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Photo-editing, Self-esteem and Cosmetic Surgery


A recent study shows that using digital appearance manipulation apps like Facetune2 could increase consideration of cosmetic surgery, without changing self-esteem scores.

Your patients know all about filters on Instagram and snapchat that smooth the skin, and apps that apply makeup or change the shape of the nose or jawline. The rise in social media over the last decade has made sure of that by making digital appearance manipulation as commonplace as selfies.

However, these visual improvement apps have also been criticized for creating unrealistic expectations and possibly negatively affecting self-esteem.

A recent study in Facial Plastic Surgery and Aesthetic Medicine asked the question, does having access to digital appearance manipulation applications directly cause an increased acceptance of aesthetic surgery? And what impact does photo-editing have on self-esteem, self-rated attractiveness and self-rated personality traits?

To answer this, researchers recruited 20 subjects from July to September 2019 using University e-mail list invitations and had them first complete an intake questionnaire that included demographic information, a baseline acceptance of aesthetic surgery, Rosenberg self-esteem, and self-perception scores.

Study subjects then had two headshots taken of them, one with a neutral face and one smiling. After an introduction on how to use the Facetune2 app, they received digital copies of their photographs and were asked to edit the photos using the app.

After one week of manipulating the photos in Facetune2, subjects submitted their best edited photos and completed the questionnaires a second time.

Wilcoxon signed rank test analysis was then used to assess the changes in the photos before and after digital appearance manipulation.

The results indicated that study participants had an increase in the acceptance of cosmetic surgery scale after manipulating the photos (+3.45, p=0.04).

When the two sexes were compared, women showed increased consideration for antiaging procedures (+1.4, p=0.04), while men were more socially motivated to undergo cosmetic surgery after digitally manipulating their appearance (+1.5, p=0.04).

All 20 subjects (Male: +1.0, p = 0.04, female: +0.8, p = 0.03) indicated that they “could end up having some kind of cosmetic surgery” in the future, according to the researchers.

Comparing the subject’s questionnaire answers from before and after manipulating the photos, personality perception and Rosenberg self-esteem scores showed no significant changes.


Parsa KM, Prasad N, Clark CM, Wang H, Reilly MJ. Digital Appearance Manipulation Increases Consideration of Cosmetic Surgery: A Prospective Cohort Study. Facial Plast Surg Aesthet Med. 2020; epub ahead of print.

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