The Journal of the American Medical Association has identified a new disorder: "Snapchat dysmorphia." It describes people — usually young women — seeking plastic surgery to make themselves look the way they do through filters on social media apps like Snapchat and Instagram.
Here & Now's Robin Young talks with plastic surgeon Matthew Schulman about what he's seen in his practice.
On how body dysmorphia disorder is defined and how plastic surgeons look for it
“Body dysmorphia disorder is a recognized mental health condition, where people become obsessed about a perceived imperfection of their body. The key with BDD, or body dysmorphia disorder, is that that imperfection is usually only seen by the person, and it doesn't really become obvious to other people, so we're talking about someone who looks pretty good and is obsessed, because they think that there's something wrong with them that other people can't see.
"These are the exact patients we don't want, because nothing that we can do surgically is going to make them feel better about that body part, because there's really nothing wrong with the body part."Matthew Schulman
“As a plastic surgeon, we are trained obviously in surgery, but we also have a lot of training in recognizing people with BDD. These are the exact patients we don't want, because nothing that we can do surgically is going to make them feel better about that body part, because there's really nothing wrong with the body part. So, we're very in tune with BDD and try to pick up on signs that a person may have this disorder when we first meet them in consultation.”
On social media's effects on plastic surgery
“One thing to keep in mind is social media is here. This is what everything's about in 2018. The filters that are available on social media, such as Snapchat and Instagram, give people a really easy way to change the way they look, and we're not talking about someone coming in with a silly rabbit filter, where they look like a rabbit and [say] make me look like a rabbit. We're talking about people that are using these filters that make their skin look smoother or make their nose look a little smaller or make their eyes look wider.
“That's the thing that people are bringing into us to kind of show us what they want to look like, which on the surface, is really not unhealthy. Right? It's just a way for someone to illustrate to the surgeon what their expectations are.
“To some extent, it's actually a good thing, and we like it. It's when people take it a little too far and they fail to recognize what they actually look like, because they think that the filtered appearance is their real appearance.”
"If someone comes in and they really want to look like a like a deer or a rabbit or a dog with their tongue hanging out, clearly that's a problem. "Matthew Schulman
On the pros and cons of social media in relation to plastic surgery
“If someone comes in and they really want to look like a like a deer or a rabbit or a dog with their tongue hanging out, clearly that's a problem. But, there are ways that we can we can kind of give the changes that they may like. Such as, a little bit of botox around the eyes can make the eyes look a little wider. If they bring a filter where their nose looks smaller, that may be a patient that is a good candidate for a rhinoplasty procedure. They are using that filter to show us what their ideal nose would look like.
“It's kind of a slippery slope: It can be very dangerous, but there can be some positives if it's used the right way.
“One thing to keep in mind too is if you think back to years ago, in order for people to change their appearance in a picture, they had to be very skilled, they had to use things like Photoshop and some softwares that you really had to know what you're doing. With Snapchat and Instagram, with one swipe, the average person can just morph their face into something different, so it's so easy for people to change their picture.”
On the suggestion that some people become so attached to their Snapchat-filtered appearance that they don’t want to be seen any other way
“As plastic surgeons, this is really kind of nothing new to us, because these are the things — like I was talking about at the beginning about body dysmorphia disorder — that we're aware of and we look for signs of it. People that come in and exhibit unrealistic expectations or signs of a true dysmorphia, those are people that we clearly won't operate on, and those are people that should be referred for psychiatric evaluation to help them, as opposed to having a surgical procedure done by us.
“Those are things that we should look out for, and in the plastic surgery community, this has been around for 40, 50 years, we've known about. It's just now that you kind of add the social media aspect to it and the Snapchat dysmorphia term, the public might becoming more aware of this.”
On how Snapchat dysmorphia is being treated as a legitimate disorder, and how plastic surgeons respond to teenagers who want surgery
“It's a recognized psychiatric disorder, but obviously, I just want to be clear that not everyone that wants to change things about themselves has dysmorphia, but clearly we need to define those people so that we can get them the help they need, and also, we don't operate on them, because it's not going to make them feel better about themselves.
“As a plastic surgeon, I don't operate on young people. Now, there are people that do rhinoplasties, and nose jobs are commonly done on young people, but there is an age limit. Usually people wait till the child is about 16 years old, so their nose has grown into their face and we know that physically there's no more changes. In that situation, the teenager would need to have parental permission, so there is kind of established guidelines for that.
“But no, if someone comes in who's 17 years old, and she says, ‘I want my eyes to look wider, and I want my lips to be plumper,’ nobody's going to do anything on that person, nor should they.”
On whether plastic surgeons ever tell people they should seek psychiatric help
“We say it all the time. It's really important to select our patients appropriately, based on the physical characteristics and also the psychological characteristics of each patient, so about 25 percent of the people that come to me for any type of surgery, I turn down, because either I don't think psychologically they're quite right for the procedure, or physically they're not quite right. So, it's very common to send people away and say that, ‘You need help, and it's not help from a surgeon,’ and refer those people back to their primary doctor for psychiatric consultation.”
This segment aired on August 29, 2018.