Advertising on Social Media: The Plastic Surgeon's Prerogative

A 9-Year Review of Ethics Complaints to the American Society of Plastic Surgeons

BACKGROUND

The American Society of Plastic Surgeons (ASPS) provides an avenue for filing formal complaints regarding unethical behavior of members. These complaints are investigated by the ethics committee and referred to the judicial council if a violation may have occurred.

METHODS

A review of complaints filed with the ASPS from 2013 through 2021 was performed. Data surrounding both complaints and complainant type were reviewed, as well as region of complaint origin. Categories of violations resulting in formal investigations and judicial council referrals were also reviewed.

RESULTS

A total of 584 complaints were filed with the ASPS ethics committee from 2013 through 2021, which was nearly 100 fewer than from a previous review of 2004 through 2008. Twenty-one percent of complaints were formally investigated by the ethics committee, and 26% of these were referred to the judicial council. The most common complaint investigated was related to advertising or misleading communications; the most common complaint referred to the judicial council was regarding expert testimony. Most complaints were filed by ASPS members.

CONCLUSIONS

The total number of complaints filed over time has decreased significantly, the reasons for which are unclear. Evolution of culture and thought likely had an impact, not only on specific behaviors but also on the likelihood of reporting those behaviors. It remains incumbent on plastic surgeons to use the self-regulating mechanisms available to maintain the autonomy plastic surgery enjoys as a profession.

Social media use among French spine surgeons: an underrated tool?

PURPOSE

The goal of this study was to determine the use of social media (SM) among the French spine surgeons.

METHODS

In 2022, an online questionnaire has been sent to the community of French spine surgeons. All surgeons were asked to answer a 21-question survey about their use of SM in their daily practice.

RESULTS

Eighty-five surgeons were included, with 80% claiming to use SM. Mean age was 45 ± 10.7. Usage rate significantly differed among experience categories: 85% of younger surgeons and 69% after ten years of experience (p = 0.01). LinkedIn was the most commonly used (78% among SM users), then Facebook (46%). Instagram was less used by most experienced surgeons (p = 0.01). Time spent on SM was more important at home (p < 0.01). About 31% of participants' patients were able to contact their surgeon through SM, mainly through LinkedIn, professional websites and Facebook (respectively 15%, 13% and 12%). Pictural data were shared on SM by 29% of SM users, mainly on LinkedIn (19%), then professional websites (12%). Google reviews were significantly less valued by most experienced surgeons (p = 0.01) but more valued by private practice surgeons (p = 0.009).

CONCLUSION

80% of French spine surgeons use social media for professional purposes. However, SM may not be used to its full potential as only 25% of SM-using broadcast pictures and contact their patients through SM. The most popular network is LinkedIn, followed by Facebook. Most experienced surgeons use less SM, particularly Instagram, and value less Google reviews.

TikTok in Plastic Surgery: A Systematic Review of Its Uses

TikTok (San Jose, CA) is a popular and rapidly growing social media platform. With beauty and skincare among the top 5 most popular categories, TikTok represents an important platform for plastic surgery education and communication. However, given the vast array of content shared daily, regulating content for veracity is challenging. It may also be an important and potentially overlooked avenue for the dissemination of inaccurate information pertaining to plastic surgery. This systematic review evaluates TikTok's impact on plastic surgery. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines, a systematic literature review was performed of the use of TikTok within the plastic surgery field. The following databases were queried: PubMed (National Institutes of Health; Bethesda, MD), EMBASE (Elsevier; Amsterdam, the Netherlands), and PsychInfo (American Psychological Association; Washington, DC). The search captured 31 studies of which 7 were included in the final analysis. The studies examined the following areas: gender-affirming surgery (n = 1), breast reconstruction (n = 1), aesthetic surgical procedures (n = 1), plastic surgeon profiles (n = 1), and profiles of videos relating to plastic surgery hashtags (n = 3). The videos' quality was assessed using the DISCERN scale. Physician videos scored notably higher than nonphysician videos. The mean DISCERN score across all the videos (n = 386) was 1.91 (range: 1.44-3.00), indicating poor quality. TikTok is a popular medium for sharing plastic surgery content. The existing literature has demonstrated overall poor-quality information on plastic surgery, and further study is needed to evaluate its impact in terms of perceptions of the specialty and healthcare behaviors. Future work should focus on promoting accurate, high-quality videos, potentially including a peer-review function for healthcare content. This can leverage TikTok's potential for disseminating content while upholding patient safety.

