Harnessing Social Media to Advance Research in Plastic Surgery:

Confronting Craniosynostosis: Maternal Concerns, Challenges, and Coping for their Children

OBJECTIVE

The study objective was to characterize shared online experiences surrounding craniosynostosis.

METHODS

Isolated and syndromic craniosynostosis-related consecutive posts (N = 700) made by patients and caregivers were extracted from TikTok and Instagram between 2017-2024. A cross-sectional qualitative analysis following guidelines for practical thematic analysis was performed.

RESULTS

The majority of posts were by caregivers (96%) and by females (97%). Forty categorical subthemes from social media posts were synthesized into 4 predominant themes. Overarching thematic trends included Emotional and Psychological Support (47%), Medical Information and Treatment (27%), Family and Social Dynamics (15%), and Awareness, Education, and Advocacy (12%).

CONCLUSION

Social media is used by caregivers, primarily mothers, for emotional support, processing health information, sharing experiences, raising awareness, and celebrating "cranioversaries." Male and patient perspectives were underrepresented. Physicians may use social media to gain insights, disseminate quality health information, and connect with patients.

A Systematic Review on the Reinforcement Loop in Aesthetic Medicine and Surgery: The Interplay of Social Media, Self-Perception, and Repeat Procedures

INTRODUCTION

This systematic review delves into the impact of social media on self-perception and the escalating interest in clinical aesthetic procedures, proposing that social media significantly influences beauty standards and increases demand for aesthetic enhancements.

METHOD

Following PRISMA guidelines, a mixed-method analysis of 34 articles was conducted, sourced from various databases, focusing on social media's psychological effects on clinical aesthetics decisions. The studies encompassed a broad spectrum, including qualitative, quantitative, and mixed methodologies, reflecting diverse geographical and cultural perspectives.

RESULTS

The quantitative analysis demonstrated a strong positive correlation between social media usage and the consideration of aesthetic procedures (r=0.45, p<0.001), indicating a significant impact. Specific findings included a large effect size (Cohen's d=0.8) for the relationship between time spent on social media and the desire for aesthetic enhancements. Individuals spending more than 3 hours per day on social media platforms were twice as likely to consider aesthetic procedures compared to those with less usage, with a 95% confidence interval indicating robustness in these findings.

CONCLUSION

Confirming the reinforcing effect of social media on aesthetic decision-making, this study highlights the complex interplay between digital media exposure, altered self-perception, and the increased inclination towards aesthetic procedures. It suggests a critical need for practitioners to carefully navigate the digital influence on patient's desires, reinforcing the significance of understanding psychological motivations and societal pressures in clinical aesthetics. This comprehensive analysis offers pivotal insights for clinical practice and ongoing research into social media's role in contemporary beauty standards.

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 .

Hashtags in Plastic Surgery: A Sentiment Analysis of over 1 Million Tweets

BACKGROUND

Current literature has sparse recommendations that guide social networking practices in plastic surgery. To address this, we used natural language processing and sentiment analysis to investigate the differences in plastic surgery-related terms and hashtags on Twitter.

METHODS

Over 1 million tweets containing keywords #plasticsurgery, #cosmeticsurgery, and their non-hashtagged versions plastic surgery and cosmetic surgery were collected from the Twitter Gardenhose feed spanning from 2012 to 2016. We extracted the average happiness/positivity (h-avg) using hedonometrics and created word-shift graphs to determine influential words.

RESULTS

The most popular keywords were plastic and cosmetic surgery, comprising more than 90% of the sample. The positivity scores for plastic surgery, cosmetic surgery, #plasticsurgery, and #cosmeticsurgery were 5.72, 6.00, 6.17, and 6.18, respectively. Compared to plastic surgery, the term cosmetic surgery was more positive because it lacked antagonistic words, such as "fake," "ugly," "bad," "fails," and "wrong." For similar reasons, #plasticsurgery and #cosmeticsurgery were more positively associated than their non-hashtagged counterparts.

