AI filters take 'ideal beauty' to extremes that don’t exist naturally, says Dr Debraj Shome

Every year, an alarming number of Indians—especially the youth—lose their lives in incidents linked to the growing selfie craze. Beyond the physical dangers, a deeper psychological cost is emerging. A study, published in the Journal of Cosmetic Dermatology, examined how taking, editing, and posting selfies on social media impacts self-esteem, confidence, body image, and mood among Indians. The study found that selfie habits are strongly associated with self-image dysmorphia and an increased desire to undergo cosmetic surgery. Among the 300 participants studied, researchers observed a significant rise in social anxiety, a dip in self-confidence, and a marked increase in cosmetic surgery aspirations. In conversation with THE WEEK, Dr. Debraj Shome, Co-Founder and Director of The Esthetic Clinics and co-author of the study, unpacks the nuances of the younger generation’s struggles with “digital beauty.”

Q: How is Gen Z’s relationship with digital beauty—through selfies, filters, and social media—reshaping the way cosmetic consultations are approached by surgeons and dermatologists?

A: Gen Z and Gen Alpha are rewriting the rules of beauty. Having grown up in a digital world, “looking good” for them has a lot to do with how they appear on a six-inch screen, under filters and algorithms that decide what’s beautiful. They’re growing up with a digital mirror that’s constantly altering their sense of reality and self.

We often see this in the clinic as well. Earlier, patients came in with photographs of celebrities; today, they bring their own selfies, but airbrushed, filtered, and retouched. In our 2019 study published in the Journal of Cosmetic Dermatology, we found that people who posted retouched selfies reported an 82 per cent higher desire to undergo cosmetic procedures compared to those who didn’t. To me, this means that our role as surgeons has evolved. We aren’t just technicians anymore, but part counsellor and part educator. We spend as much time helping patients understand what’s medically possible and psychologically healthy as we do discussing the procedures themselves.

Q: What new ethical boundaries are surgeons having to negotiate as AI-driven filters and social platforms distort patients’ expectations of “ideal beauty”?

A: This is one of the biggest challenges we face today. AI-driven filters can create flawless, symmetrical, and “perfect” faces with the smoothest skin, sharpest jawlines, biggest eyes, and most aesthetic noses. But as the name suggests, these filters cut out a certain sense of reality to push anatomy to extremes that aren’t surgically possible or even healthy to attempt. In fact, participants of our study who retouched their selfies before posting were more likely to report dissatisfaction with their real-world appearance and a stronger desire for surgical alterations. That dissatisfaction can spiral into body image issues and, in some cases, body dysmorphic disorder (BDD).

We see more and more patients who want to look exactly like their filtered selfies. The ethical question for surgeons is, where do we draw the line? I believe that we must balance patient autonomy with professional responsibility. Sometimes that means saying no to certain requests and helping patients understand why. Our role is not just to deliver any procedure that a patient asks for; it’s also to safeguard their physical and psychological well-being. That requires empathy, transparency, and, in some cases, guiding patients toward healthier ways of seeing themselves.

Q: In what ways does the act of posting edited selfies correlate with heightened social anxiety and reduced self-confidence, as observed in the study?

Posting selfies has become a form of social validation for Gen Z, but there’s a hidden cost. Our research found that after uploading selfies, participants experienced a significant increase in social anxiety (P < .004) and a drop in confidence levels (P < .002). Interestingly, those who edited their selfies before posting were the most affected.

What’s happening here is a psychological disconnect. When you repeatedly post a filtered, perfected version of yourself, over time, you might start internalizing that as your “true” identity. When reality doesn’t match this curated version, it creates feelings of inadequacy and self-doubt. This gap between the digital self and the real self is what drives the anxiety.

I’ve seen this play out in consultations, too. Many patients tell me they feel “less attractive” offline than they appear online, and they want surgery to “close that gap.” It’s a classic feedback loop, and understanding this psychological dynamic is becoming as crucial as understanding surgical techniques.

Q4. How does gender influence the psychological impact of selfies, with women showing higher levels of anxiety and desire for cosmetic change compared to men?

Gender plays a significant role in how individuals experience the pressures of digital beauty. Historically, women have faced far greater societal scrutiny over their appearance, and social media has amplified that pressure. Our study reflected this clearly: 70% of women reported a decrease in confidence after uploading selfies, compared to 55% of men. Similarly, 65% of women expressed a greater desire to change their looks through cosmetic procedures versus 62% of men.

Interestingly, while women remain more affected, we are starting to see men entering this space too. Male grooming, aesthetic treatments, and procedures like jawline contouring or hair restoration are gaining acceptance, especially among younger men.

But for women, the issue is often compounded by the internalisation of beauty ideals perpetuated by filters and influencer culture. These platforms often present a homogenised “perfect” look, and for many women, the pressure to match this standard can become overwhelming. This is why gender-sensitive counselling during consultations is critical.

Q: Are AI beauty filters worsening self-image dysmorphia by setting unattainable standards, and how does this affect the demand for cosmetic surgery?

A: Absolutely. AI-powered filters take “ideal beauty” to extremes—perfect symmetry, poreless skin, and proportions that simply don’t exist naturally. Our study showed that participants using editing apps like BeautyPlus and Candy Camera reported greater dissatisfaction with their natural appearance and a significantly higher desire for cosmetic procedures compared to those who posted unedited selfies.

This has directly impacted the demand for cosmetic surgery. More patients now come in wanting to replicate the “filter-perfect” version of themselves. But here’s where professionals must tread carefully: not every “desired change” is psychologically healthy or anatomically achievable. We always make sure to check in on the patient’s reasons for wanting surgery and say no when it seems unsafe.

We need to differentiate between enhancing confidence and chasing an unattainable ideal. For patients showing signs of self-image dysmorphia, surgery often won’t solve the underlying problem—in fact, it can make it worse. In such cases, guiding patients toward therapy or helping them reset expectations is a far more ethical approach.

Q: How can cosmetic professionals differentiate between genuine patient needs and those shaped primarily by social media pressures?

A: For me, this is where the consultation process becomes critical. Today, it’s not enough to ask what a patient wants; we also need to understand why they want it. If a patient repeatedly uses phrases like “I want my face to look like this filter” or “I want to look better on Instagram,” that’s often a red flag that their request is driven by external pressures rather than intrinsic dissatisfaction. We’ve introduced psychological screening as part of our process, especially for younger patients. Tools to assess tendencies toward body dysmorphic disorder help us identify individuals who may not benefit from surgery. In borderline cases, we collaborate with mental health professionals to ensure that patients make informed choices.

The goal is simple: cosmetic procedures should support well-being, not fuel an endless chase for algorithm-driven beauty. As practitioners, we have to take on the responsibility of drawing that line.

Q: How are influencer culture and excessive selfie-taking interconnected, and what impact does this relationship have on beauty ideals and cosmetic surgery demand?

A: Influencer culture and selfies feed each other. The more perfect images influencers post, the more they set new beauty benchmarks. And the more we scroll, the more we compare ourselves, the more we post, and the cycle continues. In our study, participants who spent over six hours a day on social media reported far higher dissatisfaction with their looks and a stronger drive toward cosmetic enhancements.

The bigger problem is that this has created a kind of copy-paste beauty. Everyone wants the same lips, the same jawline, and the same skin texture. Demand for quick, minimally invasive procedures like fillers, Botox, and skin rejuvenation treatments has skyrocketed because people want to look “Instagram-ready” all the time. But I always remind my patients: the goal isn’t to look like everyone else. Real beauty lies in individuality, not uniformity. That’s a message we need to hold on to.

Health