“Look at my phone, my nose is too big!” Sound familiar? When consulting with a patient, are we certain which version of the patient we’re attempting to treat? Is it an iPhone image, what they see in a mirror, or their appearance as we see it? Over the last five years, the “Selfie Mania” craze has exploded into pop culture with no regard for boundaries or borders. Selfies have without a doubt impacted our consultation process and maybe even the way we practice facial plastic surgery.
When the President of the free world is seen taking a selfie with the Prime Ministers of Britain and Denmark at a gathering of global leaders, there is no denying this craze is cross-cultural and accepted by people of all backgrounds.
Selfies allow us to conveniently and immediately capture a moment in one snap. They can be used to promote new friendships as well as strengthen the bonds of existing ones. When we ask another to pose next to us, it is a sign of affection implying the importance of the moment. Yet, it has also been known to destroy relationships. More than a few breakups and divorces no doubt were triggered by an unexpected, overexposed, suspicious selfie. Additionally, the question begs to be asked: if so intent on preserving a moment with a selfie, do we really appreciate the presence of the moment? Or, are we pilfering from the present to produce an image of a moment that may never exist? Maybe a question best left for Siddhartha Guatama to unravel. Additionally, there is no denying that for some, selfies provide fodder for secondary gain. While sharing with close friends can be salacious, flashing it on Facebook can be fallacious, boasting how wonderful an experience is; the irony being if such a moment is so wonderful, why be diverted away to announce it to others.
I have to admit, for years I was resistant to taking selfies. I didn’t want to sacrifice the current for the future, but as a father of three teenage girls, I am desperately seeking to hold on to every experience I share with them, so I now desire keepsakes for myself, as well as creating reminders for them. I am now on the selfie bandwagon. Being a novice selfie-taker, I have yet to master how to capture my best angle. My eyes are always diverted or I end up cutting off half my head. So I decided to reach out to an expert – my 16 year old daughter who learned from the Master of Materialism, and the self-proclaimed Sire of Selfies, Kim Kardashian. In my daughters words, “Dad, you have to hold the camera above your face and direct it down as you look up, and you never want to take a selfie from below your face. And for me and my girlfriends, we like to purse our lips out like a duck.” Professor Kim who has perfected the “duck lip” look has taught a whole generation of women how to manufacture a more femininely attractive image, and she just might be right! Maybe we can all learn something from the regal resource of reality. What Kim has mastered is based on the physics of photographs merged with the science of beauty. I wonder, where did she do her fellowship?!
When a photo is taken close to an object, the portion of the image closest to the lens will be enlarged and distorted (think fish eye). So, when the lens of the camera is only a few centimeters away or arms length away, it makes whatever feature of the face closest to it, look biggest. If the camera is straight on, then the nose looks largest, if from above, then the eyes look greatest, and if taken from below, then the chin and lower one third of the face predominates. But do not fear, to the rescue is the “selfie stick!” (Noot Products, NY, NY. I have no conflict of interest here to report). This convenient portrait-pleasing device can be attached to any smart phone and allows for would-be starlets to take selfies from a distance of 10 meters, thus, producing a more proportional and flattering facial image, which is the same reason photographers take photos from a significant distance from the lens.
As experts in beauty, we recognize that a female face with a large upper third, highlighted by prominent infantile eyes and coupled with a small chin is attractive. We also appreciate luscious pouty and fertility-defining lips that grab attention. Therefore, Professor Kim’s “duck lip” pose enlarges and accentuates the relative size of the lips, especially when the photo is taken from above the face. In contrast, patients that take a selfie with the camera directly in front of their face notice a nose appearing bigger and inconsistent to what it is in real life; a discouraging reality to the recent rhinoplasty patient, especially when they look in the mirror and are equally discontent but unsure why. A mirror is a reverse image of what is seen in a photograph. A bump on the left side of the nose, now becomes a bump on the right side of the nose and it gets confusing to the disgruntled. Additionally, we tend to be most comfortable with our reflection because it’s the version we see most frequently of ourselves. But even the physics of a mirror differs from what others see of us. In a mirror, our facial size is half of what it is in real life, regardless of the distance you stand from the mirror. Yet most people believe the dimension of their face is the same size in the mirror as in reality. So our brain compensates by overestimating facial features. Try it for yourself, mark the outline of your facial image in a mirror and then grab a measuring stick and determine it for yourself.
Again, we have a phone and a mirror photo that are opposite images of each other and both varied from what an outside observer perceives. So when a patient is disappointed with how they look and desires a smaller nose, which version of the patient are we attempting to improve? This puts us in an Alice in Wonderland scenario of questioning what is real and who it is exactly that we’re treating.
Perhaps the best way to address this is to educate our patients by pulling out a mirror, and a camera phone to demonstrate the image differences. Letting them know that while we want to improve their appearance and meet their expectations, we are also interested in keeping them natural appearing. And if we treat only their “selfie” image, we may inadvertently make their nose too small. We’re certainly in a difficult position where we are tasked with making people look better naturally, yet also meeting their demands. I guess part of being a physician is to be a teacher and perhaps it is our responsibility to educate our patients, the media, and a new generation of selfie-takers the physics of a selfie? And if all else fails… maybe next Christmas we hand out extending selfie sticks to all.