In a desperate search for Insta-perfection, young women – and even teenagers – increasingly resort to cosmetic medicine to replicate the "flawless and poreless" faces they see on social media. But industry experts warn about the too-much-too-soon trap that can lead to early ageing, distortion and "alienisation" of faces. Jane Phare reports.
The images come at young women, and men, from all directions. Flawless faces with full, pouty lips, glossy hair, thick, arched eyebrows, big, perfectly formed boobs, not a pimple or pore in sight. They're there on TV, dashing around in dental-floss bikinis marooned on tropical islands or holed up in Spanish mansions; they're on Instagram, TikTok, and YouTube, racking up followers while holding the camera phone at just the right angle.
Of course, we all know they use filters, face-tuning apps, heavy contour make-up and, often, professional lighting. But still, the images are relentless and seductive.
It's a conundrum that has the #MeToo movement shaking its collective head in despair. School principals suspect that some of their female students care more about watching Charlotte Tilbury makeup demos on TikTok than they do about study. And parents, who at one time only had to nag their kids to wear sunscreen and a hat, now fight a losing battle against impossibly glamorous influencers "brainwashing" their teenage daughters.
London cosmetic doctor Steven Harris calls 2022 the Year of the Alien, hitting out at his own industry on Instagram (@Drharrisclinic) for bowing to demands brought on by unrealistic beauty standards on social media.
He fears the daily bombardment of abnormal and filtered images results in brainwashing, causing a "perception drift" around beauty and what is considered normal. With that comes a rise in people suffering from Body Dysmorphic Disorder.
In an interview with the Daily Mail Harris talks about the rise of "alienisation," faces so distorted by an excess of cosmetic procedures they start to look like aliens. He slams unscrupulous colleagues for creating distorted faces - think large, unnatural and hyper sexualised lips - by using too much filler.
He's not the only one who's pushing back. Auckland appearance medicine expert Dr Sarah Hart was initially reluctant to go on social media, mindful of its intrusiveness. But she felt compelled to do some "debunking" after seeing influencers on social media promoting injectables such as Botox and fillers.
"The Kardashians chose to share a lot of that stuff and that's been incredibly influential," she says. "It's almost like you need to fight influencer with sane influencer."
That pressure is causing young women in their early 20s, and even some teenagers, to approach beauty therapists, skin specialists and appearance medicine doctors for treatment. Cosmetic practitioners and beauty therapists say young people want the "flawless and poreless" images portrayed by Kylie, Kendal, Khloe and Kim, but they are not yet mature enough, mentally and physically, to make appropriate decisions.
Some women in their early 20s want Botox injected into areas before lines appear, what cosmetic medicine expert Dr Catherine Stone, calls "pre-juvination". She'll tell a 23-year-old with no visible lines to come back when there's something to be fixed. And she tells them the reality: "You'll never look like the girl in the magazine because the girl in the magazine doesn't look like that."
Hart warns that too much Botox at too young an age will have the reverse effect.
"If anything I personally think that high-dose Botox from a young age could actually make your face age faster because it's going to make the muscles smaller."
Skin specialist Dale Chandler says teenagers and young women come into her House of Aesthetics business wanting tiny imperfections fixed, many that are almost invisible. Others will want laser treatment on minor pigmentation.
"In some cases it's just a few freckles. It's this ideal that skin has to be flawless and poreless. It's the impossible search for that."
Chandler asks young clients to bring any products they are using for the initial consultation.
"Often it's just unbelievable, the amount of skincare, makeup, supplements, a whole range of different products in an attempt to deal with their insecurities.'
Young women will use filters and editing apps to create their ideal self and then expect appearance medicine and cosmetic surgeons to make it happen, she says.
"Deep down they know that's not what they look like."
She's lost clients by being straight up, telling them the result will not be what they wanted, and that good skin involves diet and lifestyle changes as well.
