Social Media Return on Investment: How Much is it Worth to My Practice?

Association Between Social Media Activity and Ratings on Physician Review Websites Among Orthopaedic Surgeons With an Active Online Media Presence

Background

Social media has the potential to play a substantial role in the decision-making of patients when choosing a physician for care.

Purpose

The purpose of this study was to determine whether an association exists between physician social media activity and patient satisfaction ratings on physician review websites (PRWs) as well as number of reviews. It was hypothesized that there would be a significant association between physician social media utilization and patient satisfaction ratings.

Study Design

Cross-sectional study.

Methods

The American Orthopaedic Society for Sports Medicine database was queried for the complete membership list. The online media profile and level of activity of the members were evaluated, and an online media presence score was calculated. The surgeons with the approximately top 10% of online media presence scores were compiled to assess the relationship between social media usage (Twitter, Instagram, YouTube, and Facebook) and patient satisfaction ratings on the Google Reviews, Healthgrades, and Vitals PRWs. Bivariate analysis was performed to compare demographic variables and level of online presence.

Results

A total of 325 surgeons were included in the analysis. The most common platform used was Facebook (88.3%). There was no significant relationship between active social media use and overall ratings on any of the PRWs. Active Twitter use was associated with a greater number of ratings on all review websites, a greater number of comments on Google Reviews and Healthgrades, and shorter patient-reported clinic wait times on Healthgrades. Active Instagram use was associated with a greater number of comments on Vitals. No relationships were observed for YouTube or Facebook.

Conclusion

For the included sports medicine surgeons who were most active on social media, no significant relationships were found between social media use and overall ratings on PRWs. Of all the platforms assessed, active use of Twitter was the only significant predictor of more reviews on PRWs. Thus, when deciding which form of social media engagement to prioritize in building one's practice, Twitter may serve as a relatively low-demand, high-reward option.

Social Media and Digital Footprints in Orthopaedic Trauma: An Analysis of 1465 Orthopaedic Trauma Association Members

OBJECTIVES

The purpose of this study was to quantify social media usage among Orthopaedic Trauma Association (OTA) members.

METHODS

All active OTA members were searched for involvement among common social media platforms. Surgeons were then classified as "active" on any given social media site if they posted within the past 6 months. Surgeons were also identified by the region they practiced in, sex, and their practice setting (academic vs. private). Finally, a surgeon's score and number of reviews from common physician review websites were examined.

RESULTS

A total of 1465 OTA members were included in the analysis. Most surgeons were male (89.1% [n = 1305]) and practiced in a private setting (54.5% [n = 799]). A total of 590 surgeons (40.3%) had at least one form of social media account. Social media sites most used were LinkedIn with 48.7% (n = 713) and ResearchGate with 29.2% (n = 428). Academic surgeons were more likely to have a ResearchGate, LinkedIn, and Twitter account while private surgeons were more likely to have a personal website ( P < 0.05). Finally, there was no correlation between surgeons more active on social media and average scores on Vitals.com or Healthgrade.com ( P > 0.05).

CONCLUSIONS

Most orthopaedic trauma surgeons do not have professional social media accounts. Although social media may help spread scholarship, having a professional social media account does not correlate with better online physician reviews or increased online reviews among orthopaedic trauma surgeons.

How Does Social Media Correlate With Clinical Appointments: A Quantitative Analysis

Social media has become an important part of plastic surgeons' practices. Is it true that the more followers, the more efficient it is to the plastic surgeon's branding? This study is to verify the quantitative correlation between social media and clinical appointments and to optimize its utilization. One hundred and five plastic surgeons were divided into 3 groups according to titles. WEIBO served as a targeted platform and descriptive data, including numbers of followers and clinic appointments were collected for analysis. The promotive effect was quantified as and correlation analysis was conducted to quantify the relationship between followers and outpatient appointments. From this research, it was found that 62% of participants were social media users, while 38% were not. No statistical significance was found between them by comparing the number of clinic appointments. For surgeons with social media, a positive correlation was proven between followers and clinic appointments, whose Pearson's correlation was 0.266 (attending: 0.557, associate consultant: 0.315, consultant: 0.060). Meanwhile, the conversion rates in this study were 22.49±44.67% (attending), 13.10±24.57% (associate consultant), and 18.88±36.05% (consultant). Outpatient consultations of senior surgeons without social media (2652±14492) were significantly higher than young surgeons with social media (1800±1718, P <0.05). The regression equation was Clinical Appointments=ln (Followers)×316.906-992.588 ( R2 =0.270, P =0.023). In conclusion, this study proved that social media positively influenced clinic appointments but the traditional personal brandings like reputations, academic pedigree, and word of mouth still played an indispensable role in career development. Young surgeons benefited most from social media. The promotive effect of social media would reach its saturation when the followers were up to ∼50,000.

Aesthetic Surgery Before-and-After Photography Bias on Instagram

PURPOSE

This study aims to systematically assess body and facial aesthetic surgery before-and-after photography bias on Instagram.

METHODS

An Instagram search using the term "plastic surgeon" was conducted on October 2020. The top 11 plastic surgeons' accounts were selected, and the first 15 images were selected from these profiles pertaining to different anatomical locations. Each photo was analyzed by a blinded board-certified plastic surgeon utilizing a 5-domain clinical photography bias score. The domains covered: (1) photo quality; (2) photo background; (3) position; (4) exposure/coverage; (5) bias.

RESULTS

The search strategy identified a total of 161 sets of before and after. The most common anatomical site posted was the nose (n=47), followed by breasts (n=37). The most common angles posted were anterior-posterior view (n=61). The majority of images showed bias toward the post-operative image (70.8%). The main culprit with photo characteristics occurred due to there being a different post-operative background which was more flattering for the post-operative result (n=46, p=0.006) and a different view or angle, which again, flattered the post-operative image (n=36, p=0.02). Other factors that influenced the post-operative bias included photos of the patient covered with clothing (n=15, p=0.014) or standing (n=20, p=0.001), compared to a supine pre-operative image.

