As social media evolves over time, I have found it interesting to keep up to date with which channels are the most highly visited, have a tangible benefit for businesses, and provide the most fulfilling social network for family and friends. For this reason, I enjoyed reviewing the paper, “Patients’ and Surgeons’ Perceptions of Social Media’s Role in the Decision Making for Primary Aesthetic Breast Augmentation” by Montemurro et al of the Akademikliniken clinic based in Stockholm, Sweden.1 This aesthetic surgery practice has offices in Sweden, Norway, Denmark, and Ireland according to their practice website with an array of aesthetic surgical procedures of the face, breast, and body as well as the offerings of a full medspa.2 Akademikliniken’s Facebook page has 26,457 followers3 and they typically reply to messages instantly, which is impressive for a large group practice, and their Instagram profile has 7479 followers.4 While there have been studies looking at the evolution and usage of social media either by patients or by surgeons, the authors performed this study since there was no available information that compared its usefulness in both groups. Their main objective was to compare views held by patients and plastic surgeons alike towards social media and other internet resources in relation to aesthetic breast augmentation. The study was carried out with a questionnaire presented to 648 consecutive patients who came to their clinic for consultation for primary breast augmentation from September 2016 to March 2017. A separate “surgeons’ questionnaire” was answered by a group of 138 plastic surgeons who either worked at the clinic, had previously done fellowship there, or were visiting the clinic.1 The authors had an amazing (if not unheard of) 100% response rate for the questionnaire with all 138 surgeons and 648 patients responding. In addition, 91.4% of patients said that they had searched online and 61.4% had searched in specific online groups for information on breast augmentation. Furthermore, 72.5% of surgeons thought that over three-quarters of patients gather information on the internet while only 20.3% of surgeons thought that over three-quarters of patients utilize social media for their information. The authors correctly concluded that while patients seek social media to help make their decision, it is far from the only deciding factor. Surgeons underestimated the patients’ use of social media, and the authors found that both groups were concerned about the amount of inaccurate information on these channels, stressing the importance of providing factual, evidence-based information to patients. The landscape for finding information on the internet has changed dramatically in a short amount of time, such as since I presented findings of a similarly structured study at the 2009 ASAPS Annual Conference, and later published the paper, “Contemporary decision making and perception in patients undergoing cosmetic breast augmentation” in this journal in 2010.5 Reviewing the questionnaire used in our study, we didn’t list any social media outlet as a potential answer to questions like “which factor most influenced your choice of surgeon?” and “once you had the idea of getting breast augmentation, where did you start your search for information?.” While respondents had a blank line after “other” to free-form write in answers not listed in the multiple-choice questions, not one person wrote in Facebook or any other social media channel (Appendix A, available online at www.aestheticsurgeryjournal.com). Top places searched were as follows: “Google,” “a BA portal site,” and “the plastic surgeons’ website” in that order (Figure 1).5 Figure 1. View largeDownload slide Information searching habits. Each response indicates how patients first began their search for information on breast augmentation. Reprinted with permission from Oxford University Press.5 Figure 1. View largeDownload slide Information searching habits. Each response indicates how patients first began their search for information on breast augmentation. Reprinted with permission from Oxford University Press.5 For those of you who are millenials, breast augmentation (BA) portal sites were message board/ physician directory pages that have gone by the wayside in popularity since social media sites like Facebook and Instagram took over. Examples of now defunct BA portal sites included implantforum.com, implantinfo.com, and bi411.com. When we initially sent our survey to the patients in my private practice in Manhattan in 2007, social media sites in existence such as Facebook and MySpace were mainly used for social networking with friends and family members. Facebook, the most popular social networking service to-date, launched to the public beyond Harvard University in 2004 as a place to keep up with friends. Instagram and Snapchat weren’t even in existence. I looked back into the history of my own social media channels after reading this paper and noticed I first joined Facebook in November 2007. This month and year coincided with Facebook launching their first version of an advertisement system (Beacon, now defunct) that sent data from external websites to Facebook for the purpose of targeted ads and allowing users to share their activities with their friends.6 On that same day Facebook Pages was launched, which has become a globally popular and indispensable way of