7 mins


Cosmetic doctor and campaigner for natural-looking results Dr Joshua Van der Aa looks at the effect AI filters and ‘magic avatars’ have on body image and patient expectations

A picture is worth a thousand words, as we tend to say, and this can certainly be true during consultations – if the image is suitable.

Patients frequently rely on photographs to describe how their facial features once looked or to help illustrate how they’d prefer them to appear going forward. They’re usually incredibly helpful aids, encouraging discussion and helping with treatment planning.

Of course, I’m also shown many that are the opposite: pores pixelated with too much zoom orclose-ups of lip corners; even distant shots too grainy to decipherwhen magnified. And, like all of us, I’m sometimes presented with images of celebrities whose facial structures bearlittle resemblance to those ofthe patient sitting opposite me, triggering an entirely different conversation altogether.

Lately, however, I’m almost at the point of holding my breath when a patient delves into their bag in search of their mobile phone. Why, exactly? Well, because there’s a new ‘red flag’ in town: ‘magic avatars.’

Yes, really. In recent months – on three separate occasions – when I’ve been asked: ‘Can I show you a picture?’ I’ve been shown a portrait created by Artificial Intelligence software.

If the concept is unfamiliar, allow me to elaborate. There’s an app called Lensa that went viral towards the end of last year for its Magic Avatar feature. Users upload several selfies and then receive their photos revamped by AI into zany art styles, including Kawaii, Anime, Pop, and Fantasy. So far, so fun.

But some users find they prefer how these make them look – that they’re “more beautiful” – depicted in Cosmic or Fairy Princess mode and, quite alarmingly, want their real-life features reshaped to match the illusion.

That’s worrying on several levels, not to mention potentially dangerous, and could it be more common than I dare think? Given that I market myself entirely on the foundation of natural looking results, it’s surprising anyone should come to me of all people in hope of exaggerating their features in line with such cartoonish – or unhuman – depictions. So, are less scrupulous, or even ‘lay’ practitioners being asked the same question – and more frequently? More importantly, are they agreeing to attempt this?

Lensa app users can upload a selection of selfies and, for a small fee, receive AI-generated “magic avatar” digital portraits in a variety of art styles.

Of the re-imagined portraits shown to me – incidentally, all three patients were women – the features topping their wish lists were overly pronounced cheekbones, inflated glossy lips and very big hair. But, unlike typical filtered images, which are also problematic, not all Magic Avatar art emanates from human facial ratios. Put another way, what I’ve experienced is that some people are now measuring their beauty against these artificially illustrated likenesses, turning to them almost as barometers.

Lensa avatars aside, in recent years I’ve been having weekly conversations in my consulting room – often more than once a day – about shots doctored by face-altering filters and the misplaced belief that the pictures and videos seen on Instagram are real.

There’s been an over-reliance on them for some time, to such a degree that it would be hard to find many users who’d contemplate posting their selfie without one – as many as nine in ten young women do according to one study by University of London’s Gender and Sexualities Research Centre; never more so since Lockdown ended, in my experience.

By this time the surge in activity on the platform – and too much time scrutinising reflections in mirrors after glimpsing an unfortunate Zoom angle – meant that those who weren’t rushing to backstreet injectors before restrictions lifted were, instead, relying heavily on editing apps to show their face online. The impact on some has been to feel dissatisfied with their actual appearance and to chase any and every possible ‘fix’ to look more like their digitally modified version.

It’s understandable, to a point. We take our phones with us everywhere, so we’re fed a constant diet of perfected images. It’s no longer simply about the re-touched models in magazines – benefiting from professional photographers, studio lighting, make-up artists and airbrushing art directors – our phones pour an unending stream of edited pictures of the people we know: friends, colleagues, and neighbours, all looking impossibly fabulous, or FaceTune enhanced.

It’s easy to see how, after time, we forget the ‘behind-the-scenes’ reality and accept the representations on our phones as genuine. We’re living in a land of ‘comparison culture’ fuelled by a combined social, digital and reality media age, and it’s not an easy one to navigate. The depictions of beauty standards we consume minute by-minute are complex, shifting, unattainable, conflicting, and untrue.

