The marriage of plastic surgery and social media: a relationship to last a lifetime

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 .

The influence of social media on public attitudes and behaviors towards cosmetic dermatologic procedures and skin care practices: A study in Saudi Arabia

BACKGROUND

Social media has fostered a landscape where trends, ideals, and beauty standards have significantly proliferated. Images of flawless skin, sculpted features, and curated aesthetics inundate user feeds, potentially shaping their self-perceptions and aspirations. The rise of influencers, dermatologist social media engagement, and beauty campaigns sharing skincare routines and product recommendations wield substantial influence over individual appearance-related decisions.

AIMS

The main aim of this study is to determine the pattern of behavior in using social media to seek dermatological procedures and skin care routine.

METHODS

We conducted a nationwide, online cross-sectional study targeting the general Saudi population. Our survey aimed to understand participant social media behaviors and gather insights into skincare products, cosmetic procedures, and makeup habits.

RESULTS

Gender-related differences emerged in seeking skincare advice. Females preferred dermatologists on social media (p < 0.001) and beauty influencers (p < 0.001), whereas men leaned towards pharmacists (p < 0.001). Women displayed stronger engagement with dermatologist social media reputation regarding non-cosmetic concerns (p < 0.001), education (p < 0.001), and social media impact on cosmetic decisions (p = 0.001). They frequently sought dermatologists on social media before appointments (p = 0.001), whereas men emphasized dermatologists' fame (p = 0.024). Common cosmetic barriers included high costs (62.5%), complications (40.3%), and trust issues (40.2%). Women underwent various cosmetic procedures (p < 0.05), influenced by social media in their decisions and skincare routines.

CONCLUSIONS

Our study reveals significant gender-based disparities in seeking skincare advice. Women rely on social media, clinics, friends, and beauty influencers, whereas men prefer pharmacists. Additionally, women depend on dermatologists' social media reputation and conduct thorough pre-appointment research. Their heightened social media engagement links to skincare practices and influences cosmetic procedure considerations based on age and usage frequency.

The Ethics and Responsibilities of Social Media Usage by Plastic Surgeons: A Literature Review

BACKGROUND AND OBJECTIVES

Social media has revolutionised how plastic surgeons advertise their work and promote their services, but concerns have been raised regarding the ethics of these practices. This review aims to identify said concerns and develop measures to address them.

METHODS

PubMed, Cochrane and Medline were searched for studies assessing the ethics of social media use by plastic surgeons. Five search terms were used and 23 studies identified. Results were catalogued according to which principle of medical ethics was infringed.

RESULTS

Autonomy: Patients must not be coerced into allowing their operative media to be shared and content anonymised by removing identifiable features and scrubbing metadata. Beneficence: It is difficult to balance the benefit to patients of posting photographs for educational purposes with the risk of identifiable features being present, particularly within craniofacial surgery. Non-maleficence: Taking operative media could be a distraction from the patient and lengthen the procedure which could lead to harm. Any content posted on social media should be adapted to avoid trivialisation or sexualisation. Justice: Surgeons should not entertain their audience to increase their following at the expense of patients.

CONCLUSIONS

Greater oversight of social media use by plastic surgeons is required to avoid patient harm and tarnishing of the specialty's professional standing. Professional bodies should be tasked with devising a course dedicated to the responsible use of these platforms. This should ensure the public's trust in the specialty does not become eroded and patients are not harmed by unethical social media use. This review highlights the relevant shortfalls of SoMe use by plastic surgery Several proposals are made to reduce the incidence of these shortfalls and to ensure SoMe is used in a professional and responsible manner It also lists areas of the specialty where SoMe is underused and could be of help, such as academia 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 http://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 .

#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.