reaching potential clients, consumers, and patients as well as giving the public an opportunity to learn about one’s business and brand. In 2007, I remember searching online to find I was one of the first plastic surgeons on Facebook with a public-facing profile and page; this was by design so that potential patients, friends, and family could follow me since I had begun my practice outside my home state of Texas. Now many more plastic surgeons and medspas employ Facebook and recognize that social media benefits their practice, although it may not be the highest contributor to practice volume. It comes as no surprise that in the Montemurro et al1 study the percentage of patients who looked online (websites, blogs, forums and social networks) for information was much higher than figures reported in previous studies including ours, especially since social media was in its infancy at the time our study and not really used for this purpose. A community-driven site that was not mentioned in the Montemurro et al study, which is quite popular in the United States, is RealSelf.com. Moreover, 57.1% of RealSelf.com’s visitors are from the US.7 Since RealSelf’s formation and public launch in 2006, the site has grown to be a major player in providing online information about aesthetic procedures in a forum for patients to discuss their surgeon, post reviews, rank procedures, and tell the world if it was worth it all. Most importantly, RealSelf has gained mass appeal and influence in its consumer-centric focus on the patient experience, and in so doing it has a 8 million unique visitors each month. I was involved with RealSelf early on, and wrote one of the first answers to a question posed by a patient. This feature is an interactive and equalizing functionality that has served to define RealSelf and, since its inception, grow its popularity online for both consumers and surgeons. It is the interactivity of sites such as Facebook, Instagram, and RealSelf that has changed the tone of online information gathering, rather than the passivity of a surgeon’s website showing one-sided content in a static manner to the public. Despite this, I still personally find the plastic surgeon’s own website to be an extremely important source of information about a surgeon and her or his practice and its menu of services for public consumption. My patients comment on the usage and content of my practice website on a near daily basis, so I know it is being visited. Accuracy of information and before and after images on one’s own practice website should be a top priority for board-certified plastic surgeons so that our patients arrive relatively informed and educated, or, at the very least, hopefully decide against going to a non-core provider. In both the Montemurro et al and my study, clinical photographs were an important source of information in finding a plastic surgeon for breast augmentation, and the clear majority of patients had indeed searched the internet in some form or fashion to find their plastic surgeon. One limitation of Montemurro’s study as its authors state was that all patients were Swedish, yet it represented that country’s population of a developed nation with significant social media penetration. They admit their findings may not be representative of other countries where social media is used less frequently. Only 8 of the surgeons who responded were from America, and given that Americans are obsessed with Instagram and other popular social channels, if this questionnaire were given in the US, I would predict an even higher number of patients and surgeons consuming and dispensing information on breast augmentation online. For example, the social media behemoth Instagram itself has over 800 million monthly active users, and a 2016 Pew Research study of US residents found that of the 32% of online adults who have Instagram, women are in the majority.8 Amazingly (to me at least), 70% of American Instagram users have a post-secondary education. According to a 2016 Instagram announcement, users “like” 4.2 billion posts daily—and that was when their user base was “only” 500 million. Video posts on Instagram have been a huge hit with users since the feature launched in 2013, as evidenced by 5 million videos that were uploaded in the first 24 hours. According to Instagram, users share an average of 95 million photos and videos per day. AdWeek reported “brands are uploading to Instagram Stories more than twice as often as they are on Snapchat.”9 Instagram’s latest internal figures show 25 million businesses have a business profile on the network (70.7% of US businesses), and over 200 million users visit at least one business profile every day.10 One thing that is novel for plastic surgeons is that Instagram users are not shy about following brands they like (we are accustomed to people denying any interest in plastic surgery despite having had a procedure done). There are 75% of Instagram users taking action, such as visiting a website, after looking at a brand’s post. If you have attractive products (as aesthetic plastic surgeons often do), Instagram has obvious advantages. For example, the popular Instagram profile @PlasticSurgery (owned and operated by veteran internet marketing guru Christopher Jilly) has 35 to 50 million impressions per month and over 333,000 organic followers. Stating that it will only work with board certified plastic surgeons