Plastic surgery residents are stepping into a profession where their digital footprint can overshadow their surgical reputation. Social media has created “social media influencers” who cultivate massive followings and profit from sponsorships. Physicians can function as social media influencers, colloquially termed “medfluencers” (medical influencers), raising ethical dilemmas beyond current social media guidelines. The rise of medfluencers is outpacing ethical foundations taught in residency, raising concerns about professionalism, public trust, and the commercialization of medical expertise. Unlike traditional marketing through print or broadcast media, digital marketing involves personalized data tracking and analytics, enabling parasocial relationships and algorithmic amplification of content.1 Social media can conflate digital popularity with professional expertise based on a surgeon’s online follower count, potentially influencing patient decision-making when paid promotions are undisclosed.2 Many plastic surgeons use social media to brand, attract patients, and educate. Plastic surgery residents are more active on social media than attendings, valuing follower count the most.3 With most plastic surgery posts made by nonprofessionals,4 plastic surgeons must stay engaged. However, residency lacks formal training on medfluencer ethics, leaving residents prone to emulate attending surgeons who built a digital reputation after their surgical one, and risking the prioritization of online popularity over patient trust and professionalism. Medfluencer culture can affect residents and compromise the core ethical principles of beneficence, nonmaleficence, autonomy, and justice. This includes the following: Exploitation of trust: Followers may assume physician-influencer content is objective, trustworthy, and in their best interest. Conflict of interest: Brand deals and partnerships can contribute to biased advice. Transparency: Followers often do not know which posts are sponsored unless stated. Professional identity: Promoting certain products or services may dilute medical credibility. Impact on residents: Trainees may feel incentivized or pressured to build a following and monetize. As plastic surgery leads medicine in social media presence, it must also lead in defining ethical engagement with influencer culture. Recent online forum discussions show some applicants are considering listing social media influence under “hobbies” in residency applications, reflecting a cultural shift surrounding professional identity in medicine and the urgency of developing structured digital ethics education. Although the 2025 American Society of Plastic Surgeons Social Media Guidelines5 set ethical expectations for digital engagement, they rely on preapproval and record-keeping requirements for advertising and paid endorsements. This is ill-suited for the fast-paced nature of social media, and proactive medfluencer ethics training embedded within residency would better prepare trainees to apply these principles responsibly in real-time digital environments. We recommend a coordinated effort to develop formal education for ethical online engagement. This could include the following: Expanding the American Society of Plastic Surgeons Code of Ethics to include disclosure requirements specific to influencer activities and sponsorships. Incorporating “Digital Professionalism and Medfluencer Ethics” modules into the Accreditation Council of Graduate Medical Education plastic surgery curriculum. Encouraging residency programs to host case-based discussions on digital conflicts of interest and public trust. Creating model policies for physicians on social media monetization and patient interaction. Social media use is ubiquitous and should not be discouraged. Instead, formal education on medfluencer ethics can ensure that the next generation of plastic surgeons engages responsibly, preserving both the artistry and integrity of the specialty while balancing personal branding. DISCLOSURES Dr. Janis receives royalties from Thieme Medical Publishers and Springer Publishing. The other author has no financial interest to declare in relation to the content of this article.
Maini et al. (Fri,) studied this question.