Patients' and Surgeons' Perceptions of Social Media's Role in the Decision Making for Primary Aesthetic Breast Augmentation

Reasons for Silicone Breast Implant Removal After Long-Term Implantation in Chinese Patients Without Complications: A Questionnaire-Based Study

BACKGROUND

There are few studies of Chinese patients who request silicone breast implant removal after at least 10 years of implantation without any complications. This study aimed to study the characteristics of these patients, explore their reasons for breast implant removal and associate factors that affect their choice, so as to provide valuable information on clinical decision making.

METHODS

A total of 55 eligible female patients (110 breasts) were enrolled from 2016 to 2022. A preoperative questionnaire survey before removal surgery and a telephone follow-up 1 year after removal surgery were conducted to collect data.

RESULTS

The mean age of the patients was 40.6±8.8 years with the average time from breast augmentation to implant removal or replacement ranged from 10 to 15 years. Concerns about the aging of silicone gel-filled breast implant and the adverse effects of its long-term placement on body health were the top two reasons for breast implant removal. 63% of patients refused implant replacement, who were nearly 10 years older than those accepted implant replacement (p<0.05). Older age at implant removal (OR=0.67; 95%CI: 0.44-0.89) and a history of basic diseases (OR=0.02; 95%CI: 0.00-0.39) were statistically associated with lower rate of implant replacement.

CONCLUSIONS

Concerns about the aging of silicone gel-filled breast implant were the main reason for uncomplicated patients to remove their breast implants. A comprehensive analysis based on patient's subjective choice and physical condition was suggested when an uncomplicated patient asks for implant removal.

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 .

The Impact of Social Media on Seeking Dermatological Care

INTRODUCTION

Social media is used by more than half of the world's population. Social media is becoming more widely recognized as a significant factor when looking for healthcare services because of its capacity to affect an individual's decision. Therefore, we aim to investigate the influence of social media and the use of filters on seeking cosmetic dermatological procedures among the general population of Jeddah, Saudi Arabia.

METHODS

This cross-sectional study utilized an online form for data collection. The questionnaire was developed by the authors after an extensive literature review. The data collection took place in October 2022 in Jeddah, Saudi Arabia. Participants were recruited using convenience and snowball sampling methods.

RESULTS

A total of 1,031 responses were analyzed, with females representing the majority (85.2%, n = 878). About half (47.4%, n = 489) indicated a willingness to undergo an aesthetic procedure, 16.3% (n = 168) had already done one procedure at least, and 53.2% (n = 548) had a specific procedure to do in the future. Healthcare professionals were the most common source of information (53.9; n = 556), followed by social media (22.7%; n = 234). In the Snapchat application, 94.5% (n = 974) of the participants used face filters. Undergoing an aesthetic procedure showed statistically significant associations with age, gender, educational level, employment, and income.

CONCLUSION

Hiding skin lesions or acne was the most frequently reported reason for using photo editing apps or filters. While healthcare providers were the most frequently reported source of information, Snapchat influenced around 33% of the study's participants to undergo an aesthetic procedure.

The Impact of Botulinum Toxin Injection on the Outcomes of Breast Surgeries: A Systematic Review and Meta-Analysis

BACKGROUND

Breast surgeries aim to restore the natural appearance of the breasts with acceptable functional and cosmetic outcomes. However, these surgical procedures may be associated with considerable adverse events. The present systematic review and meta-analysis was designed to reveal the functional and aesthetic outcomes of botulinum toxins (BTX) injection in patients subjected to breast surgeries.

METHODS

A literature review was performed up to 21 September 2022. All clinical studies included patients older than 18 years old and treated with BTX injection for breast surgeries were included.

RESULTS

The present study included 12 articles, encompassing 496 patients. The average dosage of BTX injection ranged from 20 to 100 units. Injecting BTX significantly reduced the mean post-operative opioid analgesics usage (SMD -1.577; 95% -2.087, -1.067; P < 0.001) and the risk of severe animation deformity (RR 12.37; 95% 1.76, 86.66; P = 0.01). There was a statistically significant higher mean expansion volume per visit in the BTX injection group (SMD 1.166; 95% 0.313, 2.018; P = 0.007). There was no statistically significant impact of BTX injection on the risk of surgical site infection (RR 0.59; 95% 0.15, 2.34; P = 0.45) and seroma (RR 0.51; 95% 0.03, 10.15; P = 0.66).

