Two months ago, a 12-year-old girl from Mumbai faked her age, said she was 16 and entered the clinic of cosmetic and reconstructive surgeon Dr Debraj Shome, demanding that her lips be enhanced like the filtered selfie on her phone. She had even got a cash advance of Rs 25,000. “I sensed something was grossly wrong, demanded that I speak to her parents and wanted her Aadhar card. She admitted to being just 12 and threatened me that she would abuse me online if I did not comply with her request. A few days later, a 16-year-old brought in a collage of eyes, nose, hairlines and lips of her favourite stars, with lips like Angelina Jolie, hair like somebody else and so on,” he says.Body dysmorphia — obsession with perceived flaws in appearance that to others can’t be seen or appear minor, and a desire to fix them surgically — is the greatest mental health challenge that every teen has to negotiate today. “Doctored and filtered selfies are leading to a greater desire for cosmetic surgery. Through a selfie filter, young people get used to seeing themselves in a certain way that’s vastly different from their mirror image. This perception drift even changes the neural wiring of the brain,” says Dr Shome, who devotes more time to counselling young people about their body image and saying “no” to requested procedures.The desire for becoming a selfie clone is so deep-rooted that Dr Shome actually did a study across metros — Delhi, Mumbai, Bengaluru and Chennai — and found that body dysmorphia cases had spiralled since 2019, with increased dependence on screen time.Preliminary results from an ongoing 5,000-participant study by The Esthetic Clinics helmed by him indicate rising selfie addiction among youth, fuelling an increased desire for cosmetic surgeries. Early research confirms retouched selfies heighten anxiety, lower confidence and boost cosmetic surgery aspirations. The findings have been published in The Journal of Cosmetic Dermatology.Why are young patients approaching cosmetic surgeons with filtered selfies or AI-edited images as references?That’s because images can alter psychological states. “We found a direct correlation between selfie activity and heightened levels of social anxiety, body dissatisfaction and the wish to change one’s physical features through surgical means. Participants who used filters and editing apps before uploading their selfies were the most affected,” says Dr Shome.“The selfie craze and the demand for cosmetic surgery in teens are not just about vanity. They are a cry for help from a generation struggling to find their authentic self in a world of filtered perfection, a world where the line between a healthy desire to look good and a debilitating mental health condition has become dangerously blurred,” says Dr Shaunak Ajinkya, psychiatrist at Kokilaben Dhirubhai Ambani Hospital (KDAH), Mumbai.Story continues below this adIn recent years, most young people have referenced AI-generated or filter-enhanced images, from digitally smoothened skin, contoured jaws, bigger eyes and narrowed noses. “This behaviour reflects a shift in how young people perceive beauty — not as something natural or individual but as something that must match a manipulated digital standard. What’s especially concerning is that these altered images are often not achievable in real life, leading to a disconnect between perception and reality,” says Dr Shome.Social media platforms reward certain visual aesthetics, pushing users to compare themselves to digitally perfected versions of others and, increasingly, of themselves. This creates unrealistic benchmarks. “Our research showed that even a single selfie upload, particularly one that’s retouched, can trigger immediate negative emotions: decreased confidence, dissatisfaction with appearance and increased social anxiety. These effects are amplified in young people, especially girls, who are more exposed to appearance-based validation through likes and comments,” says Dr Shome.Over time, this constant exposure can lead to filter dysmorphia — a condition where individuals no longer see themselves clearly and instead chase the illusion created by a screen.Social media algorithms, which are designed to keep users engaged by showing them content similar to what they’ve already interacted with, magnify the problem. “If a teen starts looking at content about nose jobs or lip fillers, the algorithm will show them more and more of it, normalizing these procedures and making them seem like a common, even necessary, part of life. This creates an echo chamber that reinforces the belief that their perceived flaws are a serious problem that requires a surgical solution,” explains Dr Ajinkya.How to scent out red flags?Story continues below this adDr Ajinkya advises parents and adults to watch out for abnormal behavioural patterns in teens, like constantly checking themselves in the mirror or avoiding them completely.“They may try to hide themselves away under layers of makeup or clothing, or be constantly grooming themselves. They may seek constant validation from everybody and not believe them when they give the clean chit. Watch out for any social avoidance patterns, like not going out of the house or not interacting with peers, signs of withdrawal and depression,” he says.What goes on in a teen mind?The teenage years are a critical period of development marked by significant changes in the brain’s structure and function. The adolescent brain is still developing, particularly the prefrontal cortex, which is responsible for executive functions like decision-making, long-term planning and impulse control. Conversely, the limbic system, which controls emotion and reward, is highly active.“This imbalance means teens are more prone to seeking immediate gratification (like the dopamine hit from a positive social media interaction) and less capable of considering the long-term consequences of their actions, such as undergoing an irreversible surgery,” says Dr Ajinkya.Story continues below this adAdolescents experience a psychological phenomenon known as the “imaginary audience,” a belief that everyone is constantly watching and judging them. This can amplify feelings of self-scrutiny and shame about one’s appearance.“We must understand that for them their bodies are closely linked to their identities. A core task of adolescence is to figure out ‘who am I?’ and ‘where do I fit in?’ They use social feedback — likes, comments, and shares — as a barometer for their self-worth. When a selfie or a video doesn’t get the desired reaction, it can be interpreted as a personal failing, leading to intense self-criticism. So shift that validation to their extra-curricular activities,” suggests Dr Ajinkya.What about therapy?Therapists, particularly those specialising in cognitive-behavioural therapy (CBT), can help teens challenge their distorted thought patterns and develop a healthier self-perception. “Teaching teens how to critically analyse and deconstruct the images they see on social media is crucial,” says Dr Ajinkya.In addition to psychotherapy, Selective Serotonin Reuptake Inhibitors (SSRIs) are often prescribed because body dysmorphia may be linked to an imbalance of brain chemicals like serotonin. These medications can help control negative thoughts and repetitive behaviours, making it easier for a patient to engage in and benefit from CBT.Story continues below this ad“Parents serve as a crucial gatekeeper and protective influence against the negative effects of social media and poor body image. They must be patient and supportive, listening without judgment and creating a space for open communication. It is vital that they avoid dismissing a teenager’s concerns by saying things like ‘you look fine,’ as this can invalidate their feelings and make them feel as if they cannot be open about their struggles,” says Dr Ajinkya.A parent’s own relationship with their body and the language they use around food, weight and appearance can significantly influence their child’s mindset. They should praise their child for their skills, talents and character rather than their physical appearance, thereby reinforcing that their worth is not tied to how they look.On a broader scale, Dr Ajinkya feels, “a societal shift is required toward media literacy and a re-evaluation of beauty standards.”