Researchers now are cautioning that patients interested in cosmetic procedures should not turn to self-photographs as guidance when considering making changes to their faces.
"Patients, people, even my family have to be aware that if you're taking a selfie, it's not really how you look," said Dr. Boris Paskhover, a facial plastics and reconstructive surgeon at Rutgers New Jersey Medical School and a leading author on the study.
"Selfies make your nose look wider and thicker when it really isn't, and people like a smaller nose," Paskhover added. "My fear is that the generation out there now doesn't know. All they know is the selfie."
Selfies have quickly become emblematic of our time, thanks in part to the popularity of social media sites such as Facebook and Instagram. Within its first year of existence, Google Photos saw more than 25 billion selfies uploaded onto its servers, according to Anil Sabharwal, vice president of Google Photos.
To put that into perspective, there are about 8 billion people living on the entire planet.
The selfie phenomenon might be causing people to engage in surgeries based on photographs that distort their features, Paskhover says.
According to a 2018 poll conducted by the American Academy of Facial Plastic and Reconstructive Surgeons, 55% of surgeons reported having patients who said they were seeking cosmetic procedures to improve their perceived appearance in selfies or other photos posted on social media in 2017, up from 42% in 2016.
The JAMA study relied on data from the National Institute for Occupational Safety and Health to approximate the facial dimensions of individuals from a variety of racial and ethnic backgrounds in the United States. Using mathematical modeling, the researchers found that photographs taken at a distance of 12 inches increased nose size by 30% in men and 29% in women compared with photographs taken at an infinite camera distance.
Photographs taken at a distance of 5 feet from the subject were not shown to significantly distort nasal dimensions.
"At 5 feet, the distance between your nose and the camera and the distance between your facial plane and the camera is almost the same," Paskhover said. "Because the difference is very small, the nose doesn't get skewed."
In 2017, there were about 17.5 million cosmetic surgical and minimally invasive cosmetic procedures performed in the US, a 2% increase from 2016 and a 200% increase from 2000, according to a report released Thursday by the American Society of Plastic Surgeons.
Of these procedures, 218,924 were nose-reshaping cosmetic surgeries.
"Overall, cosmetic surgeries are up again," said Dr. Jeffrey Janis, chief of plastic surgery at the Ohio State University Wexner Medical Center and president of the American Society of Plastic Surgeons. "They have trended up over the last several years, and they continue to grow.
"I think we are all aware of the power and influence of social media on cosmetic plastic surgery," Janis added. "People are sharing images in real time in large numbers with people that they know and, in some cases, with people that they don't."
Nose reshaping, or rhinoplasty, was the third most common cosmetic surgical procedure in 2017. It typically costs $6,000 to $15,000 per procedure, according to Paskhover.
Breast augmentation was the most common cosmetic surgery performed in 2017, accounting for over 300,000 procedures. Liposuction, eyelid surgery and tummy tucks were also among the top five cosmetic surgical procedures performed last year, according to the report.
"I think people also feel more unencumbered, more free, to talk about plastic surgery in a way that doesn't carry any sort of social stigma," Janis added. "But I definitely think that there's been a lot of interest because of selfie culture."
Rhinoplasty and other forms of plastic surgery are generally considered to be safe, but as with any surgical procedure, there are risks involved. Complications such as infection, poor wound healing and skin discoloration still occur in a small number of cases, according to the American Society of Plastic Surgeons.
But the biggest risk is a disconnect between the patient's expectations and reality, according to Janis.
"The biggest risk in my mind is actually more around levels of expectation," he said. "You need to make sure that, number one, the patient is an appropriate candidate, and number two, you have a very thorough conversation with the patient about having appropriate levels of expectation about what can be delivered."
Both Janis and Paskhover also emphasized that finding a well-trained, board-certified plastic surgeon is an important factor in the success of any cosmetic procedure.
"The biggest risk I see with rhinoplasty is that if you go to someone who's inexperienced, aesthetic outcomes are variable," Paskhover said.
"It underscores the importance of public safety," Janis said. "You don't want somebody who didn't get the necessary training and doesn't operate in an accredited facility to be operating on you."
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