Level of Evidence 3

Face-off: Social Media Responsibility in Medicine and Non-surgical Treatment of the Face

The practice of reaching an audience through social media to promote non-surgical treatments of the face is in its infancy. Young adults, arguably the most health-literate generation to date, comprise both the majority of users targeted by social media and the fastest growing demographic seeking cosmetic consultation. We know that this age group is also at an increased risk of depression and body dysmorphia in an era where non-surgical cosmetic options are typically thought to be gateways to surgical treatments. In light of these facts, it seems the ethics of medicine might be lagging behind the amorphous, rapidly evolving nature of social media and, specifically, its use as a platform for business promotion and health information. As cosmetic treatments become a normalized facet of society's health care routine, in large part due to its ubiquity on social media platforms, its promotion by providers requires reexamination so that its pro-social potential can be realized. This is ensured by fostering a social media presence and in-office attitude that treatments should be an agreement between patient and provider on realistic expectations and how best to meet them.

Mining the Twittersphere: Insights about Public Interest in Facial Reanimation Surgery from a Decade of Twitter Data

Background  With 500 million tweets posted daily, Twitter can provide valuable insights about public discourse surrounding niche topics, such as facial paralysis surgery. This study aims to describe public interest on Twitter relating to facial paralysis and facial reanimation surgery over the last decade.

Methods  Tweets containing the keywords “facial paralysis” and “Bell's palsy” posted between January 1, 2009, and January 1, 2019, were collected using Twitter Scraper. Tweets were screened by keywords relating to facial paralysis, and usage of these terms trended over time. Logistic regression was used to identify correlations between the quantity of publications per year and these terms posted on Twitter.

Results  32,880 tweets were made during the study period, with no significant difference in the number of tweets per year. A very strong ( r  = 0.8–1.0) positive correlation was found between time and frequency of the term “plastic surgery” and “transfer” ( p  < 0.05). A strong ( r  = 0.60–0.79) correlation was found between time and frequency for the following terms: “facial reanimation,” “gracilis,” “masseter,” “plastics,” “transplant” ( p  < 0.05). A total of 619 studies with the keyword “facial reanimation” were published in PubMed within the study period. A very strong, positive correlation between publications per year and frequency was found for the terms “plastic surgery,” “function” and “esthetic,” and a strong, positive correlation was found for the “plastics,” “transplant,” “Botox,” “surgery,” “cosmetic,” “aesthetic” and “injection” ( p  < 0.05).

Conclusions  An increasing number of discussion about facial paralysis on Twitter correlates with increased publications and likely surgeon discourse on facial reanimation surgery, driving public interest.

#Botox 101: Subgroup Analysis of Twitter's Top 101 Neurotoxin Influencers

BACKGROUND

Recent studies demonstrate that board-certified plastic surgeons and dermatologists are underrepresented in posting public-directed marketing content about botulinum toxin A on YouTube. However, educational content and peer-to-peer social media influence regarding the topic of neurotoxins has not been studied. Twitter is a social media platform that has emerged as a unique network for public education and for the exchange of ideas among physicians.

OBJECTIVE

The purpose of this study is to identify Twitter's top social media influencers on #botox, to describe their characteristics and to relate their social media influence to academic influence.

METHODS

Twitter influence scores for the topic search #botox were collected in January 2019 with Right Relevance software. #Botox was the only neurotoxin term with sufficient activity to generate an influencer list. The user accounts associated with top influencers were connected to individual names, identification as a plastic surgeon or dermatologist, board certification status, location, and academic h-index.

RESULTS

The top 101 Twitter influencers on #botox are presented. Seventy-five percent of influencers are physically located in the United States. Academic h-index of #botox social media influencers ranged from 0 to 62 (mean, 8.6).

CONCLUSION

This study shows that the top #botox social media influencers on Twitter and primarily board-certified or eligible plastic surgeons located in the United States. This study also elucidates the influencer network within which other plastic surgeons and dermatologists can interact to augment their own influence within the social media network. This is the first study to describe social media influencers in this way.

How cosmetic surgeons portray cosmetic procedures through Instagram? A content analysis on cosmetic surgeons' posts on Instagram

The present study intends to explore the visual and textual content of posts cosmetic surgeons shared on Instagram pages in order to present their cosmetic surgical or non-surgical procedures. To do so, this study employed a qualitative approach using textual and visual content analysis on 200 Instagram posts shared by cosmetic surgeons. The results demonstrated that the content of analyzed posts can be categorized as 12 sub-themes which are clustered around four main themes; "You have got some body imperfections," "Body imperfections are worrisome," "Cosmetic procedure is the solution; we provide it for you" and "It's not a real surgery!."

