Why cosmetic surgery games aimed at children as young as three need to be cut out

Andrea Mara is the Irish Endangered Bodies representative. She shares her concerns about cosmetic surgery games aimed at children as young as three

Cosmetic surgery games for children – five words you don’t expect to see together. Yet that’s exactly what came up when my nine-year-old searched online for “free games for kids” one afternoon a couple of months ago.

She showed it to me and we had the usual discussion about downloading apps without asking, then I took a closer look. The game is set in a clinic, and players perform cosmetic surgery on animated patients. My patient wanted her nose fixed, which involved marking where the incision should go, using a scalpel to cut into the skin, moving a bone inside the nose, then gluing and stitching up the wound.

According to the game blurb, “Every girl dreams of delicate face and stunning figure. If makeup can’t give the beauty you want, then come to join this amazing plastic surgery game!”

I deleted the game, and explained to my daughter that I thought it was a little bit gross and a lot inappropriate and that it gives the wrong message to children about appearance. I’m not sure she understood the last part, but she was happy to forgo the game as it was a bit – in her words - “ick”.

So is it simply about the “ick” factor or are there greater concerns about children playing cosmetic surgery games? Psychologist Deirdre Cowman, who is campaigning to stop games like this being marketed to children, says it’s not just about the graphic imagery. “It’s also because of the message these games give to young people about changing your body to meet societal expectations of beauty. I want kids to grow up feeling comfortable in their bodies and not to be exposed to games about plumping lips and removing wrinkles - which ultimately teach them that their bodies are things to be fixed rather than enjoyed.” The #SurgeryIsNotAGame campaign is being run by Endangered Bodies, an international movement challenging body-toxic culture. The campaign includes a petition calling on Apple, Amazon and Google to prohibit the marketing of cosmetic surgery applications to children.

One of the challenges facing the campaign is that research is scarce. “The games are such a new phenomenon, there isn’t really concrete evidence out there yet,” says Dr Cowman. “However, research has shown that when children and adolescents view idealised images of women and men, they have stronger body dissatisfaction. And interestingly, research conducted by the University of the West of England found that young girls who played with ‘makeover’ apps for only ten minutes showed a decrease in their body confidence. This suggests that exposure to these games could potentially be harmful in terms of how young people see themselves.”

Dr Farrah-Hani Imran is a plastic, reconstructive and cosmetic surgeon who is currently undertaking a PhD in the School of Medicine and Medical Science, University College Dublin - she encounters people every day who are dissatisfied with their appearance. “When people find out my day job, the questions that immediately follow are, ‘How can I change X’, or ‘I hate my lips, nose, cheeks, chin, eyes, breasts’ and so on. This is usually from a person with no functional deformity, exhibiting clear signs of low self-esteem; enamoured by glossy magazines and media images to conform to perceived ideals.”

Dr Imran is concerned that cosmetic surgery games may contribute to this problem. “While it is fun to play virtual dress up and do basic operations - think of the board game Operation - once it goes into actual aesthetic procedures and cosmetic surgery aimed at children, a line has been crossed. The games trivialise and normalise aesthetic procedures and cosmetic surgery.”

Left: Dr Deirdre Cowman is calling on Apple, Amazon and Google to stop cosmetic surgery games being marketed to children. Right: Dr Farrah-Hani Imran, concern over games.

Dr Cowman is keen to point out that the issue isn’t the games themselves, but rather the fact that they’re being played by children. “We’re not asking for these games to be banned,” she explains. “It’s totally up to the individual to decide if they want to play games like this. However, we are calling on Apple, Amazon and Google to stop the games from being marketed to children.

The games generally feature large, bright logos and cartoon characters, which appeal to a young audience. We’re asking these three major platforms to do more than simply including a recommended age range for these games. We’re asking them to implement a policy which is clear to every game developer, that they will not accept any such apps that are targeted at children.”

I contacted Google to find out how apps get their ratings and a spokesperson explained it as follows. “Google Play’s policies are designed to provide a great experience for users and developers. While we don’t comment on specific apps, we can confirm that our ratings are based on the International Age Rating Coalition (IARC) guidelines. If users come across any apps they think violate these policies, we encourage them to report it to our support team so we can review the app and take action if necessary.”

I checked the age rating for the game my daughter downloaded – it’s a “PEGI 3” meaning it’s suitable for children aged three and upwards. So how does a plastic surgery game end up with an age rating of three?

Lee Cash, a game producer who has worked in the gaming industry here and abroad, explains how the rating system functions. “The developer completes a self-assessment form declaring the nature of the content contained within their app or game. The content is then reviewed and, if the platform holder agrees with the assessment, it passes and is fit for publication on the store. The crux of the issue, and why inappropriate content can sneak through the morality net, is down to the sheer volume of content that is relentlessly flung at the platform holders. Nudity and violence is universal in its classification of propriety; few would argue where such content falls on the spectrum of suitability. Plastic surgery apps aimed at children, however? It’s fuzzy and, quite simply, the platforms likely have no clear designated position on content of this nature.”

Of course, the first line of defence for monitoring online activity is the parent, and in a perfect world, we would all make sure our children never download inappropriate games. However, I suspect mine is not the only household in which apps can slip through the parental net.

James Kelleher, developer of The Lonely Beast apps, feels it goes without saying that children shouldn’t be playing these games. “There are hundreds of these shoddy surgery clones littering the app stores - I remember seeing one where you could operate on a badly-drawn bootleg Peppa Pig - and they’re usually vehicles for countless in-app purchases and spammy ads.

“These plastic surgery games are a disturbing sub-genre of an already weird game niche, and a good reminder of why parents shouldn’t rely on PEGI ratings or app stores to filter what their kids are playing.”

In the meantime, what can parents do to help children to develop positive body image? “It’s hard to completely shelter your children from the world’s obsession with appearance and weight so it’s important to encourage kids to think critically about the media they consume,” says Dr Cowman.

“As well as traditional media, this also includes cartoons, music videos, social media and computer games which often subtly - and not so subtly- promote the idea that only very thin or very muscular bodies are acceptable.” She says it’s also a good idea to be aware of how you talk about your own body and other people’s bodies in front of children.

“Children pick up on little things and if they grow up hearing their parents criticise their bodies or being overly concerned about calories, it has an impact on how they feel about themselves and their bodies. We hope that the #surgeryisnotagame campaign can also start a conversation about how we can raise body positive children and create a society that accepts and celebrates all bodies.”

• There are eight Endangered Bodies representatives around the world supporting the petition and Andrea Mara is the Irish representative.