CONCLUSION

Before-and-after photography conditions in aesthetic surgery is biased toward the post-operative result on Instagram. This observation was noticed across all surgical anatomical areas. Accounts photographer tends to misrepresent the photo background, view of angle, patients pose or position, or covering certain body parts.

LEVEL OF EVIDENCE IV

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 .

Perceptions of social media utilization among orthopaedic foot and ankle surgeons

BACKGROUND

The growing social media presence in healthcare has provided physicians with new ways to engage with patients. However, foot and ankle orthopaedic surgeons have been found to underuse social media platforms despite their known benefits for patients and surgeons. Thus, this study sought to investigate the reasons for this phenomenon and to identify potential barriers to social media utilization in clinical practice.

METHODS

A 19-question survey was distributed to active attending physicians identified through the American Orthopaedic Foot & Ankle Society membership database. The survey included demographic, practice characteristics, and social media use questions assessed by a 5-point Likert scale. Logistic regression was used to identify predictors of positive attitudes toward social media.

RESULTS

Fifty-eight surgeons were included. Most respondents were male (n = 43, 74.1%), in private practice (n = 31, 53.5%), and described their practice to be greater than 51% elective procedures (n = 46, 79.4%). The average years in practice was 14.8 years (standard deviation, SD: 10.0 years). A total of 32.8% (n = 19) of surgeons reported using social media as part of their clinical practice. Facebook (n = 19, 32.8%), a professional website or blog (n = 18, 31.0%), and LinkedIn (n = 15, 25.9%) were the most used platforms-primarily for practice marketing or brand development (n = 19, 32.8%). A total of 58.6% (n = 34) of surgeons reported they did not use social media. The primary reasons were the time commitment (n = 31, 53.5%), concerns about obscuring professional boundaries (n = 22, 37.9%), and concerns regarding confidentiality (n = 11, 19.0%). Many surgeons reported that social media positively influences foot and ankle surgery (n = 23, 39.7%), although no individual predictors for these views could be identified.

CONCLUSIONS

Foot and ankle orthopaedic surgeons tended to view social media use positively, but the time investment and concerns over professionalism and confidentiality pose challenges to its use. Given the influence of a surgeon's social media identity on patient satisfaction and practice building, efforts should be made to streamline social media use for foot and ankle surgeons to establish their online presence.

LEVEL OF EVIDENCE

Level IV, cross-sectional study.

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

Surveying the Landscape of Social Media Usage for Health Care by Otolaryngology Patients

OBJECTIVE

To determine factors associated with social media usage for finding a doctor or seeking medical advice among otolaryngology patients.

METHODS

Cross-sectional study of 361 patients visiting our clinics. All participants were asked if they were aware social media may be used to find doctors and if they had ever done so, and also if they were aware social media could be used to get advice about a medical condition or its treatment and if they had ever done so. Demographic characteristics were examined for association with affirmative answers to these questions.

RESULTS

Facebook was the most used social media platform with 50.7% using Facebook daily. Over 50% of participants were aware social media could be used to find a doctor or seek medical advice. Daily use of Facebook was associated with using social media for finding a doctor (OR = 2.57, 95%CI: 1.41-4.67, p = 0.002) and seeking medical advice (OR = 1.72, 95%CI: 1.09-2.71, p = 0.020). Having Medicare was associated with using social media to find a doctor (OR = 2.20, 95%CI: 1.15-4.21, p = 0.017), whereas Medicaid was associated with using social media for medical advice (OR = 1.99, 95%CI: 1.08-3.67, p = 0.027).

CONCLUSION

A majority of otolaryngology patients may be aware of health care applications of social media, with Facebook being the dominant platform, and Medicare insurance identifying patients who may most use social media in this manner. There is also an indication that social determinants of health, as reflected by Medicaid insurance, may be associated with using social media to seek medical advice.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:2116-2121, 2023.

Breast Augmentation in the Digital Era: The Power of Social Media in a Surgeon's New Practice

BACKGROUND

Opening a new practice is always challenging, and one of the main problems is how to engage patients. Most of them use social media to gather information about surgery and surgeons.

OBJECTIVES

The aim was to evaluate social media's impact on a new practice, compared with a long-standing practice run by the same surgeon. Furthermore, changes in patients' and surgeons' perspectives regarding social media in recent years were studied.

METHODS

In the 2 aforementioned practices, a questionnaire was administered to patients seen in consultation for primary breast augmentation regarding their interaction with social media before booking the visit. Another questionnaire was administered to 152 surgeons to assess their perceptions of social media.

RESULTS

Two hundred forty-seven patients in Italy and 129 in Sweden answered the questionnaire. In the first year of the Italian practice, 97.2% of patients booked a consultation with the surgeon thanks to social media; after 3 years, the percentage dropped to 68.02%. Comparing Italian and Swedish patients, 68.02% vs 28.68%, respectively, booked a consultation with the surgeon specifically thanks to social media, 91.09% vs 79.84% did research about the surgeon before booking a consultation, and 36.03% vs 10.08% contacted the surgeon before booking an appointment. One hundred fifty-two surgeons from 24 different countries answered the questionnaire, and 77.9% opined that social media positively affected their practice.

CONCLUSIONS

Social media is fundamental in patient-surgeon interaction and can strongly influence patient inflow, especially at the beginning of a new practice. Surgeons should be capable of using these tools to engage patients, bearing in mind the important role of these media in patients' education.