"They want to hear that there is something that can be done. But nobody's skin is like that but they are looking at influencers who have full-on lighting. It's very sad because they are spending a fortune trying to achieve it."
Jaimee Lupton, the co-founder of Monday haircare which launched its brand on the back of beautiful Instagram images, says "for sure" she feels the pressure of living up to the beauty image.
"I don't think any of us can say we're immune at this point. They're so ingrained in our society and how we exist in it, especially as women. That said, I don't think anyone should be shamed for caring about how they look or how they present themselves to the world, as long as it's not an unhealthy obsession."
Lupton, 30, says she's at an age where she can think critically about external pressures and how much she's willing to let them influence her.
"I know more and more what I'm comfortable with and what makes me feel good, but that is different for everyone."
Lupton, in her beauty business role, is constantly surrounded by social media content - highly curated images that are "a blessing and a curse".
"It can mean you end up comparing yourself to others, and I know that can be tough for a lot of young people who are still building up their sense of self."
But she says "unique and diverse" representations of beauty also appear on sites like Instagram and TikTok, and are seen by young people.
"That's what I love about TikTok especially, a preference for that 'imperfect' aesthetic is actually built in to the platform via its algorithms."
Reality TV must take some blame
But appearance medicine practitioners say social media is not the only culprit, pointing an accusing finger at reality TV for promoting unrealistic images of beauty and normalising the pursuit of perfection.
Love Island's
season 8 winner Ekin-Su Culculoglu openly listed her pre-show "tweakments" including breast augmentation, porcelain veneers on her front teeth, and filler in her cheeks, jaw and tear troughs. That apparently did the trick; she now has more than 3.2 million followers on Instagram and has received lucrative offers from commercial brands.
Love your tear troughs
It's the injectable fillers that skilled practitioners are most worried about. Hart is not in favour of injecting dermal filler into tear troughs - the hollows under the eyes – warning the practice has its downsides.
"It closes the eye off and makes it look smaller. It can look all bulgy and unusual. So it's not something you should jump into but it's presented on Instagram as something that is easy."
She's pleased to see a trend on social media of women "embracing" their tear troughs.
Using nose filler to disguise humps or to create a more defined bridge is another procedure presented as straight forward but it's not, Hart says. There are risks involved including blockage to an artery, lips that become damaged and scarred, and Delayed-onset nodules which occur when the immune system reacts to the filler, causing it to go hard and lumpy.
Stone, who launched The Face Place more than 20 years ago, says if therapists are not skilled in using dermal filler there is a risk of infection and lumps. If the filler blocks a blood vessel there is a risk of tissue necrosis and, in rare cases, blindness. The most dangerous areas for dermal filler treatment are in the nose, the frown area above the nose, and the base of the nose.
"If they are self importing you can't guarantee what's in that product. They could end up with permanent disfigurement."
The Face Place only uses hyaluronic fillers which can be dissolved if something goes wrong. But Stone has treated two women with problems after self-injecting fillers they bought online. And there is evidence of underground operators advertising on WeChat in foreign languages, what she calls "the scary crowd".
Legislation introduced in the UK last year banned the use of Botox and dermal fillers on people under the age of 18 in what is a relatively unregulated industry. One UK columnist described her shock when a school girl – all rumpled uniform and sweets in hand – in a shop queue turned to reveal a "Love Island face," micro bladed brows, and "bruised and bloated lips".
Hart, who is also the censor for the New Zealand Society of Cosmetic Medicine says the issue in the UK is the lack of regulation.
"Anyone can do filler so they have beauty therapists and podiatrists doing it."
She hasn't seen evidence of filler being inappropriately used on teenagers under the age of 18 in New Zealand but does think better legislation is needed because some of the treatments are relatively new.
The Natural Health and Supplementary Products Bill, currently before Parliament, will further restrict the use of "medical devices," the category under which injectables fall.
Skin therapist Louise Gray, who runs the Beauty Therapy Room, doesn't do injectables but knows of young women saving up for Botox because they think it will prevent wrinkles.