CONCLUSIONS

The present study revealed the potential benefits of BTX injection in breast surgeries. This included reduced post-operative analgesics, as well as the risk of severe animation deformity. This was accomplished with increased expansion volume per visit and a similar risk of BTX injection-related complications.

LEVEL OF EVIDENCE III

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 .

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.

What factors will influence patients when choosing plastic surgeons? A behaviour analysis of Chinese patients

PURPOSE

To analyze the factors that patients consider when choosing plastic surgeons and investigate patients' attitudes toward physicians' aesthetic ability and their adherence toward same-gender physicians.

METHODS

A cross-sectional study was conducted. All patients who presented for evaluation and management between January and April 2022 were eligible for study enrolment. Data collected include demographical information and specific questions related to choosing plastic surgeons, including physician's education, surgical ability, research, title, appearance, dress, age, aesthetics, the patient's preference for physicians' gender, and the way of learning about physicians.

RESULTS

1006 valid respondents participated, and the average age was 46.44 ± 15.51 years old (participation rate 99.60%). 72.5% were female. Plastic surgery history (OR 3.242, 95%CI: 1.664-6.317, p = 0.001), education (OR 1.895, 95%CI: 1.064-3.375, p = 0.030), income (OR 1.340, 95%CI: 1.026-1.750, p = 0.032), sexual orientation (OR 1.662, 95%CI: 1.066-2.589, p = 0.025), and concern for the physicians' appearance (OR 1.564, 95%CI: 1.160-2.107, p = 0.003) were significantly associated with patients' tendency to value physicians' aesthetic ability. Marital status (OR 0.766, 95% CI: 0.616-0.951, p = 0.016), income (OR 0.896,95% CI: 0.811-0.990, p = 0.031), the attention to physicians' age (OR 1.191,95% CI: 1.031-1.375, p = 0.017), and the attention to physicians' aesthetic ability (OR 0.775,95% CI: 0.666-0.901, p = 0.001) were significantly associated with the respondents' same-gender adherence degree.

CONCLUSION

These findings suggest that patients with plastic surgery history, higher income, higher education background, and more diverse sexual orientation paid more attention to physicians' aesthetic ability. Marriage and income would affect the same-gender adherence degree, which would further influence patients' attention to the doctor's age and aesthetic ability.

How an Automated Patient Education Module Improves Patient Outcomes and Informs Quality-of-Care Measures for Providers Within a Minimally Invasive Aesthetic Practice

I conducted a quality improvement project to determine whether providing patient education before consultation and treatment would help meet the needs of aesthetic patients and providers. The project objective was to create an automated patient education module that provided consistent, accurate information to each patient who viewed it and would give the providers additional time to treat the patient and generate revenue. Before and during the 6-week study period, I administered three surveys and reviewed electronic health records metrics indicating patient check-in and check-out times and facility revenue. I used descriptive statistics to examine the demographics of the patients included in the study. I analyzed check-in and check-out times and facility revenue by conducting two-tailed Mann-Whitney U tests. There were a total of 201 patient visits in the 6-week period before the study and a total of 316 patient visits during the study period. Most patients were White, married women, 50- to 59-years-old, with at least some college education. The most common treatments administered were neurotoxin and dermal filler injections. After implementing the preappointment education, I found a significant reduction in the length of patient appointments (p < .001) and a significant increase in facility revenue (p < .037). I concluded that after implementing the education program, patient understanding about the intended treatment was improved. To better correlate how preappointment automated education impacts the amount of time the provider spends with patients and influences practice revenue, I recommend conducting a longer study with a greater number of patients.

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.

Aesthetic Evaluation of Breast Reconstruction with Autologous Fat Transfer vs. Implants

Background

Autologous fat transfer (AFT) seems to be a new minimal invasive method for total breast reconstruction, yet how patients, surgeons, and laymen evaluate cosmesis is lacking. The aim of this study was to evaluate the aesthetic outcome of AFT (intervention group) for total breast reconstruction post-mastectomy, as compared to implant-based reconstruction (IBR) (control group).

