Advertising on Social Media: The Plastic Surgeon’s Prerogative

We have entered an age which our mentors did not have the luxury of experiencing during their training. Young residents can go onto various online platforms and learn stepwise aesthetic and reconstructive procedures recorded on video. Educational platforms such as the RADAR Resource (http://www.surgery.org/radar), provided by the American Society for Aesthetic Plastic Surgery (ASAPS), and the Plastic Surgery Education Network (http://www.psenetwork.org), provided by the American Society of Plastic Surgeons (ASPS), are available to all surgeons worldwide. Electronic videos and smartphone applications now render most surgical textbooks obsolete.1 Furthermore, patients can access social media sites such as YouTube (San Bruno, CA), Facebook (Menlo Park, CA), and Twitter (San Francisco, CA) and can acquire increased exposure and a basic understanding of aesthetic surgery with only a finger touch. Recently there has been a focus on sharing aesthetic procedures live on newer social media platforms, such as Instagram (Menlo Park, CA) and Snapchat (Venice, CA). These range from non-surgical procedures, such as fillers and botulinum toxin injection, to more complex surgical procedures such as rhinoplasty and breast and buttock augmentation. The main purpose is advertisement of their surgical practice to their followers and to thereby attract new patients.2 The clips are often short (60 seconds) and sometimes do have some educational merits. Some, but not all, surgeons document that they have obtained consent from patients, with varying regulations worldwide. Recent videos being uploaded tend to glamorize these complex surgical procedures. Plastic surgeons often pose for intraoperative pictures while patients are anaesthetized. Furthermore, they emphasize the immediate positive results, without discussing any potential complications or postoperative care requirements. There are a number of issues with this approach; it drops the high standards that we as plastic surgeons should maintain and trivializes aesthetic surgery.3 While patients may become more informed in some aspects, they may develop unrealistic and potentially dangerous overall expectations.4 Some patients may feel that a simple injection of filler has no risks and that anyone can do it; that a board-certified plastic surgeon does not need to perform this procedure. Indeed, they may even feel they can administer it themselves after watching it on Snapchat. Younger patients may further be pressured to attain the perfect breast shape or perfect nose through exposure to these social media platforms.5 The question is whether these sites should be regulated and uploaded videos limited in order to demonstrate more educational value and helpful patient information.6 Standards of patient care can be upheld if the underlying principles highlighted in the Professional Standards for Cosmetic Practice Report, published by the Royal College of Surgeons in 2013,7 are formally applied to these new social media sites. To remove the blatant advertising and photoshopped before and after pictures that are commonplace in some social media accounts may not always be possible. However, those who overtly trivialize the surgeries or send provocative selfies of their patients under their Facebook or Instagram accounts should be discouraged. The boundary between surgeon and patient has become blurred in some cases and should be revisited, with those ignoring this being penalized by their regulatory bodies. There already exist general advertising guidelines, produced by ASAPS,8 ASPS,9 and The American Board of Plastic Surgery (ABPS),10 that members must adhere to. Unethical and prohibited advertising practices include promotional use of “before and after photographs that use different lighting, poses or photographic techniques to misrepresent results” and “exaggerated claims intended to create false or unjustified expectations of favorable surgical results.”9 These guidelines were produced prior to the recent increased use of social media for advertising. While still appropriate in parts, a review of these guidelines is warranted with more stringent and more relevant advertising standards that are directly relevant to current use of social media. Our overseeing organizations such as ASAPS, ABPS, BAAPS, and BAPRAS should lead the way in improving patient decision making and safety, by developing clear guidelines for advertisement and video posting on these social media sites. Plastic surgeons throughout the profession should use social media responsibly and not as a means to make aesthetic surgery entertainment. The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. The authors received no financial support for the research, authorship, and publication of this article.