were now pointing to photos ofthemselves.

While some used their selfies – typicallyedited with Snapchat or the airbrushing appFacetune – as a guide, others would say, “‘Iwant to actually look like this’, with the largeeyes and the pixel-perfect skin,” says Esho.“And that’s an unrealistic, unattainablething.”

A recent report in the US medical journalJAMA Facial Plastic Surgery suggested thatfiltered images’ “blurring the line of realityand fantasy” could be triggering bodydysmorphic disorder (BDD), a mental healthcondition where people become fixated onimagined defects in their appearance.

Like Esho, Dr Wassim Taktouk uses non-surgical, non-permanent “injectables” suchas Botox and dermal fillers to enlarge lips orsmooth a bumpy nose. He recalls a client

coming to see him in his cream-carpeted Kensington clinic, upset after a date made through anapp had gone south. “When she’d met the man, he had been quite disparaging: ‘You don’t lookanything like your picture.’”

The woman showed Taktouk the heavily filtered image on her profile and said: “I want to looklike that.” It was flawless, he says – “without a single marking of a normal human face”. He toldher he couldn’t help. “If that’s the picture you’re going to put out of yourself, you’re settingyourself up for disappointment.”

Why do we take so many photos of ourselves? A 2017 study into “selfitis”, as the obsessivetaking of selfies has been called, found a range of motivations, from seeking social status toshaking off depressive thoughts and – of course – capturing a memorable moment. Anotherstudy suggested that selfies served “a private and internal purpose”, with the majority nevershared with anyone or posted anywhere – terabytes, even petabytes of photographs never tobe seen by anyone other than their subject.

With so much of life now lived online, from dating to job-hunting, recent, quality images ofyourself are also a necessity – it is no wonder that Facetune (Apple’s most popular paid-for appof 2017) and the free follow-up Facetune2 have more than 55m users between them. StavTishler of Lightricks, the company behind them, says making airbrushing accessible haschallenged “that illusion that ‘a perfect body’ exists … and levelled out the playing field”:“Everyone knows everyone is using it, supermodels and ‘everyday’ people alike.”

Tijion Esho: ‘It’s a vicious cycle.’

However, a 2017 study in the journal Cognitive Research: Principles and Implications foundthat people only recognised manipulated images 60%-65% of the time. Esho says thepervasiveness of airbrushing on social media means it can create “unrealistic expectations ofwhat is normal” and lower the self-esteem of those who don’t use it: “It’s a vicious cycle.”

When the American Academy of Facial Plastic and Reconstructive Surgery surveyed itsmembers in 2017, 55% of surgeons said patients’ motivation was to look better in selfies, upfrom just 13% in 2016.

Even novelty filters such as Snapchat and Instagram’s, as well as adding bunny ears or specs toyour selfie, plump your lips, erase your pores and lift your jowls while they are at it. (Snapchatdeclined to respond on the record.)

“The first thing that any of these filters do is give you a beautiful complexion,” says Taktouk.“Your naso-labial [laugh] lines, from the nose to mouth, aren’t existent – but that’s not ahuman face. No one doesn’t have those. You can see them in children.” Clients still requesttheir removal, and of “the tear trough” – the groove down from the inner corners of the eyes.“People wanting bigger eyes is another one – it’s just not possible.”

The filtered-selfie look is also reflected in demand for bigger lips and taut jawlines. Such so-called “tweakments” have exploded in recent years, thanks to their relative affordability andconvenience. A “liquid nose job” using fillers might cost a few hundred pounds and takesinstant effect, compared with the slow, painful recovery from a surgical rhinoplasty. Marla, 29,from New York, got her “perfect nose” last year while on her lunch break. “I went back to workfeeling just so much more polished and confident – like I was even writing my emails better.”

Like Anika, she had always been bothered by the bump in her nose, religiously removing itfrom selfies; but she began exploring real-world options after a painful breakup. A list of prosand cons revealed that the potential risks – of her parents’ disapproval and “necrosis of theface” (“It’s very rare, but it’s definitely a thing”) – did not outweigh the benefits of having “thenose I create for myself on Facetune”.