Methods

A random and blinded 3D photographic aesthetic outcome study was performed on a selection of 50 patients, scored by three panels: plastic surgeons, breast cancer patients, and laymen. Secondary outcomes included agreement within groups and possible patient characteristics influencing scoring.

Results

Breast cancer patients and plastic surgeons did not differ in the aesthetic scores between the treatment groups. In contrast, the laymen group scored AFT patients lower than IBR patients (− 1.04, p < 0.001). Remarkably, mean given scores were low for all groups and overall agreement within groups was poor (ICC < 0.50). Higher scores were given when subjects underwent a bilateral reconstruction and if a mamilla was present.

Conclusion

Evaluation of aesthetic outcomes varies greatly. Hence, aesthetic outcome remains a very personal measure and this emphasizes the importance of thorough patient counseling including information on achievable aesthetic results before starting a reconstructive procedure.

Level of Evidence III

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 .

Which Factors Are Important to Women When Choosing a Breast Reconstruction Surgeon?

BACKGROUND

Women undergoing breast reconstruction often research their health care provider options. The authors studied which factors may influence how a woman selects a plastic surgeon for breast reconstruction surgery.

METHODS

An online survey was distributed by means of Amazon Mechanical Turk (MTurk; Amazon Web Services, Inc., Seattle, Wash.) to 1025 adult women. Participants were asked to imagine a scenario in which they had breast cancer, needed to undergo mastectomy, and were choosing a reconstructive surgeon. They were then asked to rank factors influencing this decision on a 1 to 7 Likert scale. Two-sample t tests were used to compare Likert scores between dichotomized categories based on participant characteristics.

RESULTS

Women assigned the highest scores [mean (standard deviation)] to online reviews on Vitals or WebMD [6.1 (1.2)], years of experience [5.7 (1.4)], recommendations from another surgeon [5.7 (1.3)] or family/friend [4.9 (1.7)], and attending a top medical school [4.7 (1.7)]. Lowest ranked factors were online advertising and surgeon demographics, including having a sex concordant (female) surgeon. After amalgamation into attribute subsections, mean (standard deviation) rated relative importance of surgeon reputation [0.72 (0.13)] was higher than that of appearance [0.46 (0.19)] and demographics [0.31 (0.13)]. Patient demographics influenced relative importance of certain attributes; older, educated, and higher-income patients placed higher value on surgeon appearance (all p < 0.05).

CONCLUSIONS

When selecting a breast reconstruction surgeon, women place the highest value on surgeons' online, educational, and personal reputations. Though most show no strong preferences for surgeon demographics or physical attributes, specific features may be important for some patients. Cognizance of these preferences may enable providers to more effectively understand patient expectations.

Who is talking about #Facelift on Instagram?

Background

The internet has become a powerful tool for disseminating medical information. Social media platforms have gained popularity among medical professionals to connect with patients and promote their work and practices. We aimed to understand who is posting about facelift procedure on Instagram.

Methods

Sprinklr, a social listening platform, was used to compile conversations that were posted on Instagram between January 1, 2021, and February 28, 2021, and contained hashtags #facelift, #necklift, #plasticsurgery, #plasticsurgerybeforeandafter, and #platysmabands. English and Spanish language posts were analyzed for positive sentiment. Based on the number of likes, the top 100 English and Spanish posts were selected. Posts were categorized based on primary specialty of the poster as plastic surgeon, non-plastic surgeon, country of active clinical practice, board certification, and members of international plastic surgery societies.

Results

A total of 5099 posts with a total of 11,918 mentions were collected. Of the top 100 English posts, the countries most represented were the USA (59%), followed by Turkey (6%). Physicians made up 48% of the top English posts, of whom 42% were US board-certified plastic surgeons. By contrast, of the top 100 Spanish posts, the countries most represented were Mexico (29%) and Colombia (25%). Physician posters constituted 78%, of whom 38.5% were plastic surgeons certified by their country of practice.

Conclusions

Plastic surgeons have become more active in creating popular content related to facelift on Instagram over the past few years. However, a significant percentage of IG content on #facelift, a surgical procedure, was made by non-physicians and non-plastic surgeons in 2021.

