In the age of Instagram filters and Snapchat beauty lenses, the relationship between social media, cosmetic procedures, and the poor mental wellbeing of young people in India is becoming increasingly problematic.
The interplay between social media, cosmetic procedures, and the mental wellbeing of young people in India is increasingly problematic. Photo: Nikada
Tattoo artist Karan, formerly Karan Sidhu, hit headlines in 2017 when he became the first person in India to tattoo his eyes completely black, travelling to New York for the procedure. But this wasn’t the first time the social media influencer, who has amassed an Instagram following of 118,000 and counting, sought a new and potentially risky cosmetic intervention to alter his appearance.
“I have split my tongue into two. I am an artist and modifying my body is my passion. Every time I learn about a process to modify a body part, I go and get it done,” Karan says.
Some of the most extreme include surgical procedures that modified his jawline and reshaped his forehead with silicone implants. “My blood pressure and pulse dropped drastically, which could have [led to] death. It was a really tough procedure,” says Karan, of the forehead procedure.
Karan started altering his appearance with tattoos at the age of 13. Now 34, he has a markedly different appearance. “While I was always passionate about [cosmetic interventions], I got more serious at the age of 23. I had a break-up with my partner and I was looking for attention. Every body modification would get me attention and accolades on social media. Now, I do it for my own passion and satisfaction,” Karan says.
Dr Swaroop Singh Gambhir, the plastic surgeon at Sir Ganga Ram Hospital in New Delhi who has performed most of Karan’s procedures to date, says he is regularly contacted by people interested in cosmetic procedures. While the field of dermatology is essential to treat skin problems such as burn injuries, cancers, and other skin diseases, he says demand among younger people for elective cosmetic procedures is booming.
“Karan’s story is an extreme example, but it does point towards a trend. I receive more younger people than before who would like to have skin and hair interventions to look more desirable and attractive,” Gambhir says.
Growing demand for cosmetic procedures
The quest for flawless skin and a desirable appearance has long driven demand for cosmetic products in the beauty industry. But in the age of curated social media feeds, a new trend is emerging of young adults seeking increasingly aggressive skin interventions from dermatologists and cosmetologists. These young adults want to achieve a certain look to get more positive attention on visual-based social media platforms like Instagram, TikTok and Snapchat.
“Among women, nose jobs and lip jobs are the most common interventions on the face. Among men, hair transplants [moving hair from one part of the body to another] are common."
At the reception of Gambhir’s clinic, pamphlets and booklets for cosmetics companies entice people to undertake cosmetic procedures. They advertise enhancements such as highlighting cheekbones using fillers, removing extra hair with laser, and improving hair growth with implants.
“Among women, nose jobs and lip jobs are the most common interventions on the face. Among men, hair transplants [moving hair from one part of the body to another] are common. Nose jobs, gynaecomastia removal [male breast reduction surgery], and liposuction are also very common,” Gambhir says.
“Some people want to broaden their nose, while others make it narrower or sharper. Similarly, lip augmentation requires products such as hyaluronic acid to be injected into the lips to give a pout. But there are more invasive processes in which people, especially women, go through surgery to reconstruct their lips, which requires soft tissue facial reconstruction.”
Dr Smriti Naswa Singh, a dermatologist at Fortis Hospital in Mumbai, agrees that procedures that cosmetically alter the lips, nose, breasts, buttocks and hair are most common. She says there is also growing demand for removal of skin pigmentation and the hydrated and shiny skin look made popular in Korea. "The latest trend is Korean ‘glass skin’,” Singh says.
But like any form of surgery, cosmetic procedures carry risks—including problems related to anaesthesia and surgery and excessive bleeding, infection, scarring, and failure to heal. They don’t always go as planned and extreme cases can lead to fatal complications.
In 2021, an approximately 35-year-old resident of Delhi went to a salon for a hair transplant. On returning home, he developed serious pain in his scalp followed by swelling on his face and shoulders. He was admitted to hospital and died within two days due to septic shock with multi-organ failure. He had developed Stevens-Johnson syndrome, a rare and serious disorder of the skin and mucous membranes.
During legal proceedings in Delhi’s High Court, it was noted that the transplant was performed by an unqualified person who did not have “any certificate of clearance of hair transplant”. The salon did not gain informed consent from the patient or disclose to him the risks involved with the procedure. The court ordered the Delhi and central governments to take appropriate action to avoid repeating such incidents.