Modernizing marketing strategies for social media and millennials in dermatology

Social media platforms are changing the way health care professionals interact with patients, especially the younger, millennial population. This new mode of communication provides unique marketing opportunities to reach younger generations, primarily via Facebook, Instagram, YouTube, Snapchat, and TikTok. These platforms have already become primary mechanisms by which entertainment, news, and information are consumed, shared, and disseminated in this age group. It is important to understand these evolving dynamics to take full advantage of the opportunities that these platforms confer for creating and executing marketing strategy for dermatologists and clinics.

The Digital Footprint of Academic Plastic Surgeons

INTRODUCTION

The digital age and global pandemic have transformed the way patients select their plastic surgeon. However, as more patients turn to online resources, there is little information on the digital presence of academic plastic surgeons.

METHODS

We identified all academic faculty from integrated and independent plastic surgery residency programs. Using a Google-based custom search, the top 10 search results for each surgeon were extracted and categorized as surgeon noncontrolled (eg, physician rating websites) or controlled (eg, social media, institutional, and research profiles).

RESULTS

Eight hundred four academic plastic surgeons were included. Most search results were surgeon-noncontrolled sites (57%, n = 4547). Being male (odds ratio [OR], 0.60, P = 0.0020) and holding a higher academic rank (OR = 0.61, P < 0.0001) significantly decreased the prevalence of physician rating websites, whereas career length was significantly associated with a greater number of rating websites (OR = 1.04, P < 0.0001). Surgeon-controlled websites were significantly influenced by academic rank and years in practice; higher academic rank was associated with more social media platforms (OR = 1.42, P = 0.0008), institutional webpages (OR = 1.57, P < 0.0001), and research profiles (OR = 1.62, P = 0.0008). Conversely, longer career duration was a predictor for fewer social media platforms (OR = 0.95, P < 0.0001) and institutional webpages (OR = 0.95, P < 0.0001).

CONCLUSIONS

Academic plastic surgeons do not hold control of the majority of their search results. However, digitally savvy plastic surgeons can focus attention by building on certain areas to optimize their digital footprint. This study can serve as a guide for academic plastic surgeons wishing to control their online presence.

Digital brand building and online reputation management in dermatology

The percentage of American adults who use social media has steadily increased over the years. With information just a click or swipe away, social media has allowed its users to make empowered decisions, including in health care. Its role in health care is undeniable and ranges from impacting disease awareness to influencing the professional clout of physicians. Its use in dermatology is especially relevant due to the visual nature of the field. Dermatologists can educate the public, build relationships with other users, strengthen their brand, network with colleagues, and combat the rise in fake medical news. Additionally, social media humanizes physicians, and followers have embraced a combination of both educational and personal posts. We provided an overview on the history and current state of social media in dermatology along with a commentary on the strategies for digital brand building and reputation management.

Content and Engagement Among Plastic Surgeons on Instagram

Background

Patients routinely use social media to locate providers, review before-and-after photographs, and discuss experiences, making it a powerful marketing tool for plastic surgeons. A few studies have systematically evaluated plastic surgery app content.

Objectives

This study aims to analyze engagement levels and content posted by top plastic surgeon influencers on Instagram (Menlo Park, CA).

Methods

The authors conducted a cross-sectional study in February 2022 to identify the top 10 global plastic surgeons on Instagram. Influencers were ranked based on the number of followers, and their latest 20 posts were analyzed. A total of 200 posts were categorized by 2 independent trainees as one of the following: marketing, education, personal, and miscellaneous. The number of likes was recorded as a proxy for engagement, and the average engagement for each category was calculated.

Results

The top 10 influencers work primarily in private practice focusing on aesthetic procedures. Out of 200 categorized posts on Instagram, marketing posts had the greatest presence (64.5%), followed by personal (20%), miscellaneous (11%), and educational (4.5%). More still images were posted (56.5%) than videos (43.5%). The highest average engagement was for personal content (P = .005). No significant differences in engagement levels were found between photo and video content (P = .24).

Conclusions

Although most content posted related to marketing efforts, many influencers were also using social media to post about their personal lives and promote their ancillary businesses. Although marketing content was the most common, engagement levels were the highest for personal and educational content, and no significant differences in engagement were found between videos and photos.

#CosmeticsTwitter: Predicting Public Interest in Nonsurgical Cosmetic Procedures Using Twitter Data

BACKGROUND

The utilization of social media in plastic surgery is expanding. The Twitter Academic Research Product Tract (TARPT) database provides plastic surgeons the opportunity to monitor public interest in plastic surgery procedures. Previously, TARPT was shown to be effective in tracking public interest in surgical cosmetic facial and body procedures.

OBJECTIVES

The authors sought to determine the ability of the TARPT tool to track and predict public interest in nonsurgical cosmetic procedures and to examine temporal public interest trends in nonsurgical cosmetic procedures.

METHODS

The authors employed the TARPT tool to calculate the total number of tweets containing keywords related to 15 nonsurgical cosmetic procedures from 2010 to 2020. Annual case volumes were obtained for each of the 15 procedures from annual reports provided by the American Society of Plastic Surgeons. Univariate linear regression was employed to compare tweet volumes and procedure volumes, with P < 0.05 as a threshold for significance.

RESULTS

Univariate linear regression revealed significant positive correlations between tweet volumes and American Society of Plastic Surgeons procedure volumes for 10 search terms representing 6 nonsurgical cosmetic procedures: "xeomin," "microdermabrasion," "facial filler," "fat filler," "fat injections," "fat transfer," "hyaluronic acid filler," "hyaluronic acid injection," "HA filler," and "PRP filler." Thirty-two search terms did not demonstrate a significant relationship.

CONCLUSIONS

The TARPT tool is an informative data source for plastic surgeons with the potential to guide marketing and advertising strategies, and monitor public interest in nonsurgical cosmetic procedures, helping surgeons respond to patients' evolving needs.