Analysis of social media use by European plastic surgery societies: A missing link for #PlasticSurgery

PURPOSE

The field of Plastic Surgery is prominent on social media around the world. Board certified plastic surgeons and societies of plastic surgery play a role in providing accurate, evidence-based information to the public, patients, and colleagues. The aim of this study was to explore the use of social media by European Plastic Surgery Societies.

METHODS AND MATERIALS

A retrospective analysis of the presence and activity of European Plastic Surgery Societies on Facebook, Twitter and Instagram was conducted between December 12th 2018 and December 12th 2019. The results have been compared to the American Society of Plastic Surgeons.

RESULTS

Twenty, eleven and nine European societies yielded an active account on Facebook, Twitter and Instagram respectively. Only seven European societies had an account on all three platforms and were therefore considered polypresent. The amount of followers of those seven societies was significantly higher than of the others (p-value = 0.02). Their activity yielded significantly more posts on Facebook (p-value = 0.02). The American Society of Plastic Surgeons had more followers on all three platforms than all European societies combined.

CONCLUSION

Social media are still rather unexploited by European Plastic Surgery Societies. A tendency towards increased visibility can be observed, yet a higher penetration is required to further educate and engage through social media. The quantitative data provided serve as reasonable foundation for further studies and a guide for growth of #PlasticSurgery.

Increasing a Dermatologist's Footprint on Instagram: An Analysis of Top Influencers Performing Nonsurgical Cosmetic Procedures

BACKGROUND

Patients use social media to find information about cosmetic procedures, yet dermatologists historically lack a social media presence. Misleading information from nonexperts is potentially harmful.

OBJECTIVE

To identify the top influencers posting about nonsurgical cosmetic procedures on Instagram, verify their credentials, and analyze their content to empower dermatologists to effectively join the online conversation, combat harmful misinformation, and preserve the expertise and influence of board-certified dermatologists.

METHODS AND MATERIALS

Using the Klear marketing platform, Instagram influencers with more than 50,000 followers were identified. Influence rating, top posts, and other metrics were extracted using proprietary algorithms.

RESULTS

Ninety nine influencers were identified. Of the top 10, 70% were board-certified plastic surgeons. Physicians not board-certified in a core cosmetic specialty had the highest influencer rating and number of followers. The most popular posts were of before and after photographs and personal posts.

CONCLUSION

Dermatologists may be able to increase their Instagram footprint by posting frequently, especially of before and after and personal photographs, using hashtags, Instagram live and Instagram television, and Instagram stories. It is important for the dermatology community to find a way to ethically navigate social media to have a seat at the table and meet patients where they are.

Use of Social Media by Hospitals and Clinics in Japan: Descriptive Study

BACKGROUND

The use of social media by hospitals has become widespread in the United States and Western European countries. However, in Japan, the extent to which hospitals and clinics use social media is unknown. Furthermore, recent revisions to the Medical Care Act may subject social media content to regulation.

OBJECTIVE

The purpose of this study was to examine social media use in Japanese hospitals and clinics. We investigated the adoption of social media, analyzed social media content, and compared content with medical advertising guidelines.

METHODS

We randomly sampled 300 hospitals and 300 clinics from a list of medical institutions that was compiled by the Ministry of Health, Labour and Welfare. We performed web and social media (Facebook and Twitter) searches using the hospital and clinic names to determine whether they had social media accounts. We collected Facebook posts and Twitter tweets and categorized them based on their content (eg, health promotion, participation in academic meetings and publications, public relations or news announcements, and recruitment). We compared the collected content with medical advertising guidelines.

RESULTS

We found that 26.0% (78/300) of the hospitals and 7.7% (23/300) of the clinics used Facebook, Twitter, or both. Public relations or news announcements accounted for 53.99% (724/1341) of the Facebook posts by hospitals and 58.4% (122/209) of the Facebook posts by clinics. In hospitals, 16/1341 (1.19%) Facebook posts and 6/574 (1.0%) tweets and in clinics, 8/209 (3.8%) Facebook posts and 15/330 (4.5%) tweets could conflict medical advertising guidelines.

CONCLUSIONS

Fewer hospitals and clinics in Japan use social media as compared to other countries. Social media were mainly used for public relations. Some content disseminated by medical institutions could conflict with medical advertising guidelines. This study may serve as a reference for medical institutions to guide social media usage and may help improve medical website advertising in Japan.

