Plastic surgeons here have noticed a trend where patients bring in selfies, edited using filters on apps such as Snapchat, Instagram and Meitu, and ask to look like the edited version of themselves.
The phenomenon is dubbed "Snapchat dysmorphia" and is causing worry among plastic surgeons and psychologists here.
"I'm always on Instagram, so I wish I could look like (the filtered versions) without using filters," a 23-year-old woman told The Straits Times. She first did double eyelid surgery and epicanthoplasty - surgery to create bigger, doll-like eyes. A month later, she had Botox to slim her jaw and fillers to plump her lips.
Local plastic surgeons said they have seen more patients like her - ranging from teens to young adults - who use these apps to achieve what they deem as perfection and as a guide for plastic surgery.
Dr Por Yong Chen, medical director of Dream Plastic Surgery Singapore, said some patients have used apps such as Meitu, Snow and BeautyCam to show him how they want their face, nose and chin reshaped. These are free photo-editing mobile apps. China-based Meitu has 455 million active users.
Users can adjust the size of their chin, jaw and cheek in real time, as well as brighten their skin, edit away blemishes, add make-up and make their body slimmer in editing.
"Some of them want their face to look slimmer even though it was fairly slim to begin with, and they would explore options like bone shaving surgery," said Dr Por.
"These patients can go from non-invasive procedures to getting more invasive ones over time. It can turn into an unhealthy obsession."
Dr Por said he now sees one case a month in which a patient asks to look like a filtered selfie, compared with one case every two to three months three years ago. "The ability to edit photos has changed their perception of themselves. Some patients will insist on having a more unnatural appearance, and we have to counsel them. I will go ahead with the surgery only if their expectations are achievable," he said.
Dr Samuel Ho, plastic surgeon and medical director of Allure Plastic Surgery, said he has seen the number of patients who use filtered selfies double from two years ago. They are in their teens or 20s.
He said: "A 19-year-old boy came in with his father, and showed me a picture of himself with an elfin appearance. He wanted jaw and zygoma (cheekbone) reduction surgery as well as nasal and chin augmentations to look like the picture."
Dr Ho said that while the father consented to the operations, he had to turn them down as it was an "outlandish request".
He said the use of these apps is worrying. "The younger ones would come in showing selfies, pointing out things that looked imperfect in the photo, such as their eyebags, chins and noses. My youngest patient was a 15-year-old girl who did double eyelid surgery to look like her Meitu selfie."
Dr Carol Balhetchet, a clinical psychologist in private practice, said she was concerned the easy availability of these apps may be causing unrealistic expectations among teens, who are more impressionable. "They are not accepting themselves for who they really are. They look at their selfies and compare them with K-pop stars and celebrities, and turn to these apps and eventually plastic surgery to achieve what they feel is perfection. It's artificial but it's perfect to them."
And with their pursuit of perfection, Dr Balhetchet said, they become hypersensitive to negative comments about their appearance.
"If one person makes a bad comment about their appearance, it can affect them so much and they'll turn to plastic surgery."
Dr Martin Huang of MH Plastic Surgery said 20 per cent of his patients, ranging from teenagers to those in their 30s, use selfies from these apps as "supporting evidence" to explain and discuss aspects of their faces they do not like.
He said: "The use of selfies makes people more conscious of their facial features and may play a part in making them seek surgical help to address their perceived flaws."
While the trend may be worrying to psychologists and parents, plastic surgeons said they find they are able to use these filtered selfies as a guide for the operations.
Dr Por said: "When people augment a photo of themselves, they are building from their original set of features and facial structure which are unique to them, and it often results in an augmented look that is more realistic. It's better than comparing (themselves) with the photo of a celebrity."
Despite this, he noted that patients may at times over-edit to the point where the look is not achievable. "In such situations, it is important that the limitations are communicated to the patients, and we devise a solution that is safe and in their best interests."
Dr Andrew Khoo of Aesthetic & Reconstructive Centre said of the use of those apps: "While it is easier for me to understand what the patient wants, I would emphasise that shifting pixels is much easier than adjusting a patient's tissues - the surgeon must be confident he can achieve the desired result."
Dr Balhetchet said: "It's one thing to laugh at yourself looking like a rabbit with a filter, but it becomes dangerous when you're chasing perfection that is unnatural."