The rise of fillers – anything from collagen and hyaluronic acid, which break down in a matterof months, to the permanent but riskier polymethyl methacrylate beads – has been acceleratedby celebrity endorsements from the likes of the Kardashian clan. The removal and subsequentreturn of Kylie Jenner’s lip fillers have been followed with particular interest. Some doctors tryto capitalise on this with “the Kylie package” for nose, jaw and lips, says Taktouk,

Images from the Facetune2 app, showing how it can changesomeone’s appearance. Photograph: Facetune

disapprovingly. Ten years ago, his clients were deeply concerned with patient confidentiality;“Now, it’s ‘Do you mind if I Insta-story this?’ It’s not taboo any more.” He has seen lipsadvertised for £150 and noses for £200-£300. “And that’s one of the trickiest procedures of thelot.”

Fillers may be less invasive than surgery, but they are not without their risks, which rangefrom uneven results and infection to vascular blockages and even blindness. Save Face, theUK’s largest register of accredited practitioners of non-surgical treatments, says almost 1,000complaints were made in the year to October. Yet there is little regulation and no minimumage. “We have more protections for houses than we do children’s faces,” says Esho, who hascampaigned for crackdowns. “It’s crazy.”

Even Marla – who documented her follow-up nose job in a short film for Vice, and does paidpromotional work for cosmetic surgeons – says she would not encourage a young girl to do asshe did. “I know that I love myself – that’s why I let myself get little tweaks – but it would reallybother me if a young girl told me that she didn’t.”

Taktouk refuses to treat anyone younger than early 20s, but he says he has been contacted by16- and 17-year-olds, sometimes for “preventative Botox” (“They haven’t even done A-levelsyet”). Invariably it is via Instagram, where a reported 60% of users are aged between 18 and 24.The platform has become a marketplace for cosmetic procedures, with doctors showcasingtheir before-and-afters.

The process is as easy as “click-click-click, look at 10 bits of his work in the space of a minute,wow, let’s contact him”, says Anika. At the age of 20, she turned up at Taktouk’s clinic withphotos of noses he had done and a video of herself with a Snapchat filter. “You know the onethat kind of makes your face look like an alien’s? I was like, ‘This looks great – my nose looks somuch smaller.’ Dr Taktouk was like: ‘This is not what is going to happen with filler.’” Shelaughs. “He told me to come back with my mum.”

Instead, Anika took a year out to consider her decision, weighing up fillers’ merits againstsurgical rhinoplasty. “Actually, I went through a phase of thinking, ‘No, I should try and lovemyself.’” How did that go? “I didn’t do rhinoplasty,” she says drily. “I guess that’s as far as I

Snapchat’s novelty ‘augmented reality’ filters enlarge the eyes andsmooth the skin. Photograph: Elle Hunt/The Guardian

got.” By the time she returned to Taktouk’s clinic, aged 21, she had been brought “back downto earth”. He injected filler into the tip of her nose, evening out its line. She loved it instantly.“I feel like I just needed that to change me inside, so I could stop looking for perfection.”

When the filler eventually breaks down after about a year, she will repeat the procedure. “Themost beautiful thing is when someone is happy from within,” she says; “as ironic as it sounds”,her new nose helped her to attain it. “I’m not itching to get anything else.”

There was a moment just after the procedure, though, as she was admiring her new profile,when she wondered aloud if her lips needed filling, too. They were one of her most prominentfeatures; she had been called Fish Lips at school. Taktouk told her to stop being silly. “Whenyou’re in that seat, it’s quite tempting,” she says. “Like, ‘What else can I do?’”

There is an obvious danger in trying to measure up to images when they are so far from reality– or even consistency. Non-filtered selfies are flipped, front cameras produce different resultsfrom back cameras, and there are even marked differences between models of phone. Just thedistance from which we typically take selfies has a huge effect. A 2018 study found that aportrait taken from 30cm (12in) away rather than 1.5m (5ft) increases perceived nose size byabout 30%. And that’s without the distorting effects of lighting and even makeup.

It prompts the question: which are you trying to correct, the image or the reality?

Anna, 40, from Malvern – another patient of Taktouk’s – admits to having once been “fixated”on her laugh lines. “The photos exacerbate it, making it look worse, then a filter can make itlook amazing. You’re unsure of what you look like.”