Evaluation of the Online-Presence of ABA-Verified Burn Centers

Currently, patients seek healthcare information online. An up-to-date online presence is vital for success among the competition amid hospitals. Hospital websites have become an important medium to communicate with patients, provide information about certain diseases/conditions, and advertise healthcare services. This study aims to evaluate burn centers websites verified by the American Burn Association (ABA). The online presence of the 73 ABA-verified burn centers was evaluated according to criteria previously published by Benedikt et al. This included general information on burns, first aid, treatment at the burn unit, research, and education. ABA-verified burn centers were then compared with 48 German-speaking burn centers evaluated by Benedikt et al. Online information about patient care including treatment options and techniques was more often present in ABA-verified burn centers. However, this information was still provided in only half of the websites. Furthermore, ABA-verified burn centers more often used multimedia-based elements and social media platforms. On the other hand, German-speaking burn centers more often provided translations, general information (eg, staff and ward) about the burn center, as well as research and education. This study demonstrates that although many burn centers have well-designed websites, relevant burn-related information on patient care, research, and education is often missing or sparse. Today, most patients look for healthcare information online. Also, applicants for residency or fellowship programs tend to get a first picture of their potential employer on websites or social media. Keeping websites and social media up-to-date and informative can improve recruitment of patients and employees.

The Plastic Surgery Social Media Influencer: Ethical Considerations and a Literature Review

BACKGROUND

Social media use has become a relevant tool in plastic surgery. These platforms are utilized for many reasons, such as business promotion. Although beneficial, social media can cause ethical dilemmas if used incorrectly.

OBJECTIVES

A review of the literature revealed what is understood about the implications of social media in regards to sponsorship/promotion. This paper aimed to create the foundation surrounding this topic and help facilitate future discussions on this new ethical dilemma.

METHODS

A MEDLINE search with a custom publication date range and a review of the literature was conducted on June 15, 2019.

RESULTS

The search yielded 139 articles and abstracts. After review, 26 publications were chosen for analysis. Articles were taken from the following journals: Plastic and Reconstructive Surgery (n = 12), Aesthetic Surgery Journal (n = 8), PRS Global Open (n = 2), Annals of Plastic Surgery (n = 1), BMJ (n = 1), AMA Journal of Ethics (n = 1), and Facial Plastic Surgery (n = 1). The 4 principles of medical ethics were analyzed in respect to promotion and sponsorship in plastic surgery.

CONCLUSIONS

Social media is a novel platform that is becoming increasingly utilized in plastic surgery. Although its impact can be beneficial, it is not well understood in the context of social media sponsorship and promotion. To date, no peer-reviewed articles specifically discuss these limitations. It is critical that all plastic surgeons be cognizant of both the positive and negative aspects of social media before integrating it into their professional lives.

Social Media Marketing: What Do Prospective Patients Want to See?

BACKGROUND

Platforms such as Instagram, Facebook, Twitter, and Google+ have created a worldwide audience of almost 3 billion people. Society is dramatically changing, demanding evolution of marketing strategies by plastic surgeons and aesthetic doctors alike. This unknown territory provides excellent opportunities, but creates many pitfalls as well; uncertainty remains as to the most effective manner to promote one's practice/services.

OBJECTIVES

The aim of this study was to design a social experiment based on Instagram to give guidance for efficient self-promotion.

METHODS

An Instagram account called "doctor.aesthetics" was created. Content was produced, and categorized into 4 groups: Aesthetics, Private Life, Disease, and Science. No bots or other Instagram-based promotion were utilized. Every post was evaluated regarding likes, comments, clicks, new followers, impressions, and savings.

RESULTS

After 5 months and 37 posts, 10,500 people followed the account. "Scientific" posts were excluded from the analysis due to a low response rate. A significantly enhanced number of likes for "Private" postings was found. Additionally, "Private" posts led to most clicks and new followers, whereas "Aesthetics" posts were saved by most people.

CONCLUSIONS

To benefit the most from social media advertising, it is necessary to offer insights into private life. Although "Aesthetics" and "Disease" postings showed similar response rates, "Scientific" posts failed to attract people.