Social media exacerbates body image crisis
Despite the risks, in a society where beauty standards are often dictated by fair and smooth skin, young adults in India find themselves grappling with societal pressures to conform. These largely unattainable standards have a long history and are commonly linked to British colonialism, Eurocentric standards of beauty, and the caste system.
“[Social media] not only makes people want to look more desirable, but it also informs them about what is desirable, what is trending, and how to achieve it.”
The possibility of being seen and judged around the clock by people beyond one’s own immediate physical surroundings adds an extra layer of pressure—and takes a huge toll on mental health.
“Being image and body conscious is not a new phenomenon, but social media’s impact compounds this in two ways. It not only makes people want to look more desirable, but it also informs them about what is desirable, what is trending, and how to achieve it,” says Dr Kedar Tilwe, a psychiatrist at Fortis Hospital in Mumbai.
“People spend a significant part of the day preoccupied with likes and comments. The need for a perfect photo or selfie has never been felt more. Increased need for compliments has increased stress levels.”
Photo: Priscilla du Preez
A 2022 study examining the impact of Instagram on young adults in India analysed the responses of
participants across three parameters: colourism, social comparison, and mental health. It found that Instagram use increases focus on skin colour and the tendency to compare one’s life with others, both of which are associated with a rise in social anxiety. Younger people were more vulnerable to the negative impacts of colourism, social comparison, and mental health problems than older people.
“Our study covered people from 18 years to 30 years. We chose this range because 18-year-olds are very young, while 30-year-olds are relatively mature but spend substantial time on social media,” says co-author Prathamesh Churi, a former faculty member at the Department of Computer Engineering at NMIMS University who now works as a technical consultant for information technology companies.
He says the study found people were worried about their skin colour. “Nearly 50% of the participants said that they would feel more confident with a lighter skin tone,” he says. Similarly, nearly 40% of participants admitted they “feel under pressure to fit into a particular image or post specific pictures to remain popular on Instagram”.
“A lot of people experience expectations [through social media] of how the body should look—no marks, smooth, and without blemishes,” says Joshua Mark George, a counsellor at Sangath, a leading Indian public mental health NGO.
Studies show that a higher proportion of people undergoing cosmetic procedures have mental health conditions such as anxiety and depression. George says social media can amplify body dysmorphic disorder (BDD), a mental illness characterised by constant worrying over a perceived or slight defect in appearance. Many people with BDD seek cosmetic procedures, but they are often dissatisfied with the results and want further procedures.
The phenomenon of people requesting cosmetic procedures to resemble digitally enhanced images of themselves has been referred to as “Snapchat dysmorphia”. “Using filters to change appearance alienates people from their bodies and they no more appreciate the skin that they have,” George says.
Towards effective policy interventions
India has the largest youth population in the world, with around 66% of the population below the age of 35, so it is crucial for policymakers to find solutions to the growing influence of social media on cosmetic procedures and mental health problems.
Government intervention has an important role to play in the search for solutions, both in the regulation of cosmetic procedures and in reducing the impact of social media on mental health.
The elephant in the room is young people wanting cosmetic procedures in order to look “desirable” as defined by social media.
Following the Delhi High Court’s directions in the case related to the hair transplant death, the Union Health Ministry set up a committee to prescribe minimum standards for skin, hair, and dental cosmetology in clinics across India to increase safety and reduce the number of unregulated salons. However, as states are yet to frame the rules that fulfil the governing legislation, implementation of these minimum standards is yet to occur.
There is also a need to combine cosmetology with psychiatry. A 2021 review by eminent doctors makes a case for psychiatric assessment and management of clients undergoing cosmetic surgery. Considering the possibility of deteriorating mental health after surgery, they advise that a risk-benefit analysis be carried out before surgery to assess whether patients stand to benefit from it or not. If the patient doesn’t stand to gain, and in fact may slip into a worse mental state, the procedure should be avoided.
But the elephant in the room is young people wanting cosmetic procedures in order to look “desirable” as defined by social media. The American Psychological Association recommends that young people be encouraged to use social media to create opportunities for social support, online companionship, and emotional intimacy.
While it is impossible to regulate social media platforms to completely remove biases that drive norms around physical appearance, Churi says there are technical strategies that can be effective. “If gone unchecked, social media platforms underscore existing biases. That’s how the algorithms work,” he says.
“Biases can be decreased by mathematical methods,” Churi says, recommending that the government regulate social media platforms to reduce reinforcement of pre-existing biases around body image.
“The government should also bring out an advisory limiting use of social media among young people. It should become part of India’s national education policy,” he adds.
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