CONCLUSION

Plastic surgery-related hashtags are more positively associated than their non-hashtagged versions. The language associated with such hashtags suggests a different user profile than the public and, given their underutilization, remain viable channels for professionals to achieve their diverse social media goals.

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 .

Social Media Popularity and Academic Productivity in Academic Plastic Surgery: A Positive Correlation

BACKGROUND

Social media is a powerful tool that has empowered plastic surgeons to easily collaborate with one another and rapidly publicize research progression. The present study investigates the relationship between academic productivity and social media presence among both integrated and independent plastic surgery programs and their faculty.

METHODS

Plastic surgery programs on the American Council of Academic Plastic Surgeons website were included. Faculty were identified via review of each program's website. Following metrics of academic productivity were collected for each faculty member: h-index, i10-index, number of publications, and number of citations. Online review was then conducted to identify faculty and program Instagram and Twitter accounts, and the number of associated followers and posts.

RESULTS

Integrated plastic surgery programs were more likely to have an Instagram account (p < 0.001), have higher average faculty h-index (p = 0.027), i10-index (p = 0.027), and number of publications (p = 0.042). A number of Instagram followers were significantly associated with average faculty h-index (p < 0.001), i10-index (p < 0.001), and number of publications (p < 0.001). The number of posts on a program's Instagram significantly predicted average faculty h-index (p < 0.001), i10-index (p < 0.001), and number of publications (p < 0.001). Twitter followers were significantly associated with average faculty h-index (p = 0.0397), i10-index (p = 0.0432), and number of citations (p = 0.00737).

CONCLUSIONS

The present study reveals a correlation between metrics of social media popularity and academic productivity of plastic surgeons. We propose that Instagram and Twitter are effective tools with which plastic surgeons may not only publicize their clinical practice, but also rapidly disseminate important innovations among the medical community. Integrated plastic surgery programs and their faculty have significantly higher utilization of social media platforms. The number of followers and posts on a program's Instagram have a significantly positive correlation with average faculty's academic productivity. Social media platforms may empower academic plastic surgeons to disseminate their innovations on a larger scale.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Virtual Neurocognitive Testing in Craniofacial Surgery

SUMMARY

Digital communication platforms have had an impact on plastic surgery research. Although neurocognitive testing is an important tool for understanding the long-term developmental outcomes of congenital craniofacial conditions, testing has been geographically limited because of its interactive nature. Virtual neurocognitive testing is a facsimile version of in-person testing that allows researchers to overcome this limitation with high fidelity. Ten school-age subjects completed a neurocognitive assessment battery measuring intelligence quotient, academic achievement, and visuomotor skills at an average age of 7.8 ± 1.4 years. The subjects then retook the same battery through an identical virtual testing method approximately 1 year after the initial test. There were no significant differences in verbal intelligence quotient (p = 0.878), performance intelligence quotient (p = 0.813), and full-scale intelligence quotient (p = 0.982) scores obtained through in-person and virtual tests. There were no significant differences between academic achievement letter and word recognition (p = 0.999), math computation (p = 0.619), reading comprehension (p = 0.963), and spelling (p = 0.344) scores. There were no significant differences in visuomotor integration (p = 0.158), visual perception (p = 0.798), and motor coordination (p = 0.796) scores obtained through the two methods. The median at-home time to set up study equipment for the virtual testing was 5.0 minutes (interquartile range, 2.3 minutes). Seventy percent of participants reported that they preferred participating in research from home. All participants stated that the virtual research study was an overall positive experience. Virtual neurocognitive testing is an effective method of performing high-fidelity neurocognitive assessments while overcoming geographic barriers.

Representation of Global Health Initiatives in Plastic Surgery Training: A Social Media Analysis

INTRODUCTION

Over the last several years, various social media platforms have been used to increase collaboration, education, and research internationally. The purpose of this study was to evaluate how plastic surgery residency programs use social media to promote global surgery education, research, and collaboration.