How can AHPRA improve compliance of health practitioner advertising?

n/a

Who should you be following? The top 100 social media influencers in orthopaedic surgery

BACKGROUND

Social media has been credited with the potential to transform medicine, and Twitter was recently named “an essential tool” for the academic surgeon. Despite this, peer-to-peer and educational influence on social media has not been studied within orthopaedic surgery. This knowledge is important to identify who is controlling the conversation about orthopaedics to the public. We hypothesized that the plurality of top influencers would be sports medicine surgeons, that social media influence would not be disconnected from academic productivity, and that some of the top social media influencers in orthopaedic surgery would not be orthopaedic surgeons.

AIM

To identify the top 100 social media influencers within orthopaedics, characterize who they are, and relate their social media influence to academic influence.

METHODS

Twitter influence scores for the topic “orthopaedics” were collected in July 2018 using Right Relevance software. The accounts with the top influence scores were linked to individual names, and the account owners were characterized with respect to specialty, subspecialty, practice setting, location, board certification, and academic Hirsch index (h-index).

RESULTS

Seventy-eight percent of top influencers were orthopaedic surgeons. The most common locations included California (13%), Florida (8%), New York (7%), United Kingdom (7%), Colorado (6%), and Minnesota (6%). The mean academic h-index of the top influencers (n = 79) was 13.67 ± 4.12 (mean ± 95%CI) and median 7 (range 1-89) (median reported h-index of academic orthopaedic faculty is 5 and orthopaedic chairpersons is 13). Of the 78 orthopaedic surgeons, the most common subspecialties were sports medicine (54%), hand and upper extremity (18%), and spine (8%). Most influencers worked in private practice (53%), followed by academics (17%), privademics (14%), and hospital-based (9%). All eligible orthopaedic surgeons with publicly-verifiable board certification statuses were board-certified (n = 74).

CONCLUSION

The top orthopaedic social media influencers on Twitter were predominantly board-certified, sports-medicine subspecialists working in private practice in the United States. Social media influence was highly concordant with academic productivity as measured by the academic h-index. Though the majority of influencers are orthopaedic surgeons, 22% of top influencers on Twitter are not, which is important to identify given the potential for these individuals to influence patients’ perceptions and expectations. This study also provides the top influencer network for other orthopaedic surgeons to engage with on social media to improve their own social media influence.

Are You on the Right Platform? A Conjoint Analysis of Social Media Preferences in Aesthetic Surgery Patients

BACKGROUND

Social media has become an indispensable tool for patients to learn about aesthetic surgery. Currently, procedure-specific patient preferences for social media platforms and content are unknown.

OBJECTIVES

The authors sought to evaluate social media preferences of patients seeking aesthetic surgery.

METHODS

We utilized a choice-based conjoint analysis survey to analyze the preferences of patients seeking 3 common aesthetic procedures: breast augmentation (BA), facial rejuvenation (FR), and combined breast/abdominal surgery (BAB). Participants were asked to choose among social media platforms (Facebook, Twitter, Instagram, Snapchat, Pinterest, Tumblr, YouTube), information extent (basic, moderate, comprehensive), delivery mechanism (prerecorded video, live video, photographs, text description), messenger (surgeon, nurse/clinic staff, patient), and option for interactivity (yes/no). The survey was administered using an Internet crowdsourcing service (Amazon Mechanical Turk).

RESULTS

A total of 647 participants were recruited: 201 in BA, 255 in FR, and 191 in BAB. Among attributes surveyed, participants in all 3 groups (BA, FR, BAB) valued social media platform as the most important (30.9%, 33.1%, 31.4%), followed by information extent (23.1%, 22.9%, 21.6%), delivery mechanism (18.9%, 17.4%, 18%), messenger (16%, 17%, 17.2%), and interactivity (11.1%, 9.8%, 11.8%). Within these attributes, Facebook ranked as the preferred platform, with comprehensive information extent, live video as the delivery mechanism, and surgeon as the messenger as most preferred.

CONCLUSIONS

The choice of social media platform is the most important factor for patients, and they indicated a preference for comprehensive information delivered by the surgeon via live video on Facebook. Our study elucidates social media usage in common aesthetic populations, which can help improve aesthetic patient outreach.

An Analysis of Plastic Surgeons' Social Media Use and Perceptions

BACKGROUND

Social media have become ubiquitous in society with an increasing number of active daily users across multiple platforms. Social media use has grown within the field of plastic surgery; many surgeons have created a professional account to gain exposure.

OBJECTIVES

This study investigates the patterns of use and perceptions of social media in plastic surgery.

