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How Social Media is Impacting Cosmetic Surgery Culture and Disordered Eating

It's affecting a lot more than just contouring.
Call it the Kylie effect. Photo: Kylie Jenner/Instagram

Call it the Kylie effect. Photo: Kylie Jenner/Instagram

For those of us who grew up with after-school specials and the '90s self-actualization craze, the term "self-esteem" probably brings to mind hugging sitcom families and participation trophies. Or, perhaps, the seemingly endless talk show arguments about those participation trophies: Are we breeding a generation of special snowflakes; how can we expect kids to achieve if we reward underachievers; won’t somebody think of the children? In fact, pretty much since the term "self-esteem" first graced the public discourse, every major pop-culture moment has come laced with a discussion of how this celebrity or that fashion trend or such-and-such album affects how we see ourselves. And now, social media has come under the same scrutiny. 

The Instagram Aesthetic

Instagram eyebrows, rainbow hair, contouring, strobing: Take a look at the hottest beauty trends from the past five years, and odds are you'll find a YouTube star or hot Instagram craze behind it, along with plenty of mixed feelings. "Social media is the worst thing that's ever happened to the beauty industry," celebrity makeup artist Pati Dubroff told The Cut in an interview earlier this year, citing a proliferation of sameness as the result of an Instagram-obsessed culture.

That sameness has revolutionized the industry in some ways, leading to influencer-curated collections for major beauty brands and a monetization of social stardom that the business side of the industry has struggled to keep pace with. Likewise, the debate has raged on about what, exactly, that does to fans of these media mavens; whether the fetishization of a particular look is damaging in creating a false dichotomy — the right way to look vs. every other way.

There is, of course, a certain amount of beauty elitism at play in these arguments. Beauty stars on social media haven't followed the paths of traditional makeup artists, working their way up from the assistant's assistant's assistant; in fact, many of them have no formal training at all. For those who have come up in the classic hierarchy, accepting these young influencers' rise to fame can be a challenge. But social media has also opened up the industry to voices that might not otherwise have been heard: those without the freedom to work for the little-to-no pay of entry-level makeup artist positions, those who don't live in the cities where fashion weeks and editorial shoots are de rigueur, those who don't fit the industry's traditionally narrow view of what beauty looks like. In an industry that has been slow to embrace diversity, and where most beauty contracts still go to young, white, thin, cis women, some argue that circumventing the status quo entirely is the only way for society's narrow definition of beauty to expand.

The Social Media Effect on Cosmetic Procedures

Of course, the beauty discussion doesn't begin and end with makeup. Before Kylie Jenner could build a successful cosmetics brand, the star's mouth got famous on its own, as rumors circulated for months before Jenner finally confirmed that, yes, she'd had lip injections. Interest in the procedure spiked: RealSelf, an online resource dedicated to reviews and research on cosmetic treatments, estimates that interest in lip augmentation has risen by 19 percent year over year.

Hyaluronic acid fillers, like those used in lip injections, also represent a growing segment of non-surgical cosmetic procedures. Interest in CoolSculpting — a fat-cell freezing procedure — has risen 29 percent over the past year according to RealSelf; and non-surgical nose jobs, in which a temporary filler like hyaluronic acid is strategically injected into the nose to subtly alter the shape, are up 20 percent in interest since 2015.

Plastic surgeon Dr. Dara Liotta has seen more patients requesting these non-surgical options, which she believes are gaining popularity among the social-media set for a variety of reasons. "It's a very millennial procedure," she says of the non-surgical nose job boom. "It's easy, takes five minutes in the office, the downtime is essentially zero. It's reversible; if you don’t like it, you can inject and get rid of it. And it's less expensive."

Therein lies the appeal of these procedures for many social stars. "I do think that a lot of millennials are thinking about injections more like makeup," says Liotta. "It's part of the beauty upkeep routine. There's less a feeling of it being an invasive procedure than it is just what you do to keep yourself looking good." Especially with younger patients, it's seen as an ongoing preventative process, says Liotta. "I think of it like a trainer: You're not going to go to your trainer one time and work out one crazy workout and be done for the rest of your life. I tend to have appointments that are more frequent, where you see someone every two or three months and do a little tweak so that we're maintaining everything or we're pulling them in the direction they want, so they're not a different person overnight."