METHODS

A full list of active integrated residency programs was obtained from the American College of Academic Plastic Surgeons website. A total of 82 programs were identified. Instagram, Facebook, and Twitter were searched for active accounts. Only accounts dedicated to plastic surgery programs or had a significant amount of residency-related content were included. Inclusion criteria included posts relating to global health, global surgery, mission trips, international plastic surgery education, and global surgery research. Caption language was analyzed and classified as either "resident education in global surgery," "an individual's interest in global surgery," "research in global surgery," "visiting international professor," or "global collaboration." Image content was then assessed for "images with patients," "images with other surgeons/residents," "images of international location," a combination thereof, "other," or "none."

RESULTS

Instagram was by far the most used by plastic surgery residency programs with a total of 76 programs having accounts compared with only 32 programs and 33 programs having Facebook and Twitter accounts, respectively. There was no significant difference in the proportional number of posts relating to global surgery across the 3 platforms (P = 0.1911). On all 3 social media platforms, the majority of posts fell into the category of "international collaboration" with 42.5%, 50.7%, and 48.8% on Instagram, Facebook, and Twitter, respectively. None of the caption categories examined showed a significantly different proportion of posts across the 3 platforms. Image analysis showed a significant difference in the proportional representation across the 3 platforms in the categories of "images with other surgeons/residents" (P = 0.0196) "images with patients" (P = 0.0082), combination (P = 0.0225), and other (P = 0.0114).

CONCLUSIONS

Although social media offers programs an easy way to promote global surgery research, collaboration, and education with a wider audience, it is being underused for this purpose as evident by the relatively lower number of postings on each platform relating to this content.

A retrospective analysis of social media posts pertaining to COVID-19 vaccination side effects

OBJECTIVES

With an uprising influence of social media platforms like Twitter and Instagram a multitude of worldwide accessible information is available. Since the beginning of COVID-19 pandemic the exchange of medical information about several topics related to this infectious disease and its vaccination has increased rapidly. The purpose of this investigation was to assess the content associated with COVID-19 vaccination and its side effects and evaluate its educational quality.

METHODS

We conducted this retrospective study to investigate 600 Twitter and Instagram posts by #covidvaccinesideeffects due to number of 'likes', comments, type of post, language, its purpose and source. In addition, posts were evaluated due to educational quality by three examiners of different educational levels.

RESULTS

The majority of posts showed 0 to 50 "likes" and 0 to 5 comments in English language. A comparison between Twitter and Instagram by the influence of application showed significant differences in number of posts and "likes" or comments (p < 0.05). The major post type were texts for Twitter (251; 83.7%) and videos for Instagram (104; 34.7%). While a majority of posts by #covidvaccinesideeffects report about the occurrence of side effects, the majority of them were mild and general COVID-19 vaccination feedback during the first 4 months was positive. But, only 3 to 7% were rated by "excellent" educational and validatable content. Interrater reliability between all three examiners presented a high concordance with 89% (p = 0.001).

CONCLUSIONS

This study presents an analysis of quantity and quality of social media content according to COVID-19 vaccinations and its side effects. It supports the deduction that most of the content on Twitter and Instagram is shared by patients and unclear sources and thus is limited informative. Nevertheless, influence of social media on medical information especially during COVID-19 pandemic is increasing and practitioners have to face its effect on their patients.

#MadelungDeformity: Insights Into a Rare Congenital Difference Using Social Media

BACKGROUND

Madelung deformity is a rare congenital hand difference with little known regarding the patient perspective. In this cross-sectional survey study, we harnessed the global reach of social media to understand the clinical spectrum of Madelung deformity and its impact on physical, mental, and social health.

METHODS

A survey was developed based on a previously published protocol and multiple Patient-Reported Outcomes Measurement Information System (PROMIS) short forms. The survey was distributed on several Madelung deformity communities on Facebook and Instagram. T-scores were calculated, interpreted, and compared between patients who underwent surgery and those who did not. Correlations between scores were calculated using the Spearman rank correlation coefficient.