METHODS

A 16-item questionnaire was sent electronically to board-certified plastic surgeons to investigate professional social media use and perceptions. A literature review of all studies pertaining to social media and plastic surgery was also undertaken.

RESULTS

An online survey was sent to 6136 ASPS members with 454 responses (7.4%). Of the respondents, 61.9% reported having an active professional social media account. Respondents whose practice primarily consisted of aesthetic/cosmetic surgery were the most likely to have an active professional social media account (79.4%). Nonacademic surgeons were most likely to maintain an active professional social media account (71.9%) compared with university-affiliated community surgeons (41.4%) and academic surgeons (29.5%). Nonacademic surgeons were more likely to believe social media is positive for the field (48.9%) compared with the other 2 cohorts (27.6% and 35.1%, respectively). Academic surgeons are more likely to believe social media worsens the image of the field (49.3%) vs the other cohorts (35.4% and 37.2%).

CONCLUSIONS

Professional social media use is rising within plastic surgery. However, a dichotomy exists in acceptance. Private practice, younger surgeons are more likely to view social media as an acceptable method of reaching patients.

Complications of Cosmetic Surgery Abroad - Cost Analysis and Patient Perception

Supplemental Digital Content is available in the text.

Background:

Cosmetic surgery tourism is rapidly becoming more prevalent in the United Kingdom. We aim to identify the motivational factors underlying patients’ decisions to go abroad for their treatment and gather information about the ensuing complications.

Methods:

A retrospective review (January 2013–August 2017) was conducted of patients seen at a single major trauma center for complications from cosmetic surgery performed overseas. Cost analysis was performed based on national tariffs. Complications were grouped based on Clavien-Dindo classification and the Clinical Commissioning Group cost. A telephone survey was conducted to evaluate reasons for travel, details of complications, and impression of healthcare at home and abroad.

Results:

A total of 20 patients (one male, 19 females) with a mean age 36 years (23–59 years) were included. Lower cost was the most popular reason for travel, followed by lack of expertise and friend’s recommendation. Abdominoplasty (n = 9) had the highest number of complications followed by gluteal augmentation (n = 7). All major complications were due to gluteal augmentation (n = 4). The cost was for minor (n = 8, £3,448), intermediate (n = 8, £18,271), and major (n = 4, £42,083.59) complications.

Conclusions:

We raise serious concerns about the lack of regulation in cosmetic tourism and the absence of patient follow-up abroad. A particular concern was all gluteal augmentation cases had major complications. An international consensus to regulate surgical practice abroad is crucial to protect patients’ interests and promote safe cosmetic surgery.

A Quantitative Analysis of Online Plastic Surgeon Reviews for Abdominoplasty

BACKGROUND

Online reviews increasingly influence patients' decision-making. This is the first systematic, quantitative analysis of online reviews for abdominoplasty.

METHODS

Reviews for abdominoplasty were sampled from RealSelf, Yelp, and Google for six major metropolitan areas. A standard social sciences framework known as grounded theory was used to evaluate factors affecting satisfaction. The relative importance of factors was quantified using odds ratios.

RESULTS

Seven hundred ninety-four reviews met inclusion criteria. There was significant geographic variation with respect to number of reviews (p < 0.01) and average rating (p = 0.014). The authors identified 10 statistically significant themes affecting satisfaction. Of these, aesthetic outcome was the most mentioned theme [n = 368 (46.3 percent)] and the most dominant driver of satisfaction. Interactions with staff had the second highest odds ratio, driven by the fact that all negative staff interactions led to negative reviews. Postoperative care had the next highest odds ratio, and was demonstrated to counteract the negative effects of poor surgical outcomes on satisfaction. The occurrence of a surgical complication and the cost of surgery were least associated with satisfaction.

CONCLUSIONS

This analysis is the first to use quantitative methods to identify dominant and nondominant factors affecting patient satisfaction in cosmetic surgery. The authors found that aesthetic outcome, staff interactions, and postoperative diligence were the most critical factors affecting satisfaction in abdominoplasty, whereas postoperative complications and cost were least important. Understanding the relative importance of factors may help to improve and protect one's online reputation.

Google Ranking of Plastic Surgeons Values Social Media Presence Over Academic Pedigree and Experience

BACKGROUND

Patients increasingly rely on online resources to make healthcare decisions. Google dominates the search engine market; first-page results receive most of the web traffic and therefore serve as an important indicator of consumer reach.

OBJECTIVES

Our objective was to analyze the respective importance of physician academic pedigree, experience, and social media presence on plastic surgeon Google first-page search result placement.

