Treating patients in the era of reality TV - Hamilton Fraser


Summer has arrived and that means that Love Island has been back on the nation’s screens. After a break from the show last year due to the pandemic, viewers have been tuning in once again to watch a group of singles try to find love in the confines of a tropical villa, witnessing every twist and turn in their pursuit of romance. The show has an undeniable influence – it’s become a talking point in both schools and the workplace amongst people of all ages, thrusting its contestants into the public eye and turning them into stars overnight.

The impact of reality TV on mental health

But whilst many of us enjoy the show for its drama and entertainment value, it’s also having a real effect on young people and how they view their bodies. A survey conducted by the Mental Health Foundation in 2019 showed that almost one in four people aged 18 to 24 said that reality TV makes them worry about their body image.

In recent years, Government ministers such as the ex-Mental Health Minister, Jackie Doyle-Price, have blamed shows such as Love Island for fuelling a trend in cosmetic surgery, pointing out that these types of shows portray an unrealistic ideal for women, especially young women, of the ‘perfect’ body. In a survey by the doctor booking website Realself, of those who said that they were considering a nonsurgical treatment, 62 per cent were 18 to 34 years old.

The “Love Island effect” was blamed for the average age of women going under the knife dropping from 42 in 2012 to 37 in 2018. More worryingly, a poll conducted by VICE UK found that 59 per cent of 51,000 respondents believe that getting lip fillers is comparable to getting to a haircut or manicure. The normalisation of cosmetic treatments has reached a point where individuals are not fully researching procedures properly, potentially putting themselves in danger.

In this summer’s series, five of the original seven female love islanders, with an average age of just 24, have had cosmetic surgery including lip fillers, Botox and breast implants. Ashton Collins, director at Save Face, told The Mirror that since this series of Love Island started, they had experienced a 37 per cent increase in searches for lip fillers on their website.

This isn’t the first boom in the market brought on by reality TV. During an episode of Keeping Up with the Kardashians back in May 2015, it was revealed that Kylie Jenner had lip fillers, and this caused a peak in searches for the treatment. One London clinic reported a 70 per cent increase in enquiries during the following 24 hours.

What has changed?

Twenty years ago, most people seeking aesthetic treatments were patients over the age of 40, who wished to look younger. Today, more and more younger people are opting for cosmetic surgery to look like reality TV stars and celebrities. In fact, a recent global report by Allergan revealed that, out of all age groups, those aged 21-35 are the most likely to consider aesthetic treatment as soon as they notice a concern. Another report by Mintel found that 28 per cent of 18- to 24-year-olds and 31 per cent of 25- to 34-year-olds have had some form of cosmetic treatment (compared with an average of 21 per cent for the whole UK population).

Alarmingly, demand for injectables for under 18s has also been on the rise – a survey cited by MP Laura Trott, who sponsored the Botulinum Toxin and Cosmetic Fillers (Children) Bill showed that 100,000 under 16s had undergone cosmetic enhancements, with the most common being fillers.

Somewhat surprisingly, this has been an unregulated area. But the Bill will shortly become law after legislation to ban the use of invasive nonsurgical cosmetic treatment on under 18s, such as fillers or the injection of toxin, unless there is an explicit medically determined reason, received royal assent earlier this year. This marks a significant moment in the aesthetic sector and a step towards achieving the JCCP’s 10 point plan for greater regulation in the industry.

Mindful of moves towards much needed greater regulation of the aesthetics industry and the detrimental effect of reality TV and social media on young people’s mental health, what are the main considerations for an aesthetic practitioner when treating younger patients?

Celebrity culture

Today, TV shows like Love Island and Netflix’s Too Hot To Handle shine the spotlight on reality TV stars with flawless skin and fuller lips. This, it is clear, fuels the desire of the younger generation to seek cosmetic treatment so that they can emulate the same ‘look’. Whilst, for aesthetic practitioners, this may seem like great news – a boost in searches means a boost in sales –ensuring your patient is in the right frame of mind and is suitable for treatment is key. While you may not be able to prevent them going elsewhere or even seeking treatment overseas if they are determined to do so, it is important that you protect your own reputation and do what you feel is right for that patient. That may mean politely refusing to treat them.

Young woman receiving a botox injection


Education is paramount when it comes to treating younger patients. With the rise in celebrities seeking cosmetic surgery, influencers posting about their treatments on social media, and with apps like Snapchat, that come with a range of filters that can appear to adjust bone structure, make skin look smoother and lashes longer , patients may come into your clinic with a firm idea of what, or even who, they wish to look like – a trend labelled “Snapchat dysmorphia”. As an aesthetic practitioner, it is your job to merge the patient ‘wants’ with patient ‘needs’, to provide safe and subtle treatments, and meet patient expectations.

Patient selection

Prior to treatment, providing a consultation is the first step to ensure your patient is not only physically suitable for treatment, but psychologically too. According to The Journal of the American Medical Association (JAMA), filtered selfies and editing apps like FaceTune have led to a rise in Body Dysmorphic Disorder – especially in younger patients. As a practitioner, it is your responsibility to identify if your patient has full capacity to give truly informed consent for cosmetic procedures. While no one wants to turn business away and reject a patient who does not listen to your guidance and advice, saying ‘no’ to unsuitable patients can often be the safest option – not only for your patient, but for you as a practitioner, as it could prevent a claim against you in the future. For more information on the importance of patient selection you can read our comprehensive guide here.

Treatments for younger patients

According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), popular treatments amongst the younger generation include:
• Preventative treatments such as facials, platelet rich plasma (PRP) and Botox
• Lip fillers
• Non-surgical rhinoplasty
• Dermal filler
• Microneedling

Natural enhancements are recommended for younger patients, so as not to result in drastic or unnatural-looking changes they may regret down the line. Dr Rupert Critchley has developed a standardised approach to dermal filler for those in the younger age category. As a practitioner, using a ‘less is more’ approach and giving treatments over multiple sessions is advisable, providing regular follow ups and ensuring the patient is aware of the contraindications and possible side effects that may occur.

When treating younger patients, it is just as important that you follow a robust consenting and consultation process as it would be with any other patient. Be sure to check their age and do not feel pressurised into treating a patient if you feel that they are unsuitable, either due to physical or psychological reasons. If appropriate, provide a gentle and supportive introduction to cosmetic procedures that are suited to the individual patient, whilst ensuring that you are managing their expectations appropriately.

Be mindful of the ‘Love Island effect’ and if in any doubt, say no.

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