Evaluation of Social Media Utilization by Academic Plastic Surgery Programs during the COVID-19 Pandemic

Background:

In response to the cancellation of away rotations and the shift to virtual interviews due to the coronavirus disease of 2019 (COVID-19) pandemic, residency programs have pursued other methods of sharing program details, most notably with the use of social media. This study aimed to evaluate the extent of social media utilization in the setting of the COVID-19 pandemic by plastic surgery residency programs.

Methods:

Instagram, Twitter, and Facebook accounts of plastic surgery programs, program directors, and chiefs were identified. Number of followers, total posts, and posts since March 1, 2020, were extracted. Account content was categorized as informational, social, operative, research, self-promotional, guest lecture, education, or other. Spearman’s coefficient was used to determine correlations among account data. Differences among regions and program pathways were evaluated using the Kruskal-Wallis test.

Results:

Since March 1, 2020, 17 Instagram, five Twitter, and three Facebook accounts have been created. Instagram was most widely used and followed (1720 posts, 1235.7 ± 735.9 followers) compared with Twitter (722 tweets, 325.6 ± 451.0 followers) and Facebook (430 posts, 338.3 ± 363.3 followers). Although the majority of content was informational (45.1 percent), Instagram contained more social content (21 percent), Twitter contained more research (21 percent), and Facebook contained more self-promotional content (25 percent). Integrated-only programs on average posted more on Instagram (21.5 ± 15.1 posts) than did independent-only programs (9.4 ± 8.5 posts), and post volume moderately correlated with number of followers. There were no statistically significant differences among regional means.

Conclusion:

Plastic surgery residency programs have incorporated social media into their recruitment strategies and will likely continue to increase and diversify their posts to effectively engage with future applicants.

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

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

Social Media and Instant Messaging: An Online Platform for the Treatment of Cleft Lip and Palate Patients; Taipei Medical University Hospital Experience

BACKGROUND

Social media and instant messaging can improve patient education, follow-up, and outcome. The utilization of these modalities in cleft lip/palate care is not fully described. We formed an online platform consisting of a dedicated website, Facebook group and LINE group through which we provide information and counseling to our patient population. Our objective is to evaluate the impact and patient satisfaction of our online platform.

METHODS

In this retrospective study, we designed a questionnaire aimed at evaluating the quality of information and patient satisfaction of the online platform. The questionnaire was distributed online to 732 cases connected to us through the LINE application.

RESULTS

The response rate was 26%. Website information was found very necessary and sufficient by 75% and 46% of the cases, respectively. Regarding Facebook, the medical team's response was found very professional and practical by 81% and 68% of the cases, respectively. Patient-patient interaction was helpful to 96% of the cases. Regarding the LINE application, the medical team's response was found very immediate and helpful in 73% of the cases, and 91% felt that LINE saved them time from returning to the clinic on unscheduled occasions. The website, Facebook and LINE were used over 10 times per month by 17%, 32%, and 50% of the cases, respectively. A decrease in unscheduled "pop-up" visits to the clinic (from 25 to 6 per month) was registered.

CONCLUSIONS

Adapting social media and instant messaging into our cleft lip/palate care has been welcomed with high satisfaction among our patient population, increasing their knowledge, saving them time from returning to the clinic, and allowing them beneficial interaction with other families coping with similar conditions.

#Neurosurgery: A Temporal and Content Analysis of Academic Neurosurgery on Twitter

BACKGROUND

Social media has become ubiquitous in modern medicine. Academic neurosurgery has increased adoption to promote individual and departmental accomplishments, engage with patients, and foster collaboration. We sought to quantitatively evaluate the adoption of one of the most used social media platforms, Twitter, within academic neurosurgery.

METHODS

A quantitative and qualitative analysis of Twitter use across 118 academic neurosurgery departments with residency programs in the United States was performed in March 2019 and March 2021. We collated Twitter handles, Doximity residency ranking (a peer-determined ranking system), geographic location, and Twitter demographics (tweets, followers, likes, and tweet content) from before and after the coronavirus disease 2019 (COVID-19) pandemic. Tweet content was characterized by reviewers over a predetermined 6-month period. Linear regression and parametric/nonparametric tests were used for analysis.