Social Media in Aesthetic Dermatology: Analysis of the Users Behind the Top Filler Posts

BACKGROUND

Within the aesthetic realm, the influence of social media is quite prominent, with a growing percentage of patients using this technology to seek out health care recommendations and education.

OBJECTIVE

To ascertain the most accurate representation of what our patients may encounter on social media, we sought to characterize the top posts on the most popular visually-based social media platform (Instagram).

MATERIALS AND METHODS

We queried Instagram with variations of hashtags related to filler to determine which hashtags had the greatest number of posts associated with them. We then reviewed the top 100 posts associated with the top 9 hashtags, making note of whether the poster was a physician or nonphysician and whether an off-label procedure was performed or discussed.

RESULTS

Most (85.6%) of the 900 reviewed posts were written by nonphysicians, and most (84.6%) of the posts focused on off-label procedures were posted by nonphysicians. Among the physician posters, the most common specialties were Plastic Surgery and Family Medicine, followed by Dermatology.

CONCLUSION

At a time when patients are increasingly turning to social media for health care recommendations and education, most "top" content related to soft tissue augmentation is being provided by nonphysicians, many of whom are performing off-label procedures.

#TheUglyTruth? A Qualitative Evaluation of Outcomes Photography on Instagram: Introducing the SEPIA Scoring System

Photographs of cosmetic treatment outcomes on social media are prone to bias and misrepresentation from nonadherence to established photographic standards. However, there is currently insufficient information regarding which norms are most-commonly violated, precluding quality improvement efforts.

Methods

A qualitative study of cosmetic treatment photographs published on Instagram was undertaken in accordance with the Guidelines for Reporting Reliability and Agreement Studies using a newly proposed Standards for the Evaluation of Photographs In Aesthetics (SEPIA) nine-point photograph scoring system and grading scale.

Results

A total of 510 posts encompassing 2020 clinical photographs published by 102 practitioner accounts on Instagram were audited for photographic quality. The average score was 4 out of 9 (medium quality), with approximately 40% of posts scoring in the low-quality range. Zoom, lighting, timing, and presentation of multiple views were the standards most-commonly disregarded. Plastic and Reconstructive Surgery specialty and subspecialty (PRSS) practitioners scored higher (4.5/9 versus 3.1/9, P = 0.002) and had fewer low-quality posts (22% versus 54%, P = 0.001) than non-PRSS providers. Low-quality photographs were most often seen with rhinoplasty (30% versus 7%, P < 0.00001) and lip filler (60% versus 33%, P = 0.0001) compared with surgical and nonsurgical treatments, respectively, due to a higher incidence of immediate photographs and selfies.

Conclusions

Before and after photographs of surgical and nonsurgical cosmetic treatment outcomes on social media are frequently of substandard quality. This study outlines specific items frequently neglected in outcomes photography to assist practitioners in maximizing adherence to established standards of photography online.

#PlasticsTwitter: The Use of Twitter Data as a Tool for Evaluating Public Interest in Cosmetic Surgery Procedures

BACKGROUND

Plastic surgeons are increasingly turning to social media to market their services. The newly released Twitter Academic Research Product Track (TARPT) database provides free, customizable analysis of keywords that are included in tweets on the Twitter platform. The TARPT tool may provide valuable insight into public interest in cosmetic surgery procedures.

OBJECTIVES

The aim of this study was to determine TARPT's utility in tracking and predicting public interest in cosmetic surgery procedures and to examine temporal trends in tweets related to cosmetic facial and body procedures.

METHODS

The TARPT tool was used to calculate the total number of tweets containing keywords related to 10 facial cosmetic procedures and 7 cosmetic body procedures from 2010 to 2020. Annual volumes for respective procedures were obtained from annual statistics reports of The Aesthetic Society from 2010 to 2020. Tweet volumes and procedure volumes were compared by univariate linear regression, taking P < 0.05 as the cutoff for significance.

RESULTS

Variations in tweet volume were observed. Univariate linear regression analysis demonstrated statistically significant positive correlations between tweet volumes and procedure volumes for 7 search terms: "eyelid lift," "facelift," "lip injections," "mastopexy," "butt lift," "butt implants," and "liposuction." Many procedure-related keywords were not significant, demonstrating the importance of careful selection of Twitter search terms.

CONCLUSIONS

The TARPT database represents a promising novel source of information for plastic surgeons, with the potential to inform marketing and advertising decisions for emerging trends in plastic surgery interest before these patterns become apparent in surgical or clinical volumes.

Conversion Rate of Web-based Versus Non-web-based Patient Referral Sources in a Facial Plastic Surgery Practice

PURPOSE

To compare the conversion rate (number of procedures/referrals) of web-based and non-web-based referrals to a facial plastic surgery practice (2012-2019).

METHOD

Data on demographics, referral source, patient's concern, and their facial procedures were recorded. Web-based referral sources include website and Instagram. Non-web-based counterparts were the word-of-mouth, medical professionals, and others (TV, radio, printed media). Patient concerns were either cosmetic or noncosmetic (functional). Patients who underwent facial cosmetic surgery and injections (botulinum toxin A, filler, fat) were categorized in the cosmetic procedure group. Patients with functional procedures with or without facial injections were categorized in the noncosmetic procedure group. The conversion rate was defined as the ratio of the number of referrals with different facial procedures to the total number of referrals.

RESULTS

Included were 19,965 patients, majority of whom (63.3%) had cosmetic concern. Total, cosmetic, and noncosmetic conversion rates were 30.1%, 27.7%, and 2.4% for the web-based and 24.1%, 19.8%, and 4.3% for the non-web-based referrals, respectively (0.3 < p < 0.4). Cosmetic conversion rate grew from 6.7% in referrals ≤20 to more than 23% in >20 years of age (p = 0.03). It was also significantly (p < 0.001) higher in the referrals with cosmetic (28.3%) than noncosmetic (12.1%) concern. Gender and year of practice did not have a significant effect on the conversion rates.