Let’s look at a snapshot of the spectacularly mixed visuals from the past couple of years:

• Reality stars and influencers sporting “Instagram Face” – lash extensions, inflated lips, high cheekbones and hoiked brows, razor-sharp jawlines, pore-less skin and tiny noses.

• Stars in their fifties who don’t look a day over 35, attributing their ageless looks to no more than olive oil, jade rollers, and lemon water.

• TV contestants dissolving their over-done lips – a welcome step in the right direction. At the same time others, such as Katie Price, are publicly undergoing repeated surgery to enhance their already disproportionate features.

Then there’s the endless and confusing mix of tabloid messages, from filler horror stories to those that seemingly glorify extreme procedures such as “world’s biggest cheeks”. I even saw one with a sidebar link to a story on buccal fat removal.

All the while, trends for unsightly, unsafe techniques such as Russian lips and #snatched (jawlines) permeate our feeds.

There’s no quick fix for these unrealistic expectations or the desire to over-inflate facial features. Professionally, each of us – individually – has a tremendous responsibility to continue championing natural-looking results consistently reminding those we advise – in person and in marketing – where the real beauty lies.

And that, at least in part, is in some natural imperfections; those teeny and attractive quirks that add character, making us individual. Retaining a ‘human’ appearance, hopefully, goes without saying. Looking natural is timeless, real, and safer. We should play no part in facilitating distortion nor in any unnecessary endeavour to erase every perceived flaw, it’s a slippery slope and neither likely to remedy feelings of low self-worth nor provide elegant results.

For my part, like many colleagues, I dedicate most of the appointment time to the consultation. I’d go as far as to say that time is more important than that spent administering the treatments. And I find most patients welcome the chance to understand what would and wouldn’t be beneficial to balance their features, and why.

I explain the limitations of injectables because we should all respect what can’t be done non-surgically as much as what can. And I confidently and regularly refuse procedures I don’t consider beneficial.

Dissolving misplaced, migrated, or overdone filler given elsewhere is also a must before we can even think about achieving a refreshed and subtly enhanced beauty. But, fortunately, I’m finding patients are seeking removal of existing, obvious filler themselves in steadily increasing numbers. Hopefully, this indicates that the tide is turning.

Having campaigned on the matter via my platform, I’m all too aware that we must clean up our backyard where pictures are concerned. It’s not a good look for the profession when some even go as far as altering their ‘after’ images before posting them.

Maintaining uniform conditions between Before and After is virtually unachievable, but we must at least be honest and try to do better.

There are too many examples of Photoshopping, playing with facial expressions, angles, and lighting to exaggerate results. This wrongs our patients and wounds us. Posting truthful, graceful, natural-looking before-and-afters helps push back against the plethora of pictures fuelling delusory expectations and conspicuous results.

If more of us do this consistently and educate our followers on how to read these images, the more likely we are to standardise skilled and intricate results.

AI is in its infancy, but its potential is huge. One can only wonder what influence it will grow to have and the problems it could pose.

That’s why it’s more important than ever that we arrest misconceptions as they arise and change attitudes now. We need to make patients realise the difference between tweaking what they were born with and trying to reinvent themselves based on what technology can do to manipulate a few pixels.

But the point is not merely to be alert to issues arising from the growth of AI, bringing to the fore, as it can, the evolving guises of Selfie Dysmorphia.

It’s in giving space to listen to and helping patients to interpret what they see, and managing their ‘Insta-anxiety’ by encouraging them to become conscious consumers and look at it analytically. Could they do something as simple as hitting ‘unfollow’ on accounts that give rise to feelings of inadequacy?

However, ultimately, it must be about deploying our skills to achieve the most elegant, refreshing outcomes only. That, to me, is the essence of picture-perfect.

To find out more, visit or follow @drjoshualondon on Instagram.

This article appears in March 2023

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March 2023
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