Selfie Syndrome Spikes Interest in Rhinoplasty & Plastic Surgery

Selfie-Syndrome has spiked demand for plastic surgery and rhinoplasty in particular.  So what is Selfie Syndrome, why is it becoming increasingly prevalent and is it a good thing?

Selfie Syndrome also known as Selfitis is a documented mental disorder plaguing people the world over and has only been made more prevalent and severe by the social disconnect people have faced during the pandemic and with social isolation of lockdowns.

Selfies: We all take them to share with our family and friends and to document shared occasions, but many people also use the selfie as a means to look at and analyze and more problematically even manipulate their own image.  But what are the psychological and emotional effects once we start to spend more and more time with and working with our image.  And, depending on the camera, angle, and other factors, is the base image even before editing or applying filters actually an accurate image of ourselves?

Selfies evolved only after the introduction of the front-on phone from the iPhone 4 in 2010.  Since then, every phone up to the current iPhone 12 has had front-on and rear-on cameras giving us the capacity to take selfies.  The growth of the selfie with the explosion of social media platforms has led in some cases to narcissistic behaviours and/or anxieties about self-image as people not only take and possibly edit images of themselves but share them in online forums where they are either going to be “liked” or not and potentially commented upon.  This need to define oneself by one’s image – real or manufactured – and to gain attention (preferably positive attention) and reassurance, can lead to Selfie Syndrome also known as Selfitis.


A study by the Nottingham Trent University developed a “Selfitis Behaviour Scale (SBS)” to assess the levels of selfitis. 1

  • Borderline selfitis: Taking at least 3 selfies a day without posting them on social media.
  • Acute selfitis: Taking and posting (on social media) at least 3 selfies a day
  • Chronic selfitis: Unable to resist the urge to take selfies “around the clock” and post at least 6 of those photos per day

So why do we take selfies?  A German study looked into the various aspects of self-presentation and why selfies were taken and how the use of selfies was viewed by the takers/subjects versus others.  They found the highest benefit rating for selfie taking was “self-staging” came in at 62%.  Of concern, however, is that 62-67% of those taking part in the study agreed that there were potentially negative consequences to self esteem from selfie taking such as creating illusionary worlds.  Interestingly, 82% of participants said that they would prefer to see more usual images on social media in preference to selfies.  2

 Selfies & Plastic Surgery (The “Pinocchio Picture”)

In 2019 Dr Hodgkinson and Dr Ong presented a poster (above) explaining the distortions of the face that created by the selfie.  This remains a tool that Dr Hodgkinson uses to this day to explain to all cosmetic facial surgery patients such as facelift patients, cheek and chin implant patients and most of all rhinoplasty patients why the image they see in the selfie is not a true picture of their appearance.  3

Selfies are a distorted “self-portrait”.  What many selfie takers may not be aware of is that the selfie creates greater facial distortion than a third person photograph not only in the projection of the face but also in the perspective of the face and especially in the nose, which studies have proven may appear up to 30 percent larger in size.

It was found that, “when the lens is very close to the face — about 12 inches (30.4cm) — it makes the nose look about 30 percent larger compared to the rest of the face. You can see that difference below in the photo taken at selfie distance (12 inches) on the left versus regular portrait distance (60 inches – 152.4cm) on the right:” 4

      Selfies can make the nose look 30% larger: Selfie left, Portrait photograph right

An inner conflict is created in the patient between their actual image and their envisioned one.  Increased demand for plastic surgery by millennials has increased relative to their selfie addiction giving rise to the psychological syndrome, now called the Selfie Syndrome.  The prospective patients who present most commonly for plastic surgery with selfies to share are rhinoplasty patients, both male and female. For plastic surgeons, although we do take into account the selfie pictures that patients present us with as they give us a guide to patient self-perception and expectations. To combat any misconceptions arising from distortion in these selfie images, we take photographs in a studio setting which are accurate portrait photographs produced by a 100 mm macro lens on a Nikon SLR camera by an experienced photographer. We instruct potential patients not to be fooled by their own selfies and post-operative patients not to be fooled by the selfie images of themselves or others as they do not represent the true before and after pictures.  This is a further reason that it is critical that all before and after pictures on surgical websites should be not only done with professional photographic equipment but not be staged, posed, photoshopped or filtered in any way.

Selfie Dysmorphia – Can it lead to Body Dysmorphic Disorder (BDD)

Body Dysmorphic Disorder (BDD) is a also a well-documented mental disorder in which a person fixates on one or more perceived defects or imperfections in their appearance.  The constant taking of selfies, taking selfies from unusual and impossible angles, editing of images, and applying of filters in an attempt to “perfect” one’s image can be a form of fixation.  The question becomes then, is Selfie Dysmorphia sometimes called Snapchat Dysmorphia a symptom or sign of BDD.  The problem for plastic surgeons is to ascertain whether or not a prospective patient suffers from the dysmorphias as whilst they commonly seek cosmetic plastic surgery to rectify their perceived imperfections, in most cases they are not helped by aesthetic surgery as their satisfaction if achieved at all from surgery will be fleeting and they will seek further treatments regardless of the results to fuel their underlying psychological condition.

Selfie Elbow

Incredibly or not, selfie taking has been such a frequent activity for some that it is impacting them not only psychologically but physically. A RSI (repetitive strain injury) associated with selfie taking has been defined, “Selfie Elbow”. 5 In taking a selfie, people usually extend their arms fully or with only a slight bend and often at elevated angles and have to maintain this posture as still as possible whilst adjusting the frame of the image in the viewfinder/phone with a firm grip prior to engaging a thumb or finger on the extended arm to take the picture. The repetition of this process has resulted in various sequelae including swelling and pain and in the elbow joint.


In conclusion, selfies are here to stay and are a wonderful way to communicate where we are, what we are doing and share our lives with friends and families.  Selfies have also been shown to be a tool many value in self-presentation online, but we all need to be aware when we stop controlling the tool and the tool starts controlling us.  We also need to be aware that the image of ourselves in the selfie is not our true image and is distorted.   Whether we use the image as is or edit it or apply filters, the fact remains that the selfie image is not an image of how others see us or an image on which to base decisions about altering our image via surgery or any other means.


1. Balakrishnan, J. and Griffits, M.D., 2018. An exploratory study of “selfitis” and the development of the Selfitis Behavior Scale. International Journal of Mental Health and Addiction, 16 (3), pp. 722-736. ISSN 1557-1874

2. Diefenbach, S. and Christoforakos, L. 2017. The  Selfie Paradox: Nobody Seems to Like Them Yet Everyone Has Reasons to Take Them. An Exploration of Psychological Functions of Selfies in Self-Presentation

3. Hodgkinson, D and Ong, D. 2019 “You Are Not Your Selfie”, Cosmetex, Sydney





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