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And the social-media demographic does have particular ideas about how they want to look. After having taken thousands of carefully analyzed selfies, those under 35 have developed keen eyes for their own aesthetics. Liotta herself often turns to selfies to help pinpoint the best procedure for her patients, asking them to show her pictures of themselves that they love and ones where they aren't fans of what they see. "I tend to have a little bit of a different relationship with patients than my mentors did," Liotta says. "I trained with older plastic surgeons on the Upper East Side, and the relationship I would watch is the woman or man comes and sits down and the plastic surgeon tells them what they need, and it's a laundry list of things that are 'wrong' with them."

Interestingly, that homogeneity that has been driving makeup artists up the wall doesn't seem to be a driving force in the world of cosmetic procedures, according to Liotta. "Nobody wants to look like somebody else anymore," she says. Many of her patients are famous for a particular feature that might, in the classical opinion, stand out too much. "I may have a model who has a really sharp jawline where somebody might say 'Oh, you should make that softer,' but they don't want to do that; that's part of who they are. I'm a big proponent of [the idea that] people should look the way they see themselves. People should look different."

Naturally, not everyone buys into that same philosophy. Social-media shaming has pushed many users — and not only famous ones — to clap back, or in some cases leave their platforms altogether. Twitter recently made news after several expected buyout offers failed to materialize, in part because of the service's inability to curtail harassment. Meanwhile, most social-media networks have struggled for years to combat the presence of communities encouraging disordered eating.

Pro-anorexia (known online as pro-ana) communities have been around since the dark, early days of the internet, steadily shaping and moving themselves around to suit the technology at hand. For a period, many pro-ED groups took up the concept of Thinspiration, or thinspo, flooding Instagram, Tumblr and Pinterest with photos of the skeletal ribs, thigh gaps and protruding hip bones of crushingly thin men and women as well as "tips" for things like minimizing calorie intake and hiding their disorders.

Most sites have since enacted bans on these groups — with varying degrees of success. Earlier this year, researchers at the Georgia Institute of Technology found that the number of pro-eating disorder hashtags as well as user engagement with them actually rose after Instagram changed its policies in an attempt to crack down. It seems that as quickly as the tags can be censored, new ones pop up, with the groups morphing into new, less recognizable forms. For some, the preponderance of fitspo images, featuring muscular women with slogans like "strong is the new thin," appears to be a new, less overtly harmful iteration. According to a study published in the International Journal of Eating Disorders, though, women who posted fitspo photos had significantly greater risk of an eating disorder diagnosis than those who posted travel photos, though there's not enough data yet to say how these fit-spired users compare on eating disorders to average social-media users.

But tracking the origins of disordered eating as encouraged through social media isn't always as simple as tracking a certain hashtag. For years, research has shown that simply being active on Facebook was enough to increase eating disorder risk among young women, with one 2014 study finding that spending as little as 20 minutes a day on Facebook was enough to make women more anxious about their bodies and up disordered eating.

That said, not everyone is riding the Bad News Express when it comes to social media. In fact, nutritionist Brooke Alpert actually takes a positive stance on the effects of social media on wellness. "In my profession, social media is a great tool to help educate the masses on healthy eating and reach tons of people that I wouldn't have been able to reach out to," she says. "It also allows me to give a more honest look into my own life and eating habits that I feel resonate with lots of people." The concern, she says, is that a large social-media following can convey a level of expertise that isn't necessarily accurate. "Someone who has beautiful pictures and perhaps looks super healthy can all of a sudden seem to be a health expert and share their information with millions of people when it's perhaps not scientifically sound."

Liotta has experienced the overwhelming power social-media stars can have when it comes to health advice firsthand when one of her patients (who happens to be a famous social-media influencer from Saudi Arabia) Snapchatted her personal process of getting Kybella injections (which are meant to reduce fat under the chin). "Immediately after that I had people flying in from Kuwait to get Kybella," says Liotta. "I would say to them, 'Don't you have somebody who does this in Saudi Arabia or Kuwait?' and they would say, 'Yes, but I trust her, I'm coming here because she was here.' The power of social media is serious."

Whether that power does — or should — come with responsibility is another matter entirely. After all, whatever users may do or promote on social media, they're doing so within the confines of a culture, one in which the definition of beauty is variable, inscrutable and sometimes simply unattainable. For some, the social-driven shifts in the beauty sphere have come with costs, while for others it's ushered in a new era of self-defined beauty with broader representation than ever. As Liotta explains, "The new idea of beauty is natural and different. Everybody wants to be their best self and stay their best selves." But what, exactly, that means may all depend on what hashtag starts trending next. 

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