Image: W Mag

Lip fillers are “as commonplace as getting your hair done these days.” That is what British skin clinic, RTW Skin, declared in a now-defunct ad campaign aimed at encouraging mothers to bring their daughters to see RTW Skin’s “experienced and accredited practitioners” to plump up their pouts. Alongside an image of 3 young women, RTW Skin revealed that “dermal fillers” – non-surgical injections that result in fuller lips – are not only becoming an increasingly popular cosmetic procedure for women of all ages, but are especially in-demand for younger ones.

After getting wind of the RTW Skin ad by way of a consumer-filed complaint, the British Advertising Standards Authority (“ASA”) initiated a probe, questioning whether the ad is “irresponsible” for potentially “encouraging children to undertake cosmetic procedures.”

In response to the ASA investigation, RTW Skin revealed that it believed that “decision to run the ad had been a responsible one.” A representative for the clinic further stated that the author of the advertisement’s text – a 20-year old member of RTW Skin’s staff – “believed her peer group (15–25 year-olds) [is] particularly vulnerable to the messages put out by reality TV shows and social media, and believed education and discussion of the subject was important.”

The ASA was not persuaded, though. In furtherance of its finding that the ad amounts to “iresponsible advertising,” the ASA ordered RTW Skin to cease all publication of the ad and to “ensure that future ads do not present lip fillers as normal and safe for young women and teenagers and something that responsible parents should support.”

Meanwhile, the American Medical Association (“AMA”) has taken to questioning both the practical and ethical challenges that come with social media advertising of plastic surgery, particularly as up to 70 percent of patients “take advantage of this source of information” and view it as a “powerful influence on their choice of plastic surgeon.”

The AMA, which is the largest association of physicians in the U.S., noted this past spring that at present, “There are no restrictions on advertising in medicine except when it can be specifically justified as necessary to protect the public from intentionally misleading practices.” As a result, there is a significant need for “physicians to consider the likely effects” of advertising cosmetic procedures on social media, which the AMA calls “a problematic new ecosystem that can foster deceptive professional behavior,” from an ethical perspective.

For instance, “Invoking the image of a beautiful celebrity to drive demand for a surgical procedure can create a particular type of vulnerability for patients,” the AMA asserts. Beyond “unfairly anchoring patient expectations in the idealized image of a global celebrity,” sending a “message that patients’ appearance is damaged and can only be repaired by experts using highly specialized techniques means that patients who internalize that message start to evaluate the work of those experts from a disempowered position.”

With that in mind, all physicians, but plastic surgeons most specifically, should approach social media advertising of their work “with caution and probity” and should aim to use social media “to elevate and protect the science of plastic surgery and safeguard the trust of patients.”

An influx of ethics and advertising questions come as cosmetic procedures are on the rise amongst women across the globe. The American Society of Plastic Surgeons revealed that the use of minimally invasive cosmetic procedures grew by 186 percent between 2000 and 2017, with Botox injections up 819 percent over that 17 year period, and fillers, such as lip injections, growing by 312 percent.

While the number of procedures has grown, the ages of those on the receiving end of such procedures has dropped over time, thanks, in large part, to the rise of social media and selfie culture.

“You cannot understate how impactful social media has been in this field. We see it every day in a variety of ways,” Patrick Byrne, director of the Division of Facial Plastic and Reconstructive Surgery at Johns Hopkins University, told Allure last year. A recently released study from the American Academy of Facial Plastic and Reconstructive Surgery (“AAFPRS”) highlighted a “strong link between millennials and the growing demand for cosmetic procedures,” with “facial tweaks and treatments being sought after at a marathon pace.”

That study, which was published in January, found that in 2018, “72 percent of facial plastic surgeons saw an increase in cosmetic surgery or injectables in patients under age 30.” In the past 5 years, alone, there was a 24 percent increase in patients under age 30 seeking cosmetic surgery or injectables, up from 58 percent in 2013 to 72 percent last year.

“Unlike prior generations who often kept their tweaks on the low,” the report states that “millennials are coming of age in a time where facial plastic surgery is normalized – even deemed mainstream by some in an era of ‘resting rich face’, selfies and social media.”