The Selfie Image Problem

Yes, he says, at a certain age you may have lost some fullness below your lower eyelid, or the lid itself may be puffier — but the under-eye shadow you see on in a selfie can be exaggerated by the camera angle or poor lighting.

As a result, Byrne says his conversations with older patients aren’t unlike those he has with “young rhinoplasty patients.” As he describes them: “I realize it seems like you have a pretty big bag, or overhanging tissue of your lower eyelids, but you might find images where you don't. Sitting in front of me, you look pretty good.” It’s important, he says, that people realize that “getting a complete picture of how we look is not going to happen on a tiny LCD screen.”

Yet those same screens, doctors note, are also being used to convey their patients’ aspirational cheekbones, eyelids or nose during consultations.

“What I’m seeing in clinical practice is, number one, that people are using selfies rather than pictures of other people in order to try to outline what they desire, and second, that it’s not even a real picture of themselves,” says Jeffrey E. Janis, president of the American Society of Plastic Surgeons, who notes that a decade ago people brought him shots from magazines.

And no, he says, it's not only younger people who are shooting for facial perfection through a lot of filters on their phone. “I’m in clinic right now, and this just happened with a patient who had concerns about her lips,” Janis says. To express what they'd ideally look like, the middle-aged patient, “showed me a selfie of herself that had filter on it that made her look like a cat, purposefully.”

Given the slippery nature of both the digital and selfie image today, Janis stresses how important it is to find a board certified plastic surgeon who will keep sanity, and your safety, in mind. “If a patient comes in and they’re pointing out something they see that we can’t see, that’s a concern that needs to be addressed before any procedure is done,” he says.

“If someone comes in with a picture using filters or other distorted reality, I will spend a lot of time with that patient discussing what’s possible and what’s not possible,” he says. “If we can arrive at a situation where we have an appropriate level of expectation, then I’m happy to perform that surgery. But if they come in and say they want to look like a cat, they’re entitled to a second opinion.”