Smaller nose? Bigger boobs? Flatter stomach? There’s an app for that!

Kate Harvey, Senior Research Officer at the Nuffield Council on Bioethics, explores the issues arising from the growing popularity of beauty apps for phones and tablets.

Two weeks ago, beautiful Birmingham was home to a two-day workshop on the globalisation of beauty.

The workshop – organised by the network BeautyDemands (more about the Nuffield Council’s involvement with the BeautyDemands here) – saw presentations from a wide range of contributors, but it was one issue in particular which led me to do a little further digging of my own.

A presentation by Professor Rosalind Gill focused on aesthetic entrepreneurship, which highlighted a body of work around beauty which she called, ‘The quantified self’. This session explored, for example, how self-tracking and self-monitoring materialise in digital technologies, and change the way we may relate to ourselves.

The application of self-tracking and monitoring is clearly very relevant to health contexts: for example, smartphones are optimised to record how far we walk, how many calories we consume, or how well we sleep. However, over the past few years beauty apps available to mobile and tablet users have also suffused the market.

As a relative technophobe who mainly uses a smartphone to see if it’s going to rain, and to find my way to the nearest bus stop (it’s all glamour), beauty apps were very much off my radar. So I decided to find out more about them.

The Nuffield Council’s current project on cosmetic procedures will focus primarily on invasive non-reconstructive cosmetic procedures (excluding temporary changes such as tanning or the application of make-up), so I restricted my searches to specific apps which focus on cosmetic procedures and surgeries. I gave myself just one hour to explore, fearing that weeks of my working life could quite easily be sucked into a chasm of curiosity.

One hour later, although significantly more enlightened on the range of cosmetic procedure apps, I was also the proud new owner of a couple of new frown lines.

The apps I found

According to Reuters, the first cosmetic surgery app (The Shafer Plastic Surgery App) was launched in 2009 by New York plastic surgeon Dr David Shafer. This app (no longer available through iTunes) enabled those considering cosmetic procedures to access over 1,000 FAQs on a range of procedures. Two years later, a press release from Medical Tourism NYC reported that Dr Shafer had developed another app to facilitate cosmetic procedure ‘tourism’ in New York City, or according to the press release, to “empower patients worldwide with access to information, travel and the ability to book appointments for the best aesthetic and surgical care available.” This app thus clearly moves from answering questions to active facilitation of cosmetic procedures.

Similar facilitation can be found in other apps, which explicitly link to surgeons who could undertake procedures ‘for real’. In a description of the app Lift / Tuck, for example, users are invited to “play around just for fun or send your results to Beverly Hills Celebrity Cosmetic Surgeon, Dr Garo Kassabian for a real life consultation.” Another app, Breast Augmentation, developed by Dr Mark Glasgold, invites users to “download our app to easily request an appointment, to learn more about the procedures and techniques Dr. Glasgold uses, and to view our before and after photos instantly. We have also included a treatment or recovery journal, where you can track your progress & attach photos easily to view your procedure outcome.” Descriptions such as these perhaps indicate that cosmetic procedure apps are little more than thinly-veiled marketing tools.

Other apps attempt to distance themselves from ‘real’ procedures. For example, a disclaimer from the Plastic Surgery Simulator – an app which uses photo distortion, where facial features can be manipulated by dragging a finger across a touch-sensitive screen – includes a disclaimer: “There can be a huge difference between what can be achieved in the context of a real plastic surgery, and on this computer simulation tool. Only a real, certified surgeon will be able to assess what is realistically achievable. Always ask a certified plastic surgeon about possibilities, risks and financial cost of plastic surgery procedures.”

Disclaimers such as these may, in part, be offered to avoid litigation should harm come to any of the apps’ users. Other apps, however, take the possibility of future harm from cosmetic procedures as their sole purpose. Law firms may, for example, give people planning to have a procedure the opportunity to record every element of the process on an app, so that – should anything go wrong – they have a record which may support future negligence claims.

Just ‘a bit of fun’?

Shortly after the release of the first Shafer App, iSurgeon was launched by Dr Michael Salzhauer (author of ‘My Beautiful Mommy’ a children’s book focusing on a young girl whose mother undergoes abdominoplasty and rhinoplasty; as Zoe Williams wrote in The Guardian at the time, a book that might begin “Once upon a time, mommy had a tummy tuck…”). This app does not answer questions or facilitate, but rather invites users to play.

According to iSurgeon’s website, the app “combines personal image modification with high tech gaming features”, noting that it is “designed to allow users to simulate plastic surgery by easily modifying face and body features.” This app is marketed as a game – indeed, its website address is isurgeongame.com – and Dr Salzhauer notes that the app “delivers on the promise of realistic photo alterations while also allowing users to partake in plastic surgery games playing the role of a surgeon.” Closely associated with ‘games’ is ‘fun’, as is noted by the developers of Plastic Surgery Princess: “This app is for purposes of “fun” only and is not for medical use or medical advice regarding aesthetic surgery or cosmetic surgery.”