Level of evidence:  Not gradable.

US Public's Perceptions of Online Transformation Photos

BACKGROUND

Although many plastic surgeons seek to optimize their online presence and reach a broader patient base, no studies to our knowledge have evaluated the general public's perceptions of one of the most valued informational tools: transformation photos.

OBJECTIVES

The aim of this study was to evaluate the general public's preferences for viewing transformation photos online.

METHODS

Respondents representative of the US public, crowdsourced through Amazon Mechanical Turk, answered a survey assessing perceptions of the posting of before-and-after photos.

RESULTS

One thousand respondents completed the questionnaire. Ninety percent (905/1000) of respondents are willing to view online before-and-after photos. Sixty-three percent (634/1000) would consent to online posting of before-and-after photos of at least 1 body area, with comfort levels highest for facelift (36.4%), nonoperative facial rejuvenation (31.9%), liposuction (24.9%), and abdominoplasty (23.2%). Breast reduction (12.4%), breast reconstruction (10.9%), gluteal augmentation (14.0%), and vaginal rejuvenation (4.4%) are considered least acceptable for public posting. Respondents are significantly more opposed to online viewing of genitals than any other body area (P < 0.0001). Of those willing to have their own transformation photos posted online, 74.0% would allow posting on professional practice websites, 35.1% on Instagram, 26.6% on Facebook, 17.2% on Twitter, and 10.7% on Snapchat. Significantly more respondents prefer their transformation photos reside only on professional practice websites rather than on a social media platform (P < 0.0001).

CONCLUSIONS

The public considers aesthetic facial procedures and body contouring most acceptable for showcasing transformation photos online. Although most respondents prefer viewing these photos on professional practice websites, Instagram is the favored social media platform. The majority of the public seek transformation photos when choosing a plastic surgeon for a cosmetic procedure.

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 .

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.

Why do selfies increase young women's willingness to consider cosmetic surgery in China? The mediating roles of body surveillance and body shame

The present study was designed to examine a possible two mediator model with both body surveillance and body shame mediating the association of selfie behavior with cosmetic surgery consideration in young adult women. A sample of 588 young adult women participated in this study and completed questionnaires regarding selfie behavior, body surveillance, body shame, and cosmetic surgery consideration. Results indicated that selfie behavior was positively related to cosmetic surgery consideration. In addition, the mediation analysis by PROCESS revealed that body surveillance and body shame mediated the relation between selfie behavior and cosmetic surgery consideration. These findings add to the extant literature by suggesting that selfie behavior may be a new experience of self-objectification, which provide new insights into the relation between selfie activities and cosmetic surgery consideration in young women.

The Evolution of Patients' and Surgeons' Perspectives Towards the Role of the Internet and Social Media in Breast Augmentation Over 5 Years

BACKGROUND

The influence of the internet and social media (SoMe) in the decision-making of patients is recognized. Plastic surgeons are aware of this trend but are entangled between ethics, professionalism, and business acumen.

OBJECTIVES

In this study, the authors presented the evolution of perspectives of patients and surgeons recruited through a private clinic over 5 years.

METHODS

A questionnaire was administered to patients consulting for primary breast augmentation in 2014, 2017, and 2019. Plastic surgeons who worked at or visited the Akademikliniken in 2014, 2017, and 2019 completed a separate questionnaire.

RESULTS

In total, 1646 patient responses were collected. Patients who started their information gathering with the internet increased from 68.0% to 72.9%, and 94.1% of patients looked for information about aesthetic surgery on the internet before their consultation. Patients who read about aesthetic surgery on SoMe increased 29.1%. Of 462 surgeons recruited, 62% opined that the majority of patients had gathered information online before consultation. Fewer surgeons in 2019 thought that the internet and SoMe led to better information (down from 61.7% to 35.2%). An increase from 38.3% to 65.3% of surgeons attributed it to unrealistic expectations. However, only 9.7% of surgeons would support removal of plastic surgery material from SoMe compared with 21.9% in 2014.

CONCLUSIONS

The increased utilization and influence of the internet and SoMe on patients and surgeons is rapid. Aesthetic plastic surgeons must equip themselves to cope with the risks and capitalize on the opportunity for patient engagement and public education.