RESULTS

Departmental accounts grew 3.7 accounts per year between 2009 and 2019 (R² = 0.96), but 43 accounts (130%) were added between 2019 (n = 33) and 2021 (n = 76). This growth, coinciding with the COVID-19 pandemic, changed the model from linear to exponential growth (R² = 0.97). The highest-ranking programs based on Doximity were significantly more likely to have an account (P < 0.001) and have more followers (P < 0.0001). Tweet content analysis revealed prioritization of faculty/resident activity (mean 49.9%) throughout the quartiles.

CONCLUSIONS

We demonstrate rapid uptake in Twitter use among U.S. academic neurosurgical departments, accelerated by COVID-19. With the impact of COVID-19, it is clear that there will be continued rapid adoption of this platform within neurosurgery, and future studies should explore the outcomes of peer collaboration, patient engagement, and dissemination of medical information.

How the COVID-19 pandemic changed the Plastic Surgery activity in a regional referral center in Northern Italy

The Covid 19 epidemic has modified the way that plastic surgeons can treat their patients. At our hospital all elective surgery was canceled and only the more severe cases were admitted. The outpatient department activity has been reduced also. We present the number and diagnoses of patients, treated as in- and out-patients, during seven weeks from the onset of the epidemic, comparing our activity from the lockdown of elective surgery with the numbers and diagnoses observed during the same weeks of last year. Finally we underline the importance of using telemedicine and web-based tools to transmit images of lesions that need the surgeon's evaluation, and can be used by the patient to keep in touch with a doctor during the distressing time of delay of the expected procedure.

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.

Patients' Online Perception and Ratings of Neurotologists

OBJECTIVES

To assess and characterize patients' online ratings and comments of neurotologists and determine factors that correlate with higher ratings.

METHODS

All the American Neurotology Society members were queried on Healthgrades, Vitals, RateMDs, Yelp, and Google from March to June 2018. All ratings were normalized for comparison on a five-point Likert scale. All comments were categorized based on context and for positive/negative aspect.

RESULTS

Of the 560 American Neurotology Society members, 465 (83%) were rated on at least one online platform. Of those rated, 420 (90%) were on Healthgrades, 392 (84%) on Vitals, 283 (61%) on RateMDs, 232 (50%) on Google, and 56 (12%) on Yelp. Across all platforms, the average overall rating was 4.06 ± 0.68 (range: 1.00-5.00). There were significant positive correlations between overall rating and specific ratings (p < 0.01) on individual topics. Moreover, categorizing 5,317 narrative comments elicited the majority to be related to perceived physician bedside manner and clinical outcome. Although the number of positive comments outnumbered the negative ones, only the negative comments correlated (negatively) with the overall score (p < 0.01). Attending a top 25- or 50-medical schools or residency programs did not correlate with their rating.

CONCLUSIONS

Online ratings and comments for neurotologists are highly dependent on patient perceptions of physician competence, caring bedside manner, and office management. Minimizing the number of negative comments, especially regarding perceived physicians' professionalism and communication, clinical outcome, bedside manners, and office management, leads to higher calculated overall scores and online perception.

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 .

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Past Informs the Present, Academic New Media Pitfalls: A Primer for Plastic Surgeons

