Inside Instagram's Secretive Plastic Surgery Support Community

Fast forward a decade and plastic surgery has become more mainstream and relatable, with reality TV show stars showing off the results on daytime television and social media. Plastic surgeons have themselves capitalized on this trend—Snapchatting their patients as they go through their procedures in all their goriness and showing off the final results, like Dr. Michael Salzhauer (a.k.a. Dr Miami), who boasts almost a million followers across Snapchat and Instagram.

But the rise of social media has also led to a slightly less well known phenomenon: The digital revolution has given young women instant access to cosmetic surgery through their social media channels, and many patients—particularly women—have started recording their "plastic surgery journeys" on different platforms, with Instagram playing a prominent role.

While boob jobs are tricky to document due to Instagram's strict ban on female nipples, other types of accounts are rife. For example, typing in "rhinoplasty" will reveal hundreds of pages, featuring young women documenting their journeys from start to finish. They are also relatively easy to find if you know the right hashtags: #rhinoplastyjournal, #rhinoplastyjourney, and #rhinoplastydiary all bring up hundreds—sometimes thousands—of pictures.

Most of the accounts are private and very strict in terms of who gets to follow them. Ella (@rhinoplasty.diary), a 23-year-old from Toronto, Canada, launched a private Instagram page a week before her surgery in September 2015 with the aim of recording her own progress and healing.

"A lot of people try to hide their surgery. It's also scary for others to see you at your 'worst'—bruised, bloody, swollen—it's open for people to criticize," she says.

Ella had been thinking about rhinoplasty ever since she was just 13 years old. While she mainly wanted to use the account to ease her own worries, she quickly went public so it could become a source of support to others thinking of going through the same process. She now boasts over 500 followers.

"A lot of anxiety comes with changing yourself, especially your face. So I started it mostly for myself to feel at ease, but over time it became to help other people, mostly women and young girls who were either looking for a great surgeon or who were experiencing difficulty with their recovery and needed someone who went through it to help calm their stress."

Ella's account is similar to most others in the way that is shows the process, warts and all. From sitting in the car on the way to the hospital to being bandaged up post-op, she gives her followers extremely personal updates on an almost daily basis. But it doesn't always make for easy reading. One entry states: "Day 3… Can I just say I did not expect to look this awful? I had a really rough night last night. Praying this swelling calms down a bit soon. I feel that I am experiencing more pain than most people say they have experienced. Any advice? I'm so so so tired. I just want to sleep forever."

This seems to be a dominant theme for most Instagram accounts—many women seek advice and the comments between users are largely positive and reassuring, almost mimicking a close-knit community. On Ella's aforementioned post, tens of followers quickly responded, telling her to "hang in there" and advising her to take homeopathic tablets to ease the swelling.

Elle says there is "100 percent a community" and that her Instagram account has even led her to form close friendships with some of the girls she has met on the platform.

She explains: "It's hard to express how much comfort you receive from people who don't judge you for your choice to change and who are experiencing that same change with you, or are wanting to.

"When you are having a day where the pain is bad, or your swelling is looking particularly bad, the regret can be extreme. The anxiety is awful. Your nose becomes an obsession, and it's really nice to be able to look at other people and say, 'They had a bad swelling day too, and hers turned out great in the end.'"

One of the few women who set up a public account from the very beginning is Bunny (@bunnydolldiary), 25, from New York. She has accumulated over 1,500 followers since the day she had her nose job and started posting in October last year. Bunny's ultimate goal was to create the resource that she wished she had. Her feed is made up out of countless before and after pictures, with some bruised imagery from the early post-surgery days in between. Since having her nose job, she has also had a chin implant fitted and lip fillers. For Bunny, the experience of posting on Instagram has been equally positive.

"I'm shocked every day as I wake up to kind messages, comments, tags, and 'likes.' My DMs are a constant self esteem boost," she said.

For plastic surgeons, these patient accounts are undoubtedly one of their best and newest marketing tools. Dr. Reza Nassab, consultant plastic surgeon and a member of the British Association of Aesthetic Plastic Surgeons (BAAPS), agrees that the digital age has ushered in "an important time" for cosmetic surgery by providing more openness for women.

"Social media and these Instagram accounts play an important role in patient education. Rhinoplasty will lead to significant bruising and swelling after the procedure. Other people viewing these images will then know what to expect. But whoever is responsible for these accounts need to post in an ethical and educational way," he says.

Psychologist Dr. Susan Marchant-Haycox is slightly more cynical. While she recognizes that the accounts could function as a support system, the women's lack of expertise worries her.

"A surgeon will tell you the pros and cons of any surgery. These women are not qualified and that's a danger. Those looking to change themselves have to question why they're doing it, and might want to see a psychologist first. Surgery won't necessarily change underlying problems," she says.

There are also wider cultural consequences, according to Dr. Nassab. Instagram is used by a predominantly young audience, with 18 to 24-year-olds making up 22.9 percent of users in the US. These accounts, he worries, could lead to the normalization of plastic surgery.

"Cosmetic surgery has become trivialized as it's everywhere," he says. "But particularly younger people don't always realize that it's potentially life altering. They need to take the time to consider all options, and research the procedure and possible consequences of what they're embarking on."

Dr. Nassab also believes the growing popularity of these social media accounts could lead to unrealistic expectations among some young women.

"Every patient is an individual and will be different from the one before or seen on Instagram. Patients need to bear this in mind when looking at these images and have to find the right surgeon who is realistic about what can be achieved," he explains.

But it's not just the viewers who are at risk; those posting also face having abuse hurled at them. Bunny says she sometimes receives comments that aren't in favour of plastic surgery, where she is told to "stop doing it to herself," but she tends to take them in her stride.

"Of course when you have a page based on close-up pictures it can de-sensitize a stranger who doesn't see you as a person with thoughts and feelings, and they may comment on something like, 'wow you're swollen' or 'your nostrils are uneven' during the healing process. But this just cracks me up, to be honest," she says.

Despite the push back, Ella and Bunny remain adamant that their Instagram accounts' positive features outweigh the negatives ones, as they provide a safe space where they can share their fears and feelings without being judged. They will keep on posting, one Amaro filtered picture at a time.

As Bunny concludes: "There is a great sense of camaraderie and it's all so positive. I've interacted with girls all over the world, each one nicer than the next. I am confident and happy, and I am simply here to share my journey."