Ever since she was young, she has struggled with the discrepancy between how she seesherself in the mirror, and how others see her. Once, she downloaded an app that claimed “toshow you how you really look”. “It used to horrify me, and make me feel terrible about myself.But these are conversations you can’t really have, because you do sound self-absorbed andyou’re leaving yourself vulnerable.”

A 2018 study found that a portrait taken from 30cm away (top)increased perceived nose size by 30% compared with one takenfrom 1.5m away (bottom) Photograph: Linda Nylind/The Guardian

She is more self-confident now, which she attributes both to age and the occasional self-esteem boost of Botox or filler. “I’m quite realistic now, whereas in the past I’ve driven myselfcrazy.”

For Taktouk, referrals from social media make it harder to safeguard patients’ mental health.His background as a GP has helped him to spot red flags, such as badmouthing other doctors,insisting on flaws that aren’t there, and in-depth knowledge of treatments: “I’ve had someonecome in here and draw the lines on their face themselves.” But, he adds, “I’m sure some willhave slipped past without me realising” – and even if Taktouk refuses to treat them, someoneelse will.

Over the weekend it was reported that Superdrug (which began offering Botox late last year)has agreed to introduce mental health screening for people seeking Botox, following criticismfrom the NHS for not conducting “medically responsible” checks. Taktouk says far moreindustry-wide regulation is needed, before there is a headline-grabbing tragedy and appsbecome even more transformative. He points to one called Retouch Me, which superimposessix-packs on to swimsuit pictures. “I saw it and thought, this is the new wave of what we’regoing to get in: ‘Make me look like this.’”

Seeking unnecessary and unrealistic cosmetic procedures in fact supports a diagnosis of BDD,present in 2% of the population (and equally common in men and women). Dr Neelam Vashi,co-author of the American article that linked BDD to selfie dysmorphia, says further study isneeded to establish whether intensive selfie-taking could trigger BDD – but it does resembleone of the main four diagnostic criteria: compulsive mirror-checking and other repetitivebehaviours and thoughts.

The onset tends to occur in adolescence,though people with the condition may notseek help until 10 years later. The generalrule, says Professor David Veale, a consultantpsychiatrist at the Maudsley hospital in southLondon, is that you can “think about yourappearance for an hour a day before itbecomes a disorder” – but for a diagnosis, itmust be accompanied by significant distressor inability to function normally. People withBDD take selfies because they are convinced“that they are hideous”.

In 2014, then 19-year-old Danny Bowman from Northumberland was reported to be “Britain’sfirst selfie addict” after being interviewed about his experience of BDD. His problems hadbegun four years before, when he was rejected by a modelling agency at the same time as hewas being bullied at his new school and on Facebook. “For me, it was confirmation that I didlook ugly.”

Bowman was soon spending hours before the mirror, slathering himself in acne cream andmoisturiser and monitoring a steady stream of selfies for real-time improvement. After threemonths he dropped out of school, and the selfie-taking increased to hundreds a day. “I wastrying to see some gradual improvement, and take that photo that I was pleased with. I wasjust trying to get that relief, and I couldn’t get it. There wasn’t a perfect photo. There isn’t aperfect photo.”

A lip filler procedure. Photograph: Alamy Stock Photo

After six months of being housebound, consumed by his daily rituals, he tried to kill himself.“A lot of people say looking at themselves in the mirror probably makes them feel insecure, butimagine scanning through 200 pictures a day. I was just exhausted. I felt like there was no wayout.” His mother – like his father, a mental health professional – found him in time and he wasdiagnosed with BDD. Part of his 12-week treatment involved restricting access to his phone.

Now 24, Bowman is studying at the University of York and campaigns on issues related tomental health and positive body image. He has raised concerns about the impact of Instagramwith friends he sees “posting photographs of themselves every other day, Facetuningthemselves, making themselves look unlike the way they look. That was me, but on anamplified scale.” They have reacted defensively, he says. “It has become such a normal thingthat people don’t see what they’re doing as abnormal.”

He very rarely takes selfies now. “I just don’t feel the need to do it.”

• The Body Dysmorphic Disorder Foundation can be found at bddfoundation.org

• In the UK the Samaritans can be contacted on 116 123. In the US, the National SuicidePrevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 1114. Other international suicide helplines can be found at www.befrienders.org.

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