Mass communication has undergone a “new media” revolution, which includes the rise of digital, online, and social media. The impact of new media on academic processes, however, has been underappreciated. The rise of Web-based virtual platforms has profoundly impacted the way plastic surgeons publish, store, exchange, and analyze scholarly biomedical information. This new media academic phenomenon refers to electronic mechanisms with the capacity to supplant traditional publication methods, which typically rely on printed documents in the physical domain. Although such tools can be efficient and user-friendly, they also make users vulnerable to exploitation. Notable examples reveal a relative lack of regulation, oversight, reliable rating scales, user authentication, and ethical accountability in the virtual space. As with any new technique, education is key and knowledge is power. In this article, online resources related to healthcare and the practice of plastic surgery are reviewed and summarized, including open access, mega-indices, whitelists, and electronic alerts. New media provides powerful knowledge-sharing tools that can help execute scholarly endeavors, communicate between professionals, and educate the public. However, it is essential for plastic surgeons to appreciate the caveats of new media academic processes to avoid unscrupulous practices of those that may seek to manipulate these Web-based systems. This article outlines the key pitfalls associated with online information streams to better inform plastic surgeons how to navigate new media-based scholarly processes.

An Analysis of Plastic Surgeons' Social Media Use and Perceptions

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A Quantitative Analysis of Online Plastic Surgeon Reviews for Abdominoplasty

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

The "Game of Implants": A Perspective on the Crisis-Prone History of Breast Implants

Since their introduction into the market, breast implants have been the subject of many controversies. It is timely to examine the forces that have shaped the breast implant industry to make it what it is today. This review will concentrate more on the use of implants in aesthetic surgery rather than their use in breast reconstruction, but some of the factors have relevance to both indications.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Emerging trends in social media and plastic surgery

Social media has increasingly changed the landscape of medicine and surgery and is rapidly expanding its influence in most peoples' lives. The average person spends nearly 2 hours per day using social media, consuming information about everything from family updates to entertainment news to presidential elections. The concentration of consumers on social media platforms has resulted in direct medicine and medical products marketing to consumers. Similarly, social media is increasingly becoming a platform for interaction between physicians and potential patients. Some physicians have taken this opportunity to better educate patients, while allowing patients to learn more about their surgeons online. These tools can increase internet traffic online to bonafide internet sites, as well as bolster marketing for many hospitals, hospital systems, and individual doctors. It can also serve to increase knowledge about procedures and conditions through direct outreach to patients. Social media is a powerful tool which needs to be utilized wisely to avoid pitfalls.

The influence of social media and easily accessible online information on the aesthetic plastic surgery practice: literature review and our own experience

INTRODUCTION

Patients interested in aesthetic plastic surgery procedures increasingly seek advice on social media and rely on easily accessible online information. The investigatory goal was to determine the impact of this phenomenon on the everyday aesthetic plastic surgery practice.

METHODS AND PATIENTS

Five hundred consecutive patients completed a questionnaire prior to their consultation with a plastic surgeon at our clinic. A questionnaire was also completed by 128 plastic surgeons practising in 19 different countries. A literature review was performed.

RESULTS

Almost all patients (95%) used the internet to collect information prior to consultation, for 68% of them it being their first search method. Social media were used by 46% of patients and 40% of these were strongly influenced when choosing a specific doctor. The majority of plastic surgeons (85%) thought the information found on social media could lead to unrealistic expectations. However, 45% of plastic surgeons believed that their consultations became easier after the advent of social media, 29% found them more difficult. A literature review showed a high percentage of poor quality internet websites regarding plastic surgery and an increase in use of social media among plastic surgeons.

CONCLUSION

The internet and social media play an important and growing role in plastic surgery. This results in more informed patients but may create unrealistic expectations. Even if the internet provides ample information, it cannot replace the face-to-face consultation, which always should remain a detailed process, covering both risks and limitations of alternative procedures. Available literature on how social media influences the medical practice is still scarce and further research is needed.

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.

Social media and the surgeon

As the Internet has matured, social media has developed and become a part of our everyday life. Whether it is Facebook, YouTube, or LinkedIn, we now communicate with each other and the world in a very different manner. As physicians, and specifically colon and rectal surgeons, it is important that we understand this new technology, learn its limitations, and utilize it to foster growth of our practice, trade, and potentially result in better patient care.

