Social media is adding a new twist to an old problem. "Snapchat dysmorphia" is making headlines as plastic surgeons see people wanting to change their appearances to more resemble how they look when using photo filters. But while the filters are new, the desire to attain an unrealistic goal through surgery is not.
"Body dysmorphic disorder (BDD) is a very real and concerning diagnosis," said Dana Johns, MD, a plastic surgeon with University of Utah Health. "'Selfie' or 'snapchat' dysmorphia is essentially the new age social media upgrade to a long-standing disorder."
The very nature of social media makes it a gateway to BDD. On every platform posts are "liked" or "shared" as a means of approval - and it can be easy to get carried away seeking this attention. It also can be very easy for others to provide negative feedback very quickly. Both the positive and negative interactions could fuel BDD.
"The social media age in which we live in puts an entirely new level of expectations on this generation on how they should look," said Johns. "The desire to accumulate 'likes' and the damaging effects of negative feedback on social media posts are something, as plastics surgeons and as a society, that we should be aware of and understand the ramifications of these internet interactions."
We all have things we don't like about the way we look. But people with BDD become obsessed with what they feel are flaws. They may spend hours scrutinizing themselves every day, and even isolate themselves because of concerns about their appearance. In some cases they seek surgical interventions to fix their perceived problems. "BDD is a mental health disorder," said Johns. "As such, is better treated with therapy and potentially medications - not surgery."
Because BDD is not best treated by surgery, it is important for plastic surgeons to have a lengthy conversation with prospective patients before proceeding. "I ask them what they dislike, why they dislike it and how long they have been thinking about cosmetic surgery," said Johns. "Usually during the course of the initial evaluation, the reason for wanting the surgery comes out."
What a patient wants changed isn't the only matter to be discussed - it's also important to discuss how they want it changed. After all, there are things plastic surgery can do - and things it can't. "I have a frank discussion about what the realistic limitations of surgery are, what can be accomplished and what they can expect from the final results," said Johns. "If I feel that their expectations aren't achievable, I relay this and tell them why they can't be accomplished."
If the patient and surgeon decide that it is wise to move forward with a surgery there are other expectations that have to be managed. As with any surgery there will be pain. There also will be scarring - even if it's minimal. There will be a recovery period - which will differ in length depending on the surgery. Also, the results of the surgery will not be immediate. "It can take a long time to heal completely and get the final results of your surgery," said Johns. "Depending on the type of procedure it can take six to 12 months to see the final result."
The most important thing to know for anyone grappling with their appearance or considering plastic surgery is that perfection is not possible. It's not possible because it doesn't exist. Chasing it - due to magazine pictures or a photo filter that gives you freckles and a smaller nose - will be fruitless.
"Perfection is perception. Perception is relative," said Johns. "No two people's idea of perfection is the same. Fernando Pessoa, Portuguese poet and philosopher said it best: 'We worship perfection because we can't have it; if we had it, we would reject it. Perfection is inhuman, because humanity is imperfect.'"