CONCLUSION

Conversion rates were not significantly different between the web-based and non-web-based referrals. A significantly higher cosmetic conversion rate was observed for the referrals with cosmetic concern and older than 20 years.

#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.

Global Trends in Plastic Surgery on Social Media: Analysis of 2 Million Posts

BACKGROUND

Plastic surgeons and patients increasingly use social media. Despite evidence implicating its importance in plastic surgery, the large volume of data has made social media difficult to study.

OBJECTIVES

The aim of this study was to provide a comprehensive assessment of plastic surgery social media content worldwide by utilizing techniques for analyzing large-scale data.

METHODS

The hashtag "#PlasticSurgery" was used to search public Instagram posts. Metadata were collected from posts between December 2018 and August 2020. In addition to descriptive analysis, 2 instruments were created to characterize textual data: a multilingual dictionary of procedural hashtags and a rule-based text classification model to categorize the source of the post.

RESULTS

Plastic surgery content yielded more than 2 million posts, 369 million likes, and 6 billion views globally over the 21-month study. The United States had the most posts of 182 countries studied (26.8%, 566,206). Various other regions had substantial presence including Istanbul, Turkey, which led all cities (4.8%, 102,208). The classification model achieved high accuracy (94.9%) and strong agreement with independent raters (κ = 0.88). Providers accounted for 40% of all posts (847,356) and included the categories physician (28%), plastic surgery (9%), advanced practice practitioners and nurses (1.6%), facial plastics (1.3%), and oculoplastics (0.2%). Content between plastic surgery and non-plastic surgery groups demonstrated high textual similarity, and only 1.4% of posts had a verified source.

CONCLUSIONS

Plastic surgery content has immense global reach in social media. Textual similarity between groups coupled with the lack of an effective verification mechanism presents challenges in discerning the source and veracity of information.

Photographic Misrepresentation on Instagram After Facial Cosmetic Surgery: Is Increased Photography Bias Associated With Greater User Engagement?

BACKGROUND

Before-and-after images are commonly used on Instagram (Menlo Park, CA) to advertise aesthetic surgical treatments and are a powerful means of engaging prospective patients. Consistency between before-and-after images accurately demonstrating the postoperative result on Instagram, however, has not been systematically assessed.

OBJECTIVES

The aim of this study was to systematically assess facial cosmetic surgery before-and-after photography bias on Instagram.

METHODS

The authors queried 19 Instagram facial aesthetic surgery-related hashtags on 3 dates in May 2020. The "top" 9 posts associated with each hashtag (291 posts) were analyzed by 3 plastic surgeons by means of a 5-item rubric quantifying photographic discrepancies between preoperative and postoperative images. Duplicate posts and those that did not include before-and-after images of facial aesthetic surgery procedures were excluded.

RESULTS

A total of 3,477,178 posts were queried. Photography conditions were observed to favor visual enhancement of the postoperative result in 282/291 analyzed top posts, with an average bias score of 1.71 [1.01] out of 5. Plastic surgeons accounted for only 27.5% of top posts. Physicians practicing outside their scope of practice accounted for 2.8% of top posts. Accounts with a greater number of followers (P = 0.017) and posts originating from Asia (P = 0.013) were significantly associated with a higher postoperative photography bias score.

CONCLUSIONS

Photographic misrepresentation, with photography conditions biased towards enhancing the appearance of the postoperative result, is pervasive on Instagram. This pattern was observed across all physician specialties and raises significant concerns. Accounts with a greater number of followers demonstrated significantly greater postoperative photography bias, suggesting photographic misrepresentation is rewarded by greater user engagement.

The Effect of a Surgeon’s Online Presence on Surgeon Selection in Elective Joint Arthroplasty

The purpose of this study was to investigate the role that a surgeon’s online presence plays in patients’ decisions to be treated by that surgeon. Postoperative patients from our arthroplasty clinic were enrolled in a retrospective cross-sectional questionnaire. Results from 101 patients demonstrated that the most searched information was education and training (68.8%), online ratings (53.1%), online reviews (50%), associated hospital and/or university (46.9%), insurance coverage (37.5%), location (21.9%), and awards (9.4%). The results of our questionnaire suggest that orthopedic surgeons could more effectively shape their online presences by highlighting these characteristics that patients are more likely to research.

Social Media and Plastic Surgery Practice Building: A Thin Line Between Efficient Marketing, Professionalism, and Ethics

Social media sites and platforms have grown in numbers with an enormous potential to reach and disseminate information in real time. They are impacting tremendously for better or for worse on the current practice of plastic surgery. As the demand for elective plastic surgery, in particular for aesthetic procedures, continues to rise, there is a need to determine the influence of social media advertisements and how it motivates the public to undergo cosmetic procedures. Most importantly, there is an urgent need to determine how the social media are impacting plastic surgery practice building and what is proper and efficient marketing while upholding ethics of the medical profession? A thorough PICO tool-based comprehensive literature search was conducted. Fifty-one peer-reviewed publications, 15 patient-centered, 33 provider-centered, and three combined patient/provider were identified to be relevant to the use of social media in plastic surgery and were selected for this review. Evidence on how social media influences the medical practice and helps in practice building remains scarce; nevertheless, reliance of plastic surgeons on social media to improve their practice has been increasing steadily. Social media may be a powerful tool to promote one's career. It presents, however, serious professional, legal, and ethical challenges including maintenance of professionalism and protecting patient confidentiality. If misused, it may be a quick way to end a plastic surgery practice.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 .