METHODS

A Google.com search was conducted in the top 25 United States metropolitan areas to identify the top 20 websites of board-certified plastic surgeons. Social media presence was quantified by tracking the number of followers on Facebook, Twitter, and Instagram for every surgeon as well as medical school and year of graduation. The primary outcome was website ranking in the first page of Google search results. To identify the independent predictors of presence on the front page, we performed a multivariate logistic regression.

RESULTS

Total number of social medial followers was associated with Google front-page placement (P < 0.001), whereas medical school ranking and years in practice were not (P = 0.17 and 0.39, respectively). A total 19.6% of plastic surgeon practices in our study cohort still had no social media accounts whatsoever.

CONCLUSIONS

For the past few decades, plastic surgery practices relied on referrals, word of mouth, and the surgeon's reputation and academic pedigree to attract new patients. It is now clear that this practice-building model is being rapidly supplanted by a new paradigm based on social media presence to reach potential patients.

Happy and Unhappy Patients: A Quantitative Analysis of Online Plastic Surgeon Reviews for Breast Augmentation

BACKGROUND

Online reviews have become modern versions of the word-of-mouth recommendation, and prospective patients are increasingly consulting them before making decisions about their surgical care. The authors' objectives were to (1) identify trends in the use of online reviews, and (2) important reasons for patient satisfaction and dissatisfaction with aesthetic surgery. The authors selected breast augmentation as the primary procedure of interest.

METHODS

Reviews of the top 10 to 20 most reviewed plastic surgeons in each of six large metropolitan areas were obtained from Google, Yelp, and RealSelf. Reviews were assessed for predefined dimensions of satisfaction and dissatisfaction.

RESULTS

A total of 1077 breast augmentation reviews were obtained. Ratings were distributed bimodally, with peaks at five stars and one star. The majority of reviews were positive (87.5 percent). Relative popularity of Google versus Yelp varied across geographic regions, and average rating varied by platform. Between 2011 and 2016, the number of online reviews for breast augmentation grew at an average rate of 42.6 percent per year. Aesthetic outcome was the most commonly cited dimension (69.8 percent of reviews), whereas cost was mentioned in only 7.8 percent of reviews. A substantial minority of negative Yelp (37 percent) and Google (9.4 percent) reviews were written by patients who did not actually undergo surgery. Free-text analysis of heterogeneous reviews (containing positive and negative attributes) classified dimensions as critical, redeemable, or protective.

CONCLUSION

As the influence of online review platforms continues to grow, understanding drivers of positive and negative reviews may help surgeons improve patient satisfaction.

The Ethical and Professional Use of Social Media in Surgery: A Systematic Review of the Literature

Although certain medical societies have released guidelines on the use of social media, plastic surgery, with its inherent visual nature and potential for sensationalism, could benefit from increasing direction regarding the ethical use of social media. The authors hypothesized that although general platitudes for use exist in the literature, guidelines articulating the boundaries of professional use are nonspecific. Systematic searches of MEDLINE, Embase.com, and Cochrane Central Register of Controlled Trials were completed on January 18, 2017. Searches consisted of a combination of Medical Subject Headings terms and title and abstract keywords for social media and professionalism concepts. In addition, the authors manually searched the three highest impact plastic surgery journals (ending in October of 2017). Two authors screened all titles and abstracts. Studies related to clinical medicine, patient care, and the physician-patient relationship were included for full-text review. Articles related to surgery merited final inclusion. The initial search strategy yielded 954 articles, with 28 selected for inclusion after final review. The authors' manual search yielded nine articles. Of the articles from the search strategy, 10 were published in the urology literature, eight were published in general surgery, six were published in plastic surgery, three were published in orthopedic surgery, and one was published in vascular surgery. Key ethical themes emerged across specialties, although practical recommendations for professional social media behavior were notably absent. In conclusion, social media continue to be a domain with potential professional pitfalls. Appropriate use of social media must extend beyond obtaining consent, and plastic surgeons must adhere to a standard of professionalism far surpassing that of today's media culture.

The Top 100 Social Media Influencers in Plastic Surgery on Twitter: Who Should You Be Following?

BACKGROUND

Recent studies demonstrate that board-certified plastic surgeons are underrepresented amongst individuals posting public-directed marketing plastic surgery-related content on Instagram. However, peer-to-peer and education-based social media influence has not been studied. Twitter is a social media platform has been suggested to be useful for educating the masses and connecting with colleagues.