Two-person screening of mental well-being before primary breast augmentation: Can we do more?

Patients choosing aesthetic surgery are asymptomatic individuals opting for surgery. Psychologists and surgeons have been interested in identifying characteristics of these individuals' preoperative as well as postoperative psychological changes. It was identified that a small number of patients have a primary issue with self-body image, which resulted in altered perceptions and attitudes such that the preoccupation with perceived deficiencies continued even after surgery. The recommended course is to attempt to screen for the patients' mental well-being, as surgery alone does not improve the patients' symptoms. In the first author's practice, each prospective patient is reviewed by two individuals on separate occasions in order to discuss surgery and assure their mental and physical suitability. However, we encountered four patients who exhibited a strong negative reaction to their new shape, to the point that it necessitated explanation in the immediate postoperative phase in two of them. To our knowledge, this situation has not been described in the literature. We discuss the available literature as well as our consent process for breast augmentation. The first author has since introduced BREAST-Q to assess general patient well-being in the pre- and post-operative phases as a result of this experience. We also discuss the results for each of its domains and offer our thoughts about the management of such a situation.

Social Media's Influence on Breast Augmentation

BACKGROUND

The purpose of this study is to evaluate if and what social media use influences our patients' decisions to undergo breast augmentation.

OBJECTIVES

A single-institution study was designed to evaluate women who underwent elective breast augmentation from 2017 to 2018.

METHODS

Patients were contacted via validated, prompted telephone survey. Data regarding their demographic information and social media utilization pertaining to breast augmentation were collected after obtaining verbal consent.

RESULTS

Inclusion criteria were met by 180 patients, of which 69% participated in the survey. Ninety-seven percent of the participants reported utilizing social media in general; the most common platforms were Facebook, Instagram, and the physician's website. Millennials (97%) and Generation X (92%) utilized social media the most and none of the baby boomers. Sixty-four percent of participants reported utilizing some form of social media to research breast augmentation, with the most common resource being Instagram. When analyzing the impact of the social media resources utilized by the participants, Instagram was reported as the most impactful at 54%. Only 18% of participants were utilizing a physician's social media account to research breast augmentation. Among the 50% of patients who utilized social media to compare their surgeon's work with another physician's, the majority (83%) were utilizing the physician's website.

CONCLUSIONS

Social media influences patients' education and decisions to undergo breast augmentation, with Instagram being the most impactful. This study evaluated the patient population to stay up to date on their social media utilization and resources of education prior to breast augmentation.

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.

Online and Social Media Footprint of All Swedish Aesthetic Plastic Surgeons

BACKGROUND

The visual nature of the Internet and its newer technologies makes it naturally aligned to plastic and aesthetic surgery. While many studies have looked at the use of social media ('SoMe'), they have been limited by either low response rate or limited scope. Our aim was to analyse a whole community of aesthetic plastic surgeons and their use of the Internet and social media platforms over a period of many years.

METHODS

All active members of the Swedish national aesthetic plastic surgery society were identified. Webpages, professional (LinkedIn), social media (Facebook, Twitter, Instagram) and video-sharing (YouTube) accounts as well as online patient forum (Plastikoperationsforum) mentions of the surgeons and their clinics were identified, and corresponding platform-specific metrics were analysed.

RESULTS

Of the 85 active members, 67 (78.9%) had a webpage on one of the 34 different clinic websites. The websites of older established clinics had a significantly better Alexa ranking than newer ones. Surgeons with a profile on Facebook or Instagram were significantly younger than those without an account. Twitter was the least preferred social media platform. Each surgeon had a mean 12.8 threads per year as compared to a mean 34.3 threads per clinic per year.

CONCLUSION

Most of the new practices established by Swedish aesthetic plastic surgeons in the last 10 years are single-surgeon ones. Instagram and Facebook accounts of their clinics seem to be the most popular SoMe platforms. Younger surgeons were more likely to have a Facebook or Instagram account and to be using two or more social media platforms. These data provide information about all aesthetic plastic surgeons registered with the Swedish national body and their increasing use of SoMe.

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 .

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.