#OculoplasticsandSocialMedia: a review of social media in oculoplastics and relevant subspecialties

The permeation of social media into life almost goes without bounds and medicine is no exception. While social media holds great potential for physicians and medicine, it also comes with concurrent spread of disinformation. This increases the importance of evidence-based information from qualified physicians on social media.Although the definition of social media is broad, in general, it refers to the use of web-based platforms to connect one human to another. In oculoplastic surgery, these relationships can be physician to physician, physician to patient, patient to patient, and vendor to physician. These relationships mostly involve education, social support, and advertising, but can also include research and government advocacy. The purpose of this review is to evaluate the current utilization of social media in oculoplastic surgery and relevant subspecialties.

The "RealSelf Effect": Can Patient Reviews on Social Media Impact Clinic Volume?

BACKGROUND

Whether patient driven or surgeon driven, social media can serve as a strong marketing tool to attract plastic surgery patients. At many training programs, chief residents have the opportunity to run an independent clinic, in which patients are evaluated for aesthetic and reconstructive procedures. In this study, the authors sought to investigate the downstream effect of a single positive review on a major social review site on cosmetic surgery volume.

METHODS

A retrospective pre-post intervention study was performed. Operating room case logs at an urban training program were queried for purely aesthetic cases performed through the chief resident clinic in 2012 to 2018. Procedures performed by nonplastic surgery services were excluded.

RESULTS

A total of 1734 cases met the inclusion criteria. Before the online review, aesthetic cases grew from 61 to 82 (10% compounded annual growth rate). However, after the review was posted, 107 aesthetic cases were performed in the 2016-2017 academic year, driving a 30% growth rate. A large portion of this increase in growth can be attributed to the growth in number of rhytidectomies performed.

DISCUSSION

This study evaluated the impact of social media on the volume of aesthetic cases performed through an established chief resident clinic and its utility in patient recruitment. Chief residents had an increase in the number of aesthetic surgery cases they performed after their clinic was featured on an online social media physician review website. This further reinforces the impact social media and an online presence have on plastic surgery training.

Social Media and Health Care, Part I: Literature Review of Social Media Use by Health Care Providers

BACKGROUND

As the world continues to advance technologically, social media (SM) is becoming an essential part of billions of people's lives worldwide and is affecting almost every industry imaginable. As the world is becoming more digitally oriented, the health care industry is increasingly visualizing SM as an important channel for health care promotion, employment, recruiting new patients, marketing for health care providers (HCPs), building a better brand name, etc. HCPs are bound to ethical principles toward their colleagues, patients, and the public in the digital world as much as in the real world.

OBJECTIVE

This review aims to shed light on SM use worldwide and to discuss how it has been used as an essential tool in the health care industry from the perspective of HCPs.

METHODS

A literature review was conducted between March and April 2020 using MEDLINE, PubMed, Google Scholar, and Web of Science for all English-language medical studies that were published since 2007 and discussed SM use in any form for health care. Studies that were not in English, whose full text was not accessible, or that investigated patients' perspectives were excluded from this part, as were reviews pertaining to ethical and legal considerations in SM use.

RESULTS

The initial search yielded 83 studies. More studies were included from article references, and a total of 158 studies were reviewed. SM uses were best categorized as health promotion, career development or practice promotion, recruitment, professional networking or destressing, medical education, telemedicine, scientific research, influencing health behavior, and public health care issues.

CONCLUSIONS

Multidimensional health care, including the pairing of health care with SM and other forms of communication, has been shown to be very successful. Striking the right balance between digital and traditional health care is important.

Digital Footprint of Academic Vascular Surgeons in the Southern United States on Physician Rating Websites: Cross-sectional Evaluation Study

Background

The internet has become a popular platform for patients to obtain information and to review the health care providers they interact with. However, little is known about the digital footprint of vascular surgeons and their interactions with patients on social media.

Objective

This study aims to understand the activity of academic vascular surgeons on physician rating websites.

Methods

Information on attending vascular surgeons affiliated with vascular residency or with fellowships in the Southern Association for Vascular Surgery (SAVS) was collected from public sources. A listing of websites containing physician ratings was obtained via literature reviews and Google search. Open access websites with either qualitative or quantitative evaluations of vascular surgeons were included. Closed access websites were excluded. Ranking scores from each website were converted to a standard 5-point scale for comparison.

Results

A total of 6238 quantitative and 967 qualitative reviews were written for 287 physicians (236 males, 82.2%) across 16 websites that met the inclusion criteria out of the 62 websites screened. The surgeons affiliated with the integrated vascular residency and vascular fellowship programs in SAVS had a median of 8 (IQR 7-10) profiles across 16 websites, with only 1 surgeon having no web presence in any of the websites. The median number of quantitative ratings for each physician was 17 (IQR 6-34, range 1-137) and the median number of narrative reviews was 3 (IQR 2-6, range 1-28). Vitals, WebMD, and Healthgrades were the only 3 websites where over a quarter of the physicians were rated, and those rated had more than 5 ratings on average. The median score for the quantitative reviews was 4.4 (IQR 4.0-4.9). Most narrative reviews (758/967, 78.4%) were positive, but 20.2% (195/967) were considered negative; only 1.4% (14/967) were considered equivocal. No statistical difference was found in the number of quantitative reviews or in the overall average score in the physician ratings between physicians with social media profiles and those without social media profiles (departmental social media profile: median 23 vs 15, respectively, P=.22; personal social media profile: median 19 vs 14, respectively, P=.08).

Conclusions

The representation of vascular surgeons on physician rating websites is varied, with the majority of the vascular surgeons represented only in half of the physician rating websites The number of quantitative and qualitative reviews for academic vascular surgeons is low. No vascular surgeon responded to any of the reviews. The activity of vascular surgeons in this area of social media is low and reflects only a small digital footprint that patients can reach and review.