RESULTS

Mean PROMIS scores for adults were as follows: pain intensity, 4.9 ± 2.8; pain interference, 57.6 ± 10.0; upper extremity, 35.2 ± 8.1; depression, 53.8 ± 11.1; anxiety, 55.4 ± 11.4; and ability to participate in social roles and activities, 42.5 ± 7.7. Mean scores for children were as follows: pain intensity, 5.0 ± 2.8; pain interference, 55.7 ± 11.3; upper extremity function, 24.6 ± 10.4; depressive symptoms, 57.7 ± 11.3; anxiety, 57.3 ± 11.9; and peer relationships, 42.2 ± 10.3.

CONCLUSIONS

Madelung deformity has significant effects on patients' physical, mental, and social well-being, even after surgical treatment. Using social media, we were able to compensate for Madelung deformity's rarity by engaging an international audience, demonstrating the feasibility to conduct research through it, and providing a global perspective of the disease entity.

#facialtraumasurgery: Educational Content of Instagram as a Social Media Source for Facial Trauma Surgery

ABSTRACT

With an uprising influence of social media platforms like Instagram during the last decade, medical and healthcare related posts have accumulated majorly. In particular the head and face characterizes and signifies each individual's human character, which may be the reason why numerous posts are shared on social media platforms. The purpose of this investigation was to assess the content associated with facial trauma surgery and evaluate its educational quality.The authors performed a retrospective investigation on 550 Instagram posts by #facialtraumasurgery due to number of "likes," comments, type of post, language, its purpose, and source. Furthermore, posts were evaluated due to their educational quality by 3 examiners of different educational levels.The majority of posts showed 0 to 50 "likes" and 0 to 5 comments in English language. The major post type were single photographs (289; 52.5%), multiple photographs (188; 34.2%), videos (73; 13.3%) and predominantly case reports (233; 42.4%). The source was 322 (58.5%) posts by surgeons, followed by 185 (33.6%) clinic posts. Only 10% to 18% of the posts were rated "excellent." Interrater reliability between all 3 examiners presented a high concordance with 89% (P = 0.000).Our study presents an analysis of quantity and quality of social media content according to facial trauma surgery. It supports the deduction that most of the content on Instagram is shared by patients and unclear sources and thus is limited informative. Nevertheless, influence of social media on medical information is increasing and practitioners have to face its effect on their patients.

A Proposed Approach for Conducting Studies That Use Data From Social Media Platforms

The prominence of social media in contemporary society has extended significantly into the health care arena, where both patients and health care providers have used social media platforms to gather, communicate, learn, and share medical content and personal experience in real time. The medical literature has also seen an exponential increase in the number of studies that use data derived from social media coverage of various medical issues and topics. In this guide, we present a step-by-step framework for health care professionals and researchers to conduct studies that use data from social media platforms. We present 6 overarching steps: focus on framing a question that is appropriate for social media evaluation, identification of social media outlet and selection criteria of content, systematic data extraction, assessment of quality of content and sources of bias, analysis of data, and interpretation of study findings. Each step is illustrated with published examples.

Feasibility of Social Media Recruitment for Orofacial Cleft Genetic Research

OBJECTIVE

This study assessed the feasibility of unpaid social media advertising to recruit participants affected with an orofacial cleft (OFC) for a genetic study.

DESIGN

This is a retrospective analysis of recruitment based on enrollment and participation in a genetic study. Participants completed a series of enrollment surveys, provided saliva samples, and completed postparticipation feedback surveys.

PARTICIPANTS

Participants were eligible if they or a minor in their care were affected by an OFC, the affected participant was not adopted, and the mother of the affected individual had not taken antiseizure medication during pregnancy.

MAIN OUTCOME MEASURES

Success of recruitment was evaluated from the number of enrolled participants and sample return rate.

