Under the influence: The effects of social media accentuating unrealistic expectations of beauty (2023)

“Over 30 per cent of my clients come with visual references of social media influencers to demonstrate the look they’d like,” award-winning cosmetic doctor Dr Esho tells us. He specialises in non-surgical procedures using Botox and dermal fillers, with famous faces such as Love Island contestants on the receiving end of his needle. “We have a large group of patients between the ages of 25 and 35 who are most connected to social media trends.” Many are concerned with recreating a more filtered version of themselves in reality; the ideal often being a highly-symmetrical, contoured doll-like look.

While looking like what we perceive to be ‘our best’ may be a natural part of living in our society, social media is propagating and accentuating unrealistic expectations of beauty, globally renowned lecturer and leader in pioneering research on Body Dysmorphic Disorder (BDD), Professor Marcos Sforza, tells Bazaar.

The expert aesthetic surgeon and scientific director at MyBreast Cosmetic Surgery explains that with advancements in photo-editing software, the easily influenced amongst us “are at risk of losing touch with reality, internalising the expectation that we are supposed to look like a perfect, filtered, edited version of ourselves all the time”.

That’s exactly what Dr Esho is seeing in his chair. “There’s now more of a focus on a social media ideal of beauty (that is, how you look on your social platform) rather than how you look in real life,” he explains, although in many ways to achieve this in reality would be impossible.

Of course, the seemingly candid portraits and casual selfies filling our feeds are not often as they seem. “The social media ideal is usually a combination of non-surgical treatments, make-up, lighting and filters,” Dr Esho says. While some of this is obvious, some – like with ‘good’ cosmetic work – really isn’t obvious.

Naturally, when some of us who aren’t being photographed (or taking selfies) for a living struggle to achieve anywhere near the perceived perfection in pictures of those we follow, feelings of inadequacy can flood. While taking pictures of yourself isn’t bad, and can even boost self-confidence, “obsessing over the way you look in a 2D image can trigger symptoms of poor body image,” Professor Sforza confirms. Additionally, new stats from the Mental Health Foundation found that 22 per cent of adults and 40 per cent of teens say images on social media cause them to worry about their body image.

Beyond a case of dissatisfaction or ‘compare and despair’ syndrome, selfies and social media can cause concerns about how we look to become real mental health issues.

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When comparisons become obsessions

Dr Esho coined the phrase ‘Snapchat dysmorphia’, describing surgery requests based upon social media filters, which he feels is influencing the industry on a global scale. “My concern is that if we don’t do more to address mental health in young patients the social pressures on young patients will increase and ‘Snapchat dysmorphia’ won’t just be a phrase, but will become a legitimate condition of its own, such as body dysmorphia.”

Professor Sforza says, “As a cosmetic surgeon, a clear red flag for us during a consultation is when images become a reference point for a patient. When things like Snapchat filters become how the patient sees themselves, or the patient wants to look exactly like that image, that is when there is a significant cause for concern.

“These unrealistic expectations, combined with the fact that extensive research shows social media does appear to be correlated with body image concerns – may explain the emergence of serious mental health conditions like BDD.”

According to the NHS, Body Dysmorphic Disorder is medically defined as a mental health condition where a person spends a lot of time worrying about flaws in their appearance. These flaws are often unnoticeable to others. It can affect people of any age and gender but is most common in teenagers and young adults.

Counselling psychologist Dr Silver – lead therapist for eating disorders at Nightingale Hospital – who treats patients with BDD tells us, “It is worth noting that it is ‘normal’ to dislike some aspects of your appearance but in people with BDD this preoccupation interferes with a person’s ability to function.”

How to spot signs of BDD

“It is important to realise that with BDD the person has either a very slight ‘defect’ or a non-existent ‘defect’, so you will not be able to see what is causing them to be so preoccupied,” Dr Silver says.

She notes that signs of BDD include (but aren’t limited to), “spending a lot of time being preoccupied and worried about your appearance; spending a lot of time negatively comparing yourself to others; looking at yourself in the mirror for long periods of time and focusing on specific ‘flaws’ or avoiding mirrors altogether because you think that you are ‘hideous’ and ‘ugly’; avoiding certain situations for fear of being judged by others; and trying to hide your ‘defect’ for example by wearing a lot of make-up”.

BDD is a serious but treatable mental illness, with the National Institute of Clinical Excellence (NICE) recommending Cognitive Behaviour Therapy (CBT) and Selective Serotonin Reuptake Inhibitors (SSRIs) for treatment. “A GP is a really good place to discuss concerns and treatment options,” Dr Silver says. “There are also websites, books and self-help groups that offer information and support for people with BDD.”

In addition, social media can be helpful – when used in the right way. “There are some very supportive social media sites that can offer support and hope to those suffering from appearance anxiety.” However, as we know, social media sites also have the potential to fuel insecurities by encouraging them to compare themselves to others. “I would advise people to think carefully about who they follow on social media and to ensure that they follow a mixture of people including people who they admire and respect for reasons unrelated to their appearance,” Dr Silver advises.

