Tweakment Dysmorphia Is Real And It’s Costing Us Our Grip On Reality
'My under eyes looked awful: puffy and inflamed. But when I asked the doctors why this was happening, they just blamed each other’s work,' says Justine Masters, a former fashion stylist. 'It was only when I did my own research that I found out my lymphatic system had been affected by the tweakments I had and wasn’t draining properly.' For Masters, botox and a small amount of filler were the ways she chose to address feeling 'old' compared to the people she was dressing. 'It was a mix of reasons: social media and my own insecurities about ageing were definitely a part of it.'
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Masters’ story is not unusual. For many of us, the confluence of virtual meeting rooms, front-facing cameras and an uptick in celebrities admitting to the work they’ve had has increased how critical we are of our own faces. The fine lines that at one time would have spurred a vigorous rub and dollop of retinol-containing cream are now injected at first sight.
The rise of preventative tweakments and baby Botox (both ill-advised according to reputable injectors) has seen people without the lines and grooves that would necessitate treatment seek it out. One well-known influencer living in New York posts frequently about the fact she has an unlimited Botox monthly membership at her local clinic. Whether that makes her top-up more regularly in an attempt to get her money’s worth is unknown. But the allure is clear – a quick fix, whenever you need it.
Chasing an unrealistic ideal
In January of this year, the International Society of Aesthetic Plastic Surgery published research that, in 2021, surgical and nonsurgical procedures increased worldwide by 19.3% – Botox being the most popular. And it’s big business. In 2022, the UK aesthetics industry was valued at £3.6 billion, with over half a million aesthetic procedures carried out. Globally, this figure shoots up to £45.5 billion. On TikTok, videos tagged as #botox have been viewed over 73 million times while #filler clocks in at over 48 million. But what is it that we’re chasing?
'I call it "Instagram Face",' explains plastic and cosmetic surgeon Dr Paul Banwell. 'It’s when the person looks almost flawless: poreless skin and plump, high cheekbones with cat-like eyes and long, cartoonish lashes. Add a tiny, neat nose and full, lush lips and you have it.' It doesn’t take much research to see the inspiration. Kylie Jenner, Bella Hadid and Megan Fox are salient examples, their faces following the identifiers listed by Banwell.
However, we rarely see these celebrities in real life, consuming their appearance mostly via Instagram, TikTok and flash-ridden red-carpet photographs – all of which skew the way they look again. This disconnect between reality and purported reality can lead us to normalise things that, according to Banwell, are unnatural and unachievable. 'These unrealistic expectations are fuelling the pressure on young adults to surgically alter their face. There’s this "look" that people feel they must adhere to.'
It’s not just the content we consume that can spur on our desire to alter the way we look. Often, it can be a self-fulfilling cycle: the more we have, the more we want to have – a phenomenon known as ‘perception drift’.
What is perception drift?
For people who regularly receive tweakments, a widening between what they think they look like and what they know they look like can occur. This is known as perception drift: a gradual shift in self-perception where people lose objectivity on their original appearance and seek further, continual changes.
'Perception drift can affect patients and medical practitioners alike,' says aesthetic doctor Dr Glyn Estebanez. 'Patients might become fixated on achieving an ever-evolving goal while practitioners, if not laser-focused on that original starting point and goal, may lose objectivity which can lead to over-treatment.'
This isn’t always the case. There are excellent, responsible injectors and aesthetic doctors and nurses who treat patients appropriately – often saying no to things they think are not necessary. 'It’s documentation that’s key,' advises Estebanez. 'Keeping detailed photographs before and after each procedure can provide clear references (for you and your practitioner) to evaluate progress objectively and sensibly.'
Dysmorphia, more commonly known as body dysmorphic disorder or BDD, is a preoccupation with an imagined flaw or a disproportionate concern with a perceived flaw, Dr Alia Ahmed, consultant dermatologist at Get Harley explains to me. 'Tweakments are usually not as invasive as other cosmetic procedures and highly accessible, which is concerning for fuelling dysmorphic beliefs. That’s not to say that every person wanting a tweakment has BDD, but it does mean there are vulnerable people out there that can become addicted to these procedures with little or no follow-up.'
While some people won’t fulfil enough of the criteria to be diagnosed with BDD, there is another condition known as ‘body dissatisfaction’ that might apply: this is when someone has significant appearance-related concerns that impact their quality of life and the choices they make.
Now, botox, filler and other tweakments are not inherently problematic. The fact we can change the things we want to change is an exercise in agency and body autonomy. Plus, with more research available, as well as brands and products on the market, we’re able to make informed, nuanced decisions about which type of treatment is best for the results we want. No longer a taboo or dirty, whispered word, botox and filler are discussed openly, without shame. Compare this to 10 years ago and it’s a rapid, revolutionary change. It’s when tweakments are used as a foil for low self-esteem or self-image that issues arise.
'The risk tweakments pose to a person’s mental well-being is dependent on several different factors: childhood experiences, self-esteem, and the extent to which someone measures their self-value by appearances and external factors. Body image issues tend to arise when these areas are out of balance,' Dr Elena Touroni, a consultant psychologist and co-founder of The Chelsea Psychology Clinic tells me. 'When using injectables becomes a coping mechanism for feeling good about yourself or is used as a barometer for measuring self-worth, that’s when it becomes dangerous.'
Changing your mind
Susan Yara, the founder of skincare brand Naturium, former beauty journalist and content creator, meets me on Zoom to discuss her decision to have her lip filler dissolved. 'When I was pregnant I had the most beautiful, luscious lips,' she laughs. 'As my body grew, so did my lips. It made me think about getting filler after the baby was born. In the end, I had them done straight after pregnancy. However, because the skin is thinner around the lips, filler migration (when filler moves from its injected position) can happen and, in my case, it did. My doctors and plastic surgeon all said that it might be time to dissolve it all and start again.'
Yara filmed the dissolving process, from the extent to which the filler had migrated (around two centimetres above her lips) to the practitioner injecting the hyaluronidase that would break it down. 'After four years, the amount of filler that was still in there was kind of wild,' she said in the video posted on YouTube. 'When you’ve had filler for so long, you have no idea what you’re going to be left with,' she shares, revealing that she had pre-emptively already booked an appointment for lip filler before she dissolved it all.
This ability to reverse or retract some of what we’ve done to ourselves is a feat of science. But not all fillers can be. Hyaluronic acid-based fillers can be broken down with the enzyme hyaluronidase (although it might never fully disappear and adverse effects could occur), as Yara demonstrated. Semi-permanent fillers like Sculptra or Radiesse cannot be. Masters, now a facialist, says she still had filler residue over 15 years later. Botox will not respond to hyaluronidase and cannot be dissolved. However, it will naturally weaken in efficacy and, after six months, will likely have no effect.
Whether you choose to fill, tighten, smooth, reverse or otherwise alter your appearance, keeping a log of your mental state between appointments, how much and how often you compare your appearance to others and the motivation behind seeking treatment is crucial. If you feel like you’re struggling, putting yourself or your finances at risk or losing objectivity, it’s time to reach out to an expert.
Not sure how to check if that’s you? Ahmed says red flags can include not being satisfied with the end result, immediately wanting another procedure after to address another issue, asking for more than seems appropriate (filler, botox etc) and a ‘frozen’ or overfilled face. Therapy with a psychologist well versed in body dysmorphia like Touroni could help with feelings of inadequacy and defectiveness. Cognitive behavioural therapy can also help challenge detrimental patterns of thinking and improve self-esteem.
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