RESULTS

In the first 12 months of recruitment, 313 individuals completed initial screening surveys; of these, 306 participants were eligible. A total of 263 individuals completed all online surveys and were sent DNA sample kits. One hundred sixty-two subject DNA samples were returned within 12 months of sending, for a return rate of 62%. Approximately two-thirds (66.3%) of all returned samples were sent back within the first 6 weeks after receiving DNA kits.

CONCLUSIONS

Unpaid social media advertising enabled the recruitment of a large cohort of participants in a short time (12 months). The resulting study population was limited in racial and ethnic diversity, suggesting that other recruitment strategies will be needed for studies seeking specific demographic or socioeconomic groups. Nonetheless, social media recruitment was efficient and effective for recruiting participants for a genetic study in comparison to traditional clinic-based modes of recruitment.

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.

A National Survey to Assess the Population's Perception of Breast Implant-Associated Anaplastic Large Cell Lymphoma and Breast Implant Illness

BACKGROUND

The goal of this study was to gauge the public's general perception of breast implants, levels of concern, spontaneous word associations, and misperceptions that might need to be addressed by plastic surgeons regarding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant illness (BII).

METHODS

An anonymous survey was completed by a total of 979 female participants in the United States by means of Amazon Mechanical Turk.

RESULTS

Over 91 percent of participants indicated that they had never heard the term BIA-ALCL. Of the respondents who were aware of the term, 37.21 percent reported being moderately or extremely concerned about BIA-ALCL and 85.4 percent were less likely to recommend breast implants to a friend. Awareness of BII was significantly higher at 50.9 percent, whereas almost 40 percent of participants reported being either moderately or extremely concerned about BII. Over 78 percent of participants were less likely to recommend breast implants to a friend because of BII. The most common word association with BII was "pain," followed by "cancer." The terms "cancer" and "scary" were the two most common word associations with BIA-ALCL. A significant overlap in word associations was observed between BIA-ALCL and BII, potentially representing a lack of distinction between the two terms. The survey demonstrated a paucity of important knowledge within the general population; notably, 71 percent of respondents who were not aware that, to date, only textured implants/expanders were associated with BIA-ALCL.

CONCLUSION

These findings support the need for further targeted awareness to remedy existing misperceptions and fill the knowledge gaps relating to BII and BIA-ALCL.

Webinar during COVID-19 Improves Knowledge of Changes to the Plastic Surgery Residency Application Process

BACKGROUND

The COVID-19 pandemic has significantly impacted residency application process for all specialties, including plastic surgery residency. Almost all plastic surgery residency programs have suspended visiting sub-internship rotations. This study quantifies the impact of a webinar through an analysis of poll questions and a post-webinar survey sent to all registered participants.

METHODS

A dedicated webinar was organized and held by the Harvard Plastic Surgery Residency Training Program. All attendees were asked several poll questions during the webinar. The 192 participants were also sent a post-webinar survey.

RESULTS

The response rate was 68.2% (n = 131). Respondents were more confident about matching into a plastic surgery residency program at the end of the webinar compared with before the webinar (P < 0.001). Respondents who did not have a plastic surgery residency program at their home institution were less confident at the start of the webinar (P = 0.009). In addition, respondents who had not taken time off for research or for other endeavors during or after medical school were less confident about their chances to match at the start of the webinar (P = 0.034).

CONCLUSIONS

An online webinar program increased confidence levels of medical students interested in applying for residency positions in plastic surgery. Residency programs should consider webinars as a method to inform and assist medical students during the upcoming application season.

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.

Use of Social Media to Teach Global Reconstructive Surgery: Initiation of a Secret Facebook Group

The ReSurge Global Training Program (RGTP) is a model for building reconstructive surgery capacity in low- and middle-income countries.¹ The aim of this study is to assess attitudes toward social media, to develop an initial RGTP Facebook Education Group, and to assess the early results of the group’s implementation.

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 .