The ‘right’ reasons for aesthetic procedures

For anyone with BDD, cosmetic interventions are advised against strongly. Dr Silver explains: “Research has shown that many people with BDD are very disappointed with the results of cosmetic procedures which can further increase distress and shame. Even when people with BDD are pleased with the cosmetic procedures, often their distress shifts to other parts of their appearance.” BDD is a mental disorder and not a physical problem and so psychological treatment and not physical treatment is key.

Still, where BDD isn’t present, other mental health issues can play into the motivation for seeking aesthetic procedures, be they surgical or non-invasive – and when this is the case a makeover probably won’t help.

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“Aesthetic treatment in the right hands on the right patient really can change lives and boost confidence,” Dr Esho believes, “but I do think the opposite can happen when the motivation is due to either an underlying mental health problem, or to please someone other than themselves – in that scenario the answer will never be the doctor’s needle.” Or knife, for that matter.

Dr Esho says he has refused to treat patients “several times” out of worry for their mental health, which is happening “more and more recently”. He says “this shows the problem we are having in the UK with mental health in young people.” But the key isn’t just to say ‘no’, “but to counsel the patient as to why it’s a ‘no’, and to help them get the correct support they need”.

How the cosmetic industry can help

“The key is always the consultation,” Dr Esho says. “During this process you can note any verbal and non-verbal cues that can flag concerns. Also, as a doctor you're trained to ask specific questions and assess responses that will give your more of an indication. In most cases it’s a patient that has been to several clinics and has never been happy with that outcome and on further assessment and examination, it’s a disproportionate concern with how they look to what you see.” This is why seeing a doctor, (over a beautician who is trained to administer fillers, for example), is considered advisable – and, in this partly-unregulated industry when anyone can legally inject fillers, everyone needs to take responsibility.

“I believe all industry professionals involved in cosmetic and aesthetic procedures should be vigilant and closely follow the latest GMC guidelines,” says Professor Sforza. “These highlight that all industry professionals must give patients time for reflection and that they need to have the information about risks, to decide whether to go ahead with a procedure. For example, surgeons should implement a 14-day cooling-off period before any surgery is carried out,” he explains.

He also believes that a key issue is psychological education, specifically BDD, not being a prioritised point of study on many cosmetic or aesthetics courses, so when individuals move into their chosen professions, they may not be educated enough to know how to screen out patients with the condition. When it comes to surgeons, he believes “more compulsory psychological training should be provided at education level”.

Beyond advanced mental health awareness training for professionals, Professor Sforza recommends the introduction of formal screening tools in all clinics with psychiatric questionnaires utilised. This is something that high street retailer Superdrug has recently introduced as part of the in-store service of injectable procedures.

“If any professional in the beauty industry is unsure about someone’s psychological wellbeing during consultations, all potential patients must be referred to a psychologist or psychiatrist for further evaluation. Of course, care should be taken to ensure the patient fully understands why you are referring them and how seeing a specialist will benefit their overall mental wellbeing and potentially dealing with their surgical outcome,” Professor Sforza adds.

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Staying head-strong on social media

It may seem obvious, but when appearance anxiety increases with social media usage, it’s worth taking a step back and checking in with how “social media literate” you are, Dr Silver says. “By this I mean that it is important to understand that often people will modify their images to present a particular image of themselves and their lives. Often these ‘perfect’ images can fuel unfair comparisons and lead to dissatisfaction.” Unfair, being key to remember. Think: did you worry about a physical issue pre-selfies and social media?

She recommends that people set limits on the amount of time that they spend on social media and ensure that they do not check in at times that they are feeling particularly anxious about their appearance.

“I would encourage people to not to seek their validation from being on social media, but to seek validation and pleasure in other ways such as by participating in activities that they enjoy and spending time with people who make them feel good about themselves.”

Helpful, happy Instagram accounts

Curate a positive space with your feed following these accounts that celebrate beauty- and body-positivity, and help you live more #comparisonfree.

@lucysheridan (The Comparison Coach) thinks that social media and technology has caused a comparison epidemic, and offers online classrooms to help those suffering.

@iskra a.k.a. Iskra Lawrence is a hugely successful model and influencer who overcame body dysmorphia and eating disorders to becoming the poster girl for positivity.

@alexlight_ldn is a fashion and beauty editor-turned influencer whose focus is body positivity. She helped launch the successful body image campaign (#HeartNotHate) alongside Lawrence.

@julesvonhep is a spray tanner on a mission to make you feel better about your body. The man behind self-tan brand, Isle of Paradise also co-hosts Wobble, the life-affirming podcast discussing body confidence and happiness in a very real, relatable way.

@effyourbeautystandards, founded by model, blogger, and make-up artist @tessholliday and run by a body positive collective, will help shift your expectations of beauty.

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