The best marketing strategy in aesthetic plastic surgery: evaluating patients' preferences by conjoint analysis

BACKGROUND

To provide the best marketing strategy for a private clinic, knowledge of patients' preferences is essential. In marketing, conjoint analysis has been frequently used to calculate which attributes of a product are most valuable to consumers.

METHODS

This study investigates the relative importance of attributes that influence the selection and decision-making process when choosing an aesthetic private clinic, using conjoint analysis. The following attributes were chosen by the senior author (R.W.L.) and a marketing and communications director after a preselection of 25 randomly selected people: relative cost of the procedure, travel time, experience of the plastic surgeon, size of the clinic, method of referral, and online presentation. The attributes were then divided into levels. Using a random factor conducted by SPSS, 18 different scenarios were created and rated online by 150 potential patients before their potential visit or consultation. The patients could rate these scenarios on a scale from 1 to 7 with respect to the likeliness of visiting the clinic.

RESULTS

The most important attribute was experience of the surgeon (35.6 percent), followed by method of referral (21.5 percent), travel time (14.2 percent), cost of procedure (12.9 percent), online presentation (9.7 percent), and size of the clinic (6.1 percent). Six of 16 levels gave a negative influence on the decision making.

CONCLUSIONS

The authors' study shows that the two most important attributes are the experience of the surgeon and the method of referral and that conjoint analysis is effective in determining patients' preferences. It also shows which levels positively or negatively contribute per attribute.

Social media use and impact on plastic surgery practice

BACKGROUND

Social media platforms have revolutionized the way human beings communicate, yet there is little evidence describing how the plastic surgery community has adopted social media. In this article, the authors evaluate current trends in social media use by practicing plastic surgeons.

METHODS

An anonymous survey on the use of social media was distributed to members of the American Society of Plastic Surgeons. Prevalent patterns of social media implementation were elucidated.

RESULTS

One-half of respondents were regular social media users. Reasons for using social media included the beliefs that incorporation of social media into medical practice is inevitable (56.7 percent), that they are an effective marketing tool (52.1 percent), and that they provide a forum for patient education (49 percent). Surgeons with a primarily aesthetic surgery practice were more likely to use social media. Most respondents (64.6 percent) stated that social media had no effect on their practice, whereas 33.8 percent reported a positive impact and 1.5 percent reported a negative impact.

CONCLUSIONS

This study depicts current patterns of social media use by plastic surgeons, including motivations driving its implementation and impressions on its impact. Many feel that social media are an effective marketing tool that generates increased exposure and referrals. A small number of surgeons have experienced negative repercussions from social media involvement. Our study reveals the presence of a void. There is a definite interest among those surveyed in developing best practice standards and oversight to ensure ethical use of social media platforms throughout the plastic surgery community. Continuing discussion regarding these matters should be ongoing as our experience with social media in plastic surgery evolves.

A plastic surgeon's guide to applying smartphone technology in patient care

BACKGROUND

The vast array of information technology available to plastic surgeons continues to expand. With the recent introduction of smartphone application ("app") technology to the market, the potential for incorporating both social media and app technology into daily practice exists.

OBJECTIVES

The authors describe and evaluate the smartphone applications most pertinent to plastic surgery.

METHODS

Smartphone apps from all available markets were analyzed for various factors, including popularity among general consumers, ease of use, and functionality. Using various advertising guidelines from plastic surgery societies as well as the US Food and Drug Administration, each app's content was further analyzed within the context of ethical obligations.

RESULTS

The apps with the highest number of ratings were those offering the option to upload photos and morph each photo according to the user's own preference. The title of apps also appears to play a role in popularity. A majority of apps demonstrated the same features available on websites.

CONCLUSIONS

The applicability of social media marketing via smartphone apps has the potential to change future patient-surgeon interactions by offering more personalized and user-friendly encounters. The role of smartphone apps is important to the future of plastic surgery as long as plastic surgeons maintain an active role in the development of these apps to ensure their value.