Insta-Grated Plastic Surgery Residencies: 2020 Update

BACKGROUND

Recent evidence shows accelerating worldwide adoption of social media and suggests a commensurate increase in social media use by integrated plastic surgery residency programs in the United States. Programs nationwide are now making strides to include a longitudinal social media component in their plastic surgery curriculum.

OBJECTIVES

The aim of this study was to investigate the use of Instagram by plastic surgery residency programs and to describe trends in adoption, volume, and content.

METHODS

Current active Instagram accounts affiliated to integrated plastic surgery residency programs were surveyed to identify date of first post, number of posts, number of followers, number of followings, engagement rate, most-liked posts, and content of posts. All data were collected on May 12, 2020.

RESULTS

Sixty-nine out of 81 (85.2%) integrated plastic surgery residency programs had Instagram accounts, totaling 5,544 posts. This represents an absolute increase in program accounts of 392% since 2018. The 100 most-liked posts were categorized as: promotion of the program/individual (46), resident life (32), promotion of plastic surgery (14), and education (8).

CONCLUSIONS

Instagram use by plastic surgery residency programs has drastically increased since it was first evaluated in 2018. This trend will continue as we reach near saturation of residency programs with accounts. We remain steadfast in our belief that the advantages of social media use by plastic surgeons and trainees are far outweighed by the potential community-wide impacts of violations of good social media practice on peers, patients, and the general public.

Social Media Utilization Among Shoulder and Elbow Surgeons

INTRODUCTION

Social media represents a novel platform for patient-physician interaction. Although social media utilization patterns have been analyzed in other fields, no such study has been performed in shoulder and elbow specialists.

METHODS

The membership database of the society of the American Shoulder and Elbow Surgeons was queried. Online searches were performed to identify if each surgeon had professional profiles on popular social media platforms. A social media score was then calculated, defined as the number of active accounts. Statistical analysis was used to test for associations between demographics and social media utilization.

RESULTS

Six hundred seventy-six surgeons were analyzed. The average social media score was 1.61. The most highly used platform was LinkedIn (61%). The least used platform was Instagram (5% active, 11% total). Female surgeons were more likely to use Instagram than men (12.5% versus 4.9%). Academic surgeons were more likely to use ResearchGate (46.5% versus 33.3%), whereas private practice surgeons were more likely to have a website (19.9% versus 11.7%). Practitioners from the South had the lowest social media utilization.

CONCLUSIONS

Shoulder and elbow surgeons underuse social media. As the influence of social media continues to grow, it will be important for surgeons to implement social media within their practices.

Social media in interventional radiology

INTRODUCTION

Social media provides opportunities for Interventional Radiologists to share research, communicate with colleagues, provide health information and advertise their clinical practice. This study aims to examine the online and social media presence of currently practicing Australian Interventional Radiologists.

METHODS

Systematic Google searches were undertaken in May 2019 and updated in May 2020 to identify practicing Interventional Radiologists in Australia. Comprehensive searches of practice websites and social media platforms (Facebook, LinkedIn, Twitter, ResearchGate, YouTube) were undertaken for each Interventional Radiologist.

RESULTS

There were 265 Interventional Radiologists identified as currently practising in Australia, including 209 Interventional Radiologists (excluding Interventional Neuroradiologists), 49 Interventional Neuroradiologists and 7 that practise across both Interventional Radiology and Interventional Neuroradiology. 72% of Interventional Radiologists had at least one social media account, with LinkedIn the most widely used social media platform (60%). There was a significant negative correlation between the total number of social media accounts and years in practice (P = 0.04). Across the states, a higher population per IR was positively correlated with a higher average number of social media accounts per IR (P = 0.04). Interventional Neuroradiologists had a significantly higher average number of social media accounts compared to Interventional Radiologists (1.94 vs 1.29, P < 0.01).

CONCLUSIONS

Most Australian Interventional Radiologists have a readily identifiable social media presence. There is potential for further utilisation of social media for academic, educational and business purposes.

The use of social media among saudi ophthalmologists: A descriptive cross-sectional study

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METHODS:

RESULTS:

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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.

Changing in a GIF (Graphics Interchange Format): Innovations in Before and After Photography

PURPOSE

Before and after images are an important part of aesthetic counseling, but no studies have examined ways to optimize change detection through the layout of displayed images. This study compares 3 different image layouts to determine which presentation style improves perception of postprocedure changes.

METHODS

In this prospective, randomized study, participants viewed sequential images of patients who either had or had not undergone upper eyelid blepharoptosis repair or blepharoplasty ("change" and "no-change," respectively). These paired images were randomly presented in 1 of 3 formats: side-by-side, up-and-down, or alternation flicker (in which 2 images are superimposed and alternated in a graphics interchange format). Participants were asked if a procedure had been performed based on the 2 photographs. Paired t tests were used to compare response times and change detection rates between individual-level pairs of presentation modes.

RESULTS

Of 299 recruited patients, 286 completed the study. Rate of change detection trended toward increased sensitivity for alternation flicker over static images. This became statistically significant for patients less than 45 years old. Detection rates did not differ significantly between the 2 static layouts (side-by-side and up-and down).

CONCLUSIONS

Enhancing and customizing aesthetics counseling for different ages can improve patient understanding, expectations, and advertising. When using static photography, the layout, whether side-by-side or up-and-down, can be chosen to fit the mode of presentation with no statistically significant difference. To optimize detection of changes in before and after photography in a demographic less than 45 years old, the animated, alternation flicker format was statistically significantly more effective.

Criteria to Measure Social Media Value in Health Care Settings: Narrative Literature Review

BACKGROUND

With the growing use of social media in health care settings, there is a need to measure outcomes resulting from its use to ensure continuous performance improvement. Despite the need for measurement, a unified approach for measuring the value of social media used in health care remains elusive.

OBJECTIVE

This study aimed to elucidate how the value of social media in health care settings can be ascertained and to taxonomically identify steps and techniques in social media measurement from a review of relevant literature.

