Defining the road ahead for plastic surgery: Social media beauty standards challenge what is realistic, AO CMF panelists say

It seems the mirror—once the arbiter of physical attractiveness—has lost its magic in an age when social media clicks, follows, likes, shares and retweets shape global beauty standards. AO CMF faculty members Amir Elbarbary, Alberto Rocha Pereira, and Ana Catalina Tobón weigh in on how social media influencers are defining the road ahead for plastic surgery.

There’s no denying that social media has an impact on beauty standards, whether the quest is to have the impeccably contoured cheekbones of businesswoman and Instagram beauty Kim Kardashian or her sister Kylie Jenner’s plump lips.

“People come in and they’re prepared,” says Elbarbary of the patients who come to him for aesthetic surgery consultation. “They understand what is going on. That’s what’s positive about it from social media—they are so well-informed.”

Among the trends in plastic surgery is patients arriving for consultation with high expectations—and photos of the celebrity features they want replicated on their own faces.

“What patients often don’t understand is that there are several variables that may affect the outcome of plastic surgery procedures that are not shown in those photos. There’s a lot behind that look,” he explains. “And when [patients] have those high expectations, you need to help them think more realistically. When people come in showing a photo of an actress and saying, ‘I want my nose…’ or, ‘I want facial features similar to this,’ that’s where patient counseling is important because every person has his or her particular features. Maybe the nose the patient wants won’t fit with his or her facial features, so everything has to be put in perspective.”

No ‘magic recipe’

Tobón, a maxillofacial surgeon in Medellin, Colombia, experiences the same phenomenon on the other side of the world.

“In Colombia, being beautiful is still very highly esteemed—being successful is related to beauty,” she says. “It’s pretty common for patients to come to my office asking to look like [a person they’ve seen on social media]. That’s a pretty difficult thing to manage because—for one thing—the pictures they’ve seen probably involve a lot of Photoshop. And then there is the reality and how we can address that as surgeons. We don’t have a magic recipe to ‘make’ noses or eyes. That depends on the tissues and many other factors.”

Pereira, a plastic surgeon practicing in Lisbon, Portugal, sees two main problems in his patient consultations.

“The first is that people are always trying to include photos during the consultation, while we were taught since we started in medicine that we should always start with a complaint. Nowadays, people come in with a photo, but they have no complaint. They don’t have any particular feature that they want to try to change with surgery or treatment, but they ask to look like the photo. That’s not a good way to start the consultation—with the surgeon trying to think of what to do to help that patient,” he says.

Elbarbary interjects that another problem is patients asking the surgeon, “What do you see wrong with my face?”

“This is not a question you would ask your physician or surgeon because, as Alberto says, you need a complaint. What is your complaint? What do you want to change? and most importantly Why?” he notes.

“Because most of the time, we don’t need to change anything in the person’s face,” Pereira adds. “You don’t have a diagnosis and a treatment for that diagnosis. The patient is completely healthy, but they want to be more perfect in some sense in a particular feature. So, we need to start with that and then see if we are able to change it.”

‘Simply impossible’

But social media beauty standards often are not realistically achievable: It’s easy, Pereira says, to alter a photo with software; it’s not so easy to alter a human face with surgery.

“It’s simply impossible to do to the human face with surgery what a computer program does to a photo,” he emphasizes. “Even with recent technological advances that predict the impact of moving a bone, the soft tissue response to that is totally different.”

“And what is harmony, really, and how is it related to beauty?” Tobón asks. “There is the point of view that there is a balance, but there are several. Everybody wants to look exactly the same, right? But what is considered beautiful in Portugal may be different than what is considered beautiful in Colombia or in Egypt. This globalization of beauty by let’s say jet-set stars—I don’t know what to call them—is that they pretend to standardize beauty worldwide. That’s impossible. We all have different genetics and beauty is about balance in the end. That’s what I try to explain to my patients, but it’s difficult to explain that they can have a little bit better balance of facial features without evening looking similar to Kim Kardashian.”

Shifting beauty standards

Balance is good, Elbarbary points out, but exact symmetry is both unnatural and impossible for the most accomplished surgeon to achieve.

“Minor asymmetries reflect beauty. If you were perfectly symmetrical, you would look different,” he says, citing studies indicating that asymmetry contributes to an attractive face—and what’s attractive today may not be attractive a decade from now.

“It is absolutely crucial to have that deep discussion with the patient. We need to understand the patient’s expectations and to truly understand the complaint—and what the patient wants from the proposed change, how effective we can be in achieving what the patient expects, and whether the change is needed in the long term,” Elbarbary says.

Drawing the line

Pereira says he draws the line at operations or treatments that he believes are based on unrealistic expectations.

“When I see that, I try to move the patient away from that treatment and try to explain that those expectations are not realistic,” he says. “For aesthetic surgery—and it’s the same for other surgeries—there are two people who should be in full agreement on the treatment: One is the patient, and the other is the surgeon. Every time I have a patient trying to push me toward something I feel will not be a good option for him/her or where I will not be able to fulfill his/her expectations, that is the point where I stop. And, of course, I tell the patient that he/she should ask for another consultation, another opinion.”

Indeed, Tobón says, some surgeons are contributing to the problem.

“Some of us contribute a lot by showing before and after photos of patients—like a compromise that I can’t give you exactly the same results,” she explains, noting when patients ask her to share before and after photos of her patients, she educates them about both patient confidentiality and—second—she explains the reasoning behind her surgeries. “I’m an oral maxillofacial surgeon, but it happens all the time that patients are more focused on the beauty trend of full lips than fact that they have a malocclusion after the surgery. They don’t care about occlusion in the end.”

Seeing such before and after photos can lead prospective patients to think, ‘Oh, I want this. Oh, yes, but this nose is better than the other one,” Tobón says.

Looking to the future

All three panelists have some trepidation about the future of social-media-inspired beauty standards.

“I’m afraid that the way we are walking is toward globalization [of beauty]. What I feel is that, in the future, people will try to become more similar to their ideals,” Pereira predicts.

“I’m afraid that people will rely maybe on artificial intelligence to tell them what they should look like, and that is scary,” Elbarbary forecasts.

“When this happens—when we are trying to have fox eyes or prominent molars like an alien and that’s the cultural standard, it will be very difficult to go back,” Tobón says. “I think that this is going to stay and probably get worse.”

Pereira says there will always be surgeons willing to perform the surgeries people want—and those patients will be appealing because they will require multiple surgeries and treatments.

“They will become good clients for those surgeons who are open to doing what they want,” he says. “So, it will be difficult to stop it.”

Ultimately, there are some things that a surgeon cannot “fix,” Elbarbary says.

“For example, a 45-year-old person comes in and wants to fix her nose. I can see the deformity in the nose; it’s obvious. But she lived with it for 45 years and accepted it,” he says. “So, there is something you need to look deeper into: why that person wants the nose job right now. And if you dig deeper, you’ll see that it’s not about the shape of the nose. Even if you give her the perfect nose, when she looks in the mirror, she won’t recognize herself and she will be very upset because the surgery didn’t address the underlying issues motivating her to pursuit it."

“Try to find the real reason why the person is trying to change something about their face,” Pereira advises. “Otherwise, it is probably an emotional thing, and you will not solve it with surgery, of course.”