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Controversial apps for kids make cosmetic surgery into a game

"Ouch, it hurts!" squeals Tess, who has asked for help getting ready for the prom. Tears run from her cartoonish eyes, as the player sticks a syringe in her jaw and extracts some fat which would later get replaced by something blue from a vial, to smooth it out.

The character is part of a game by Bravo Kids Media called "Beauty Clinic Plastic Surgery" - one of many game apps targeted by a petition calling for Apple, Google and Amazon.com to remove or make the apps less appealing to children. Some of the games are explicitly made for children as young as 8 and have drawn scrutiny from parents and researchers uncomfortable with apps that make light of medical procedures for the sake of beauty.

"By making cosmetic surgery apps available for download, Apple, Google and Amazon are allowing companies to stoke and profit from the insecurities of children," said a petition addressed to the companies from Endangered Bodies, a group devoted to promoting positive body image. The petition was first reported by the Verge. It's one of eight that the group is promoting across the world. The petition in the United States gathered more than 119,000 signatures over the course of the year-long campaign.

(Amazon chief executive Jeff Bezos owns The Washington Post.)

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There are several problems with games that promote cosmetic surgery as part of a makeover routine, said Sharon Haywood, of Endangered Bodies' Argentina chapter. For one, they promote the idea that someone's body is a "thing to be fixed." Worse, she said, is that the surgery element is treated so lightly. "This equates makeup and hair changes with serious procedures," she said.

Many of the cosmetic surgery games also promote European beauty ideals as the best. Some games, including "Plastic Surgery Simulator," let players perform double-eyelid surgery - a procedure some Asian women choose to look more Caucasian.

Cosmetic surgery apps don't crack the charts of the most popular apps, or the highest-grossing, according to a search on the website of App Annie, an apps analytics firm. But the games' very presence is cause for concern, Haywood said. Research has shown there's reason to be concerned about the effect that games, even seemingly harmless ones, have on children. A 2017 paper published in England found that girls who spend even 10 minutes with a makeover game feel appreciably worse about their bodies - and were more drawn to historically "feminine" careers such as librarian or flight attendant.

The Nuffield Council on Bioethics, based in the United Kingdom, has also raised alarm about the growing prevalence of plastic surgery apps and has lent its support to the petition in an official report on the ethics of cosmetic procedures.

Members of Endangered Bodies had success getting Apple and Google to remove a handful of similar apps in 2014 after a global Twitter campaign. But the apps soon reappeared and proliferated, Haywood said. They now number in the hundreds across the three major app platforms, featuring bright colors and cartoonlike characters that can make them easy to slip past parents' radars, experts said.

This time around, Endangered Bodies wants the companies to discuss ways to flag these apps or reduce their appeal to children. Apple, Amazon, Google and Bravo Kids Media did not respond to requests for comment.

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Coming up with a rule on such apps marketed to children could be difficult for the companies, which tend to focus their policies on banning the worst of the worst - intense violence, hate speech or gore - and don't address the much trickier area of what other messages apps could be sending.

Some of the surgery games are graphic, with spurting blood or stomach-turning images. Others are less so, if at all. Although "Beauty Clinic" depicts open sores and bruising, there's no violence, exactly, even for those squeamish about needles.

Different parents may have different standards for what works for their own kids. But, as Stacey Merkl, founder and executive director of Realize Your Beauty, points out, parents do rely on technology firms to act as a central clearinghouse for what is appropriate for their children. The petition's aim is to force companies to wrestle more with that role when it comes to body image.

This is not a problem caused by technology, Haywood said, but companies have a responsibility to make sure their platforms send the right message.

Some of the body image advocates said they don't necessarily want the tech titans to ban all surgery apps. For instance, apps that allow players to fix a character's leg after an accident would be fine, Haywood said. But at the very least, the companies should do a better job at warning potential consumers about the content.

"If they just made them not look like cartoons, or maybe put a warning label on them," Merkl said.

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