METHODS

A total of 65 relevant articles drawn from 341 articles on the subject of measuring social media in health care settings were qualitatively analyzed and synthesized. The articles were selected from the literature from diverse disciplines including business, information systems, medical informatics, and medicine.

RESULTS

The review of the literature showed different levels and focus of analysis when measuring the value of social media in health care settings. It equally showed that there are various metrics for measurement, levels of measurement, approaches to measurement, and scales of measurement. Each may be relevant, depending on the use case of social media in health care.

CONCLUSIONS

A comprehensive yardstick is required to simplify the measurement of outcomes resulting from the use of social media in health care. At the moment, there is neither a consensus on what indicators to measure nor on how to measure them. We hope that this review is used as a starting point to create a comprehensive measurement criterion for social media used in health care.

Are We Witnessing a Paradigm Shift?: A Systematic Review of Social Media in Residency

As social media's applications continue to evolve, the pitfalls and dangers associated with misuse have been accentuated in the literature. Consequently, academic institutions across the nation have implemented social media policies. This study is aimed to evaluate the state of social media literature examining postgraduate trainees (residents/fellows).

METHODS

A systematic search was performed identifying peer-reviewed publications presenting original research. Studies published through December 8, 2018, focusing on social media use among postgraduate trainees were considered for inclusion.

RESULTS

Fifty-three studies were categorized into 4 domains: (1) resident recruitment, (2) graduate medical education, (3) professional development, and (4) academic scholarship. Thirty-four (64.15%) investigated social media's impact on professional development, of which 16 (47.05%) highlighted the detrimental potential on trainee professionalism. The remaining 18 (52.94%) focused on promoting social media training during residency, and/or enhancing social media competency to benefit professional development. Fourteen (26.42%) rationalized social media use in augmenting graduate medical education. Ten (18.87%) assessed social media's influence on resident recruitment, of which 7 (70%) depicted use as a screening instrument for program directors on resident applicants. Two (3.77%) of the studies introduced social media as a platform for academic scholarship with indicators as altmetrics.

CONCLUSIONS

The well-established disadvantages of social media use by the postgraduate trainee continue to persist in the literature. However, there is recognition of social media as a valuable resource in influencing resident recruitment, graduate medical education, professional development, and academic scholarship, representing a paradigm shift-from cautiously avoidant to thoughtful capitalization on its immense potential.

To Post or Not to Post: Plastic Surgery Practice Marketing, Websites, and Social Media?

Social media is beginning to eclipse practice websites and other traditional electronic marketing utilized by plastic surgeons. First, highlights are presented from the relevant electronic marketing literature. Next, this article presents a new case study of how, why, when, and what social media is being used by ASPS members (n = 100). Results suggest a significant disconnect between plastic surgeons and the highest impact platforms reported in the literature such as Instagram, YouTube, Snapchat, and Facebook. Plastic surgeons currently prefer to focus electronic marketing efforts on practice websites over social media platforms. This study suggests that instead of relying on their practice websites to disseminate information, surgeons should be utilizing social media, posting promotions, before-and-after photos, and videos to develop their client base.

The Public's Preferences on Plastic Surgery Social Media Engagement and Professionalism: Demystifying the Impact of Demographics

BACKGROUND

Social media discussions are alive among plastic surgeons. This article represents a primer on beginning to understand how the public would seek out plastic surgeons and how demographics shape their preferences.

METHODS

An anonymous 31-question survey was crowdsourced by means of MTurk.

RESULTS

There were a total of 527 respondents. Of these respondents, 33 percent follow plastic surgeons on social media, with those aged younger than 35 years 3.9 times more likely to do so. Google was the first place people would look for a plastic surgeon (46 percent). When asked what was the most influential of all online methods for selecting a surgeon, practice website ranked first (25 percent), but social media platforms ranked higher as a whole (35 percent). Those considering surgical or noninvasive procedures are thee times more likely to select social media platforms as the most influential online method in selecting a surgeon and five times more likely to follow a plastic surgeon on social media. The majority would prefer not seeing the surgeon's private life displayed on social media (39 percent). Respondents were evenly split regarding whether graphic surgical images would lead them to unfollow accounts. Ninety-six percent of the general public were unclear of the type of board certification a plastic surgeon should hold.

CONCLUSIONS

Clear differences in engagement and perception exist in the public based on age, sex, parental status, and reported country of origin. Social media will soon become a critical strategy in outreach and engagement and a valuable tool in clearing misconceptions within plastic surgery.

Internet and Social Media as a Source of Information About Plastic Surgery: Comparison Between Public and Private Sector, A 2-center Study

Background:

The popularity of social media among plastic surgeons and patients has increased in the last years. We conducted this study to explore the differences in patients’ social media habits between public and private aesthetic plastic surgery practice.

Methods:

A 2-cohort study was conducted in aesthetic plastic surgery clinic and public department of plastic and surgery by surveying consecutive first-time patients.

Results:

Two hundred patients completed a 18-question survey at a private aesthetic plastic surgery clinic. The questionnaire was also filled by 113 patients at a public plastic surgery department. Facebook was the most popular social media platform in both groups. Word of mouth from other patients and the clinic’s website were the most-valued source of information about the surgeon and surgical procedure for patients of both studied groups. Patients from the aesthetic group were mainly women from small towns; they were significantly younger and better educated and used Instagram more frequently than patients from public group. The aesthetic group patients focused significantly more often on the surgeon’s credentials and on before and after photographs. They appreciated social media as a source of information for patients significantly more than public group patients who stated that social media were the worst source of information.

Conclusions:

Word of mouth from other patients remains the most-valued source of information about plastic surgery. However, proper use of social media and building online image in a professional manner can provide attract more patients to the aesthetic plastic surgery practice.