"That's how it's marketed. I think it's very sad to see these young adults worrying about not being perfect."
She views injectables as a good money-making business that has its place. "But I don't want it. I'm about making the skin work for itself and getting people to understand how to look after their skin."
She's fascinated by young women who are vegetarian or vegans, into organic food and want to protect the planet.
"And I think, 'what are you doing to your face'?"
What parents can do
Ask parents of teenagers and those in the beauty industry for the three reasons driving young people towards aesthetic medicine and they'll say, "Social media, social media and social media."
As to how concerned parents can get a look in given the power of influencers, Hart admits it's tough and that there's no easy answer, particularly once youngsters get mobile phones. She knows that her own 11-year-old daughter is reaching the age where she will be more influenced by influencers than by what her mother says.
"It's an awful dilemma. I find it really difficult as a parent."
Hart's first advice to impressionable teenagers is to warn about filters and how unreal they are. And that treatments done at a young age may not look so good later on.
"The danger then is to try to correct it, it gets overdone and looks distorted.
She thinks back to constantly plucking the life out of her eyebrows in the 1990s and then regretting her ailing brow line later on.
"I tell stories like that to my daughter."
Having open conversations with teenagers is important no matter how hard that might be, Hart says. Tell them that what may look good on Instagram may look strange in real life.
"Heavy contour makeup might look great in a photo but when you look at someone wearing it, it's like you can scratch your nails through it."
She thinks one of the best weapons is to point out to teenagers that what they're seeing on social media is twisting and warping their perceptions of reality.
"I think young women are quite feisty about that, of being duped. I think if you can make them aware of how they're being manipulated then that makes them stronger to resist it."
Movie actor Jennifer Garner also warned about the risks of Botox and injectable fillers in an interview earlier this year after being asked what advice she would give her two teenage daughters.
Avoid them as long as possible, she told Harper's Bazaar, while admitting she had undergone treatment in the past.
"I've gotten Botox a few times, and I don't like it - I don't want a frozen face."
Garner's advice was to look in the mirror less, obsess less and spend that time doing something more useful.
"Be very, very incredibly judicious, and wait as absolutely long as possible to add anything. Don't think that you're 37 and you need to be shooting up your face," she said in the interview.
Chandler thinks parents, too, feel the pressure imposed on their teenagers by social media.
"They want their children to be happy and there is a lot of pressure on both the child and the parent to pay for whatever it takes to make them happy."
Practitioners in the older age group spoken to by the Herald on Sunday all mentioned memories of their first school ball - the homemade dress with minimal or no makeup, and hair that had been just washed and brushed. Compare that to today's 16-year-old movie-star lookalikes with fake tans, fake nails, professional hair and makeup, eyelash extensions and slinky dresses bought online.
Cosmetic medicine has its place
Industry leaders say that appearance medicine procedures, when used correctly and appropriately, achieve good results. Stone, now nearly 50, says there's nothing wrong with women wanting to soften lines as they get older. Stone first had Botox when she was 26 to treat lines that she developed as a 17-year-old.
"Different people age differently and there are some people in their 20s who have significant lines that make them look older than their peers." In those cases she may consider "some baby Botox".
She won't treat anyone under the age of 20 unless it's for issues like migraines, excessive sweating or structural problems. Recently back from an Allergan conference - an American pharmaceutical company that is the largest producer of Botox - Stone says there was an emphasis on "aesth-ethics" - the ethics surrounding aesthetic medicine. The company's surveys show not only an increase in the younger age group wanting injectables, but women in the 70 to 90-year age group as well.
Hart says many people have an innate fear of ageing but she warns Botox is not a magical cure.
"It just relaxes muscles and you really don't need to start it early before the line appears,"she says. "These treatments are actually wonderful when used appropriately just like makeup can be amazing when you use it appropriately, and hair colour. It's just if you feel that you have to, that's where it's not good."