The ‘gaming’ aspect of some of the apps I found made me feel uneasy as I read various blurbs. For me, the invasiveness of cosmetic procedures and the potential vulnerabilities of those who might access those procedures, means that ‘playing’ with beauty ideals is a road which should be travelled down very cautiously, if at all. Indeed, more general caution in undergoing cosmetic procedures was urged earlier this week in a House of Commons adjournment debate when the Rt Hon Ben Gummer (Parliamentary Under-Secretary of State for Health) observed that “people should think carefully about how they endorse cosmetic surgery. It is a serious intervention and if anyone seeks to glamorise something about which careful thought should be taken, people and the organisations using those endorsements should treat them with extreme care.”

Concerns might also be raised in relation to the age of users for which apps are deemed suitable. For example, the link to the iSurgeon app through iTunes specifies that purchasers must be at least 17 years old to download the app; and ModYourBod is rated for those over the age of 12. In 2014, there was an outcry against an app which was rated as appropriate for those over the age of nine.

This app – ‘Plastic Surgery & Plastic Doctor & Plastic Hospital Office for Barbie’, which was marketed as a game – was withdrawn from iTunes following campaigns on social media. Its blurb, highlighted by a number of media outlets at the time (e.g. The Independent), depicted a cartoon image of an overweight girl, which was accompanied by the description that “[t]his unfortunate girl has so much extra weight that no diet can help her. In our clinic she can go through a surgery called liposuction that will make her slim and beautiful. We’ll need to make small cuts on problem areas and suck out the extra fat. Will you operate her, doctor? [sic]” In a description offered by a piece published by The Guardian, users are then invited to tap on a surgical tool, then tap again on the body part on which that tool should be used, and “once the surgery is over there’s an opportunity to play dress-up, with a choice of a few hairstyles, dresses and shoes.” This app inarguably trivialised serious procedures, and did so by using language that could most kindly be described as ‘highly insensitive’.

‘Daring to dream’

So far, I’ve identified how apps may seek to promote or facilitate access to procedures; inform potential patients/consumers; or ‘normalise’ the use of surgery as a standard beauty procedure through gaming. One other purpose might be encapsulated in the phrase ‘daring to dream’. Plastic Surgery: Thin and Tall, for example, entices users to consider: “have you ever dream [sic] about thigh gap and bikini bridge? Thin and tall application can make your dreams come true in a few seconds. Plastic Surgery: Thin and Tall is the best application to make you look handsome.” Similarly, the ModYourBod app promises “your dream figure, at your fingertips” (this app also fits into the ‘facilitation’ category, as it enables users to request quotes for the procedure(s) they are interested in). The aspirational rhetoric of these apps again calls to question how they might affect potentially vulnerable audiences, especially given the low age threshold at which they are deemed suitable (Plastic Surgery: Thin and Tall, for example, is suitable for all ages).

Most of the applications I found during my one-hour search appear to focus on a female audience, so I quickly searched further specifically for apps that might be aimed at men. I came up with the a news item published in July 2014 by Market Wired which reported the “first ever male plastic surgery app” – called Manhattan Plastic Surgery for Men. This app is a hub for special offers and promotions for men considering undergoing cosmetic procedures, and provides access to relevant photos and “our private social media community”. Again, this app is rated as suitable for people over the age of nine.

The only other app aimed at men which I found in my searches took me into the realm of ‘giving’ cosmetic procedures as gifts to woo women. According to a piece published by Business Insider, Carrot Dating (since banned from iTunes), enables men to “bribe their way to a date” (as an aside, the first line of the press release issued by Carrot Dating is: “There’s only one method of manipulation that has stood the test of time: bribery. It’s a concept so simple that even animals understand - give a dog a bone, and it will obey. Give a woman a present, and she’ll...”) One of the bribes put forward as an option is the offer of plastic surgery to potential female partners.

At this point, I stopped searching, took a breath, made myself a strong cup of tea, and ate a custard cream.

One hour later…

Looking at the range of apps available was enlightening: in the course of an hour, I'm sure that I've only skimmed the surface of what’s available. What I've identified in this blog therefore clearly isn't any better or worse than other apps I haven’t written about – they’re just simply those which I found first.

To complete my mini research exercise, I looked for evidence as to the effect of apps on people’s motivation to actually undergo cosmetic procedures. I came up short. I found studies that report on the effect of reality TV, magazine consumption, and aspiring to film star looks. The proliferation of apps and their influence on those who access them, however, appears to be an area which hasn't been addressed empirically by researchers. Given that many people have smartphones and tablets clamped to their sides 24/7, this gap in evidence is something that needs to be addressed, and addressed soon.

This post was originally published on the Nuffield Council's website.

Kate Harvey is a Senior Research Officer at the Nuffield Council on Bioethics. She undertakes a wide variety of research for the Council’s projects and monitors policy developments. Since joining the Council in 2007, she has worked on several topics including the ethical issues of dementia, and the donation of bodily material. The most recent project she contributed to focused on ethical issues arising in the involvement of children and young people in clinical research. As part of this project, she worked with film-makers to produce animated and live action films to support the Council’s work. Her current work focuses on ethical issues which may arise in the context of cosmetic procedures.