OBJECTIVES

The purpose of this study is to identify the top influencers in plastic surgery on Twitter, characterize who they are, and relate their social media influence to academic influence.

METHODS

Twitter influence scores for the topic search "plastic surgery" were collected in July 2017 using Right Relevance software. The accounts associated with the highest influencer scores were linked to individual names, status as a plastic surgeon, board certification, location, and academic h-index.

RESULTS

The top 100 Twitter influencers in plastic surgery are presented. Seventy-seven percent of the top influencers are trained as plastic surgeons or facial plastic surgeons. Sixty-one percent of influencers are board-certified plastic surgeons or board-eligible/future eligible trainees. International plastic surgeons made up 16% of influencers. Other medical doctors made up another 10%. The other 13% of influencers were nonphysicians. Three-quarters of social media influencers were physically located in the United States. Academic h-index of social media influencers ranged from 0 to 62 (mean, 8.6).

CONCLUSIONS

This study shows that the top plastic surgery social media influencers on Twitter are predominantly board-certified or eligible plastic surgeons and physically based in the United States. This study also provides the influencer network for other plastic surgeons to engage with to improve their own influence within the plastic surgery social media sphere.

Plastic Surgery-Related Hashtag Utilization on Instagram: Implications for Education and Marketing

BACKGROUND

Recent data suggest patients are seeking aesthetic surgery to improve their appearance on Instagram and other social media. Despite the rising influence of Instagram in plastic surgery, few academic publications address Instagram, let alone evaluate its utilization in plastic surgery.

OBJECTIVES

We set out to answer the following three questions: 1) what plastic surgery-related content is being posted to Instagram; 2) who is posting this content; and 3) what specific hashtags are they using?

METHODS

Our study queried 21 Instagram plastic surgery-related hashtags. Content analysis was used to qualitatively evaluate each of the nine "top" posts associated with each hashtag (189 posts). Duplicate posts and those not relevant to plastic surgery were excluded.

RESULTS

A total of 1,789,270 posts utilized the 21 hashtags sampled in this study. Of the top 189 posts for these 21 queried hashtags, 163 posts met inclusion criteria. Plastic surgeons eligible for membership in American Society for Aesthetic Plastic Surgery (ASAPS) accounted for only 17.8% of top posts, whereas noneligible physicians accounted for 26.4%. All nonplastic surgery trained physicians marketed themselves as "cosmetic surgeons." Nine top posts (5.5%) were by nonphysicians, including dentists, spas with no associated physician, and a hair salon. The majority of these posts were self-promotional (67.1%) as opposed to educational (32.9%). Board-certified plastic surgeons were significantly more likely to post educational content to Instagram as compared to nonplastic surgeons (62.1% vs 38.1%, P = 0.02).

CONCLUSIONS

ASAPS eligible board-certified plastic surgeons are underrepresented amongst physicians posting top plastic surgery-related content to Instagram.

A Primer on Social Media for Plastic Surgeons: What Do I Need to Know About Social Media and How Can It Help My Practice?

Social media has changed the way plastic surgeons interact with their colleagues, patients, and friends. Social media is a rapidly changing phenomenon that it is critical to plastic surgeons and their practice. Plastic surgery can be marketed directly to consumers and therefore social media can provide a valuable platform to interact with potential patients and to define a surgeon's expertise and practice online. Social media impacts search engine optimization algorithms, increasing web traffic to a surgeon's site, and it can affect patients' perceptions of the practice and surgeon. Social media is a powerful tool, but it should be harnessed wisely to avoid potential pitfalls. This article provides an overview of social media, an outline of resources for surgeons to use, and some tips and tricks for new users.

Does Demand for Breast Augmentation Reflect National Financial Trends?

Aesthetic plastic surgery is a consumer-driven industry, subject to influence by financial forces. A changing economic environment may thus impact on the demand for surgery. The aim of this study was to explore trends in demand for bilateral breast augmentation (BBA) in consecutively presenting patients over an 11-year period and to examine if a correlation exists between these trends and changes in Gross Domestic Product (GDP), a key economic indicator. This study revealed a correlation between annual number of breast augmentation procedures performed and GDP values (r ² = 0.34, p value = 0.059). Additionally, predicted number of BBA procedures, based on predicted GDP growth in Ireland, strongly correlated with actual number of BBA performed (r ² = 0.93, p value = 0.000001). Predicted GDP growth can potentially forecast future demand for BBA in our cohort allowing plastic surgeons to modify their practice accordingly.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .