“Patients’ and Surgeons’ Perceptions of Social Media’s Role in the Decision Making for Primary Aesthetic Breast Augmentation” compared the view held by patients and surgeons, in the context of a renowned Scandinavian aesthetic plastic surgery clinic, towards social media (SoMe) and other internet resources, in relation to breast augmentation.1 The choice of procedure is appropriate as breast augmentation is the second commonest aesthetic surgical procedure (over 310,000 cases annually, according to latest statistics from the American Society for Aesthetic Plastic Surgery [ASAPS]), and it is the most popular procedure in the 19 to 34-year-old age group,2 a particularly digitally engaged patient demographic. In my experience, aesthetic breast surgery patients are one of the groups attending for consultation having most keenly conducted their “homework” about the procedure and my practice. The investigators consecutively distributed questionnaires to 648 of their own patients who attended their clinic for consultation for primary breast augmentation.1 One hundred and thirty-eight plastic surgeons, who were or had previously been associated with the clinic, also answered a surgeon questionnaire. The authors found that over 90% of patients had searched online for information about breast augmentation; almost 90% had specifically looked for clinical photographs; and almost three-quarters had specifically searched for unfavorable reviews of the surgeon. In contrast, fewer than three-quarters of plastic surgeons thought that most patients gathered information on the internet: remarkably only 20% thought that the majority of patients used SoMe for their information. Half of surgeons reported that SoMe affected their consultations. The authors concluded that while patients use SoMe to help make their decision, in general surgeons appear to underestimate the patients’ use of these digital platforms. SoMe is the interactive communication through web-based technologies. As such, it would be interesting in future studies to analyze the relative interest in websites vs SoMe during information gathering through internet searches by patients. What the public wants is a two-way engagement, not static brand advertising. Perhaps the days of websites are numbered, unless they become more engaged with SoMe platforms. Web browsers are being replaced by SoMe searches with digital platforms becoming the main homepage. In addition, hashtags are becoming the way for patients to find credible, aggregated information about plastic surgery topics.3 SoMe is very dynamic, with the popularity of different platforms fluctuating rapidly, becoming increasingly visual (90% of web traffic is now video), and rapidly absorbing new technologies. As virtual reality platforms become commonplace in indicating results in breast augmentation, they will become adopted into SoMe so that patients can virtually try different implants for themselves. The authors of the study described found that only 6.5% of the public found that online forums, blogs, or SoMe were the most critical factor in their final decision-making with regards to breast augmentation.1 Only one-third of patients found that the online information helped them in their decision to have breast augmentation. The quality of the information posted on SoMe is often poor, not evidence-based, is self-promotional (in two-thirds of posts) and not educational. It is typically not posted by ASAPS eligible board-certified plastic surgeons (who only account for 18% of top posts on Instagram and 6% on Twitter).3,4 In my clinic I have found that half of my patients decide to come to me for breast augmentation as a result of my SoMe profile, where I post the truth about evidence-based plastic surgery. In 2016, 79% of SoMe users used Facebook, with 32% using Instagram and 24% using Twitter.5 However, due to the financially driven algorithms embedded within Facebook (so that only a small proportion of followers see posts unless a clinic or surgeon pays a premium) and the older demographic of Facebook, the target population for breast augmentation is likely to increasingly use Instagram (59% of 18-to-29-year-old women),5 which is ideally suited to the procedure because of its visual content. Underlying a SoMe approach to building one’s practice is how to build trust: this is marketing gold. Marketing analysts suggest that the future of marketing is social. Consumers are smart: they can see through marketing when its forced from a brand. Marketing is moving towards real-time (as opposed to static) “content marketing” supplied via “influencers.” Content marketing is the process of creating and distributing relevant and valuable content to attract, acquire, and engage an audience with the objective of driving profitable customer action. Influencer marketing is by health care professionals—previously known as “key opinion leaders,” and now called “digital opinion leaders,” having powerful and increasing influence. Influencer marketing involves collaborating with prominent individuals (digital opinion leaders) to help produce and distribute content. Patients want treatments—they just don’t want to be sold to. Therefore, the key to SoMe is how to convert patients without selling. At this point the term “academic marketing” should be introduced: this is content driven marketing using education and evidence as the strategy. Perhaps the emphasis for patients on online reviews and before-and-after photographs is due to the lack of engagement and education by trusted board-certified plastic surgeons. The public want to know who to trust and the truth about which effective treatments they should have. Five-star reviews arouse suspicion; negative reviews are promoted and exploited by unscrupulous websites; fake reviews are rife and can very seriously damage an online reputation. Before-and-after photos can be manipulated; consent issues are complex; international SoMe posting rules are inconsistent; and flippant emoticons can cheapen board-certified surgeons. Marketing companies focus on online reviews as that is all they can do. As surgeons we should focus on education and building trust. We can learn from industry, but really industry should learn from us and our evidence-base related to safety and efficacy. The global lack of and inconsistency in regulation for plastic surgery makes education all the more critical. There have been 18 PubMed-cited SoMe related citations in Aesthetic Surgery Journal; and 25 in Plastic and Reconstructive Surgery, reflecting plastic surgery’s ability to stay on trend in terms of innovation. Indeed, the hashtag #PlasticSurgery is consistently the number one trending healthcare hashtag in the whole of medicine, with over 4 billion impressions per year, reflecting its public interest and the specialty’s innovative approach to patient education. Indeed, a working knowledge of SoMe has become a “surgical skill” for academic aesthetic surgeons. The data from the reviewed study show that two-thirds of patients conduct their initial reviews online with only one-third being by word of mouth.1 Word of mouth is still important as this builds trust. But it appears that word of mouth is going online. If surgeons don’t have a SoMe or digital presence, then for many they can’t be trusted as a healthcare provider. Future studies should examine conversion rates for SoMe patients—interest in initial consultation is not the same as proceeding to surgery. The reticence for many surgeons and practices to get involved in SoMe is related to their perception of risk. However, this argument should be reframed as competitors are using SoMe, and, if as a surgeon you don’t exist on the internet, then for many patients you don’t exist. A digital presence builds trust, that is, patients want to “get to know you,” which means knowing your philosophy, techniques, and outcomes even before they come for consultation. SoMe is being increasingly used by patients, and this is particularly the case for the breast augmentation demographic and those in higher income groups. There is an online conversation about surgeons, whether they like it or not, so they would be wise to be digitally engaged to ensure that the conversation about their practice is a positive one. The authors of the article discussed should be commended for their work.1 As board-certified plastic surgeons, it is our responsibility to educate. In this study there was concern from both patients and surgeons that the information on SoMe is inaccurate. This underlines the importance of providing factual, evidence-based information to patients. Patients have an appetite for science, not marketing, and are increasingly engaged in shared decision-making. It is important as board-certified plastic surgeons that we work together to support patients in their choices, and to support our profession in delivering quality. Regulation has not been successful in aesthetic plastic surgery. SoMe is a tool for us to overcome the limitations of regulation. Informed patients don’t go to “cowboys”. Disclosures The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The author received no financial support for the research, authorship, and publication of this article. REFERENCES 1. Montemurro P, Cheema M, Hedén P. Patients’ and surgeons’ perceptions of social media’s role in the decision making for primary aesthetic breast augmentation. Aesthet Surg J . 2018. doi: 10.1093/asj/sjy021. 2. Cosmetic surgery national data bank statistics. Aesthet Surg J . 2017; 37( Suppl 2): 1- 29. 3. Branford OA, Kamali P, Rohrich RJet al. #PlasticSurgery. Plast Reconstr Surg . 2016; 138( 6): 1354- 1365. Google Scholar CrossRef Search ADS PubMed 4. Dorfman RG, Vaca EE, Mahmood E, Fine NA, Schierle CF. Plastic surgery-related hashtag utilization on instagram: implications for education and marketing. Aesthet Surg J . 2018; 38 (3): 332– 338. Google Scholar CrossRef Search ADS PubMed 5. Demographics of Social Media Users in 2016 | Pew Research Center. http://www.pewinternet.org/2016/11/11/social- media-update-2016. Accessed February 12, 2018. © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: firstname.lastname@example.org
Aesthetic Surgery Journal – Oxford University Press
Published: Mar 19, 2018
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