recognized by the American Board of Plastic Surgery or the American Board of Facial Plastic and Reconstructive Surgery, this brand has posted over 15,750 plastic surgery case studies, videos, and pictures. There is a thirst for plastic surgery-related content on Instagram, evidenced by @PlasticSurgery’s broad American appeal. It’s #1 US Market is New York, #2 US Market is Los Angeles, and #3 US Market is Dallas.11 I found it interesting that in Montemurro’s study only 20.3% of surgeons thought that over three-quarters of patients draw on social media to seek information about breast augmentation, and the underestimation of its importance may be why only 37.7% of surgeons had a social media presence. Board-certified plastic surgeons may want to rethink this, given that Facebook has over a billion visitors daily and the ability to geographically target and reach its users to provide them information about a surgeon and his or her practice. In our 2007 study, the most powerful influence on choice of surgeon was the plastic surgeon’s website, meeting her in consultation, BA portal sites, and the recommendation of previous patients among other minor interests. In Montemurro’s study, the most influential factors on choice of surgeon were, in order, clinic reputation, word of mouth recommendation, practice website, and forums/blogs. The differences in the two studies on a similar topic spaced a decade apart are consistent with trending consumer market research that the plastic surgeon’s own website is becoming a less important influence for patients online in their choice of surgeon, and that, the more interactive review sites a surgeon has no control over, the more heavily trafficked and relied upon are the sites. Patients view third party website information as less biased and more authentic, with interactivity being an attractive feature which defines contemporary social media. Indeed, people are becoming less likely to visit business websites after reading positive reviews, a 17% drop from 2016.12 In this study, it was the Akademikliniken clinic’s reputation that was most important in helping prospective patients choose their surgeon.1 This raised the question in my mind of what defined “clinic reputation” for them? Was this category based upon online reviews? Was it based on local awards and accolades? Was it based on the number of followers of their Facebook page? Useful information to have would be what metrics the clinic employed to measure reputation in this study. Unfortunately (but not surprisingly), 73.4% of their Swedish patients specifically searched for any unfavorable reviews of the surgeon online, and 83.9% of the patients said that the quality of reviews affected their choice. In addition, 86% of patients were influenced by how long ago the review had been written (I had always wondered about this and was glad to see data on it). Physicians are the second-most commonly reviewed group behind restaurants in the United States (Figure 2) so we have a similar experience in this matter. According to a 2017 US consumer survey, 97% of consumers read online reviews for local businesses, with 12% looking for a local business online every day. Moreover, 85% of consumers trust online reviews as much as personal recommendations.13 Figure 2. View largeDownload slide Graphic representation of how much reputation matters to consumers when choosing a business. Reprinted with permission from BrightLocal.13 Figure 2. View largeDownload slide Graphic representation of how much reputation matters to consumers when choosing a business. Reprinted with permission from BrightLocal.13 The majority of Swedish patients in the Montemurro et al paper expressed concern about the existence of fake profiles online, and though my paper was written prior to the social media age, Montemurro et al and I came to a similar conclusion: “that plastic surgeons should take it upon themselves to provide realistic and accurate material regarding the procedure... given the large audience of women seeking health information online.”5 Both patients and surgeons are concerned about the inaccuracies of online information, for which Montemurro et al rightly states, “is an argument for plastic surgeons to take control of the social media debate.”1 Supplementary Material This article contains supplementary material located online at www.aestheticsurgeryjournal.com. Disclosures Dr Walden is a stockholder in HintMD and Ideal Implant; a key opinion leader (KOL) for ERelevance, ThermiGen, and Vision Medical; a KOL and clinical investigator for InMode Aesthetics and Viveve; a KOL, media spokesperson, clinical investigator for Lumenis; an advisory board member and media spokesperson for Sciton, Inc.; a luminary for Cyanosure, Venus Concept; and recipient of textbook royalties from Elsevier. 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. Akademikliniken Practice Website . https://www.ak.se/. Accessed January 27, 2018 . 3. Akademikliniken Facebook Page . https://www.facebook.com/akademikliniken. Accessed January 27, 2018 . 4. Akademikliniken Instagram site . https://www.instagram.com/akademiklinikensverige/. Accessed January 27, 2018 . 5. Walden JL , Panagopoulous G , Shrader SW . Contemporary decision making and perception in patients undergoing cosmetic breast augmentation . Aesthet Surg J . 2010 ; 30 ( 3 ): 395 - 403 . Google Scholar CrossRef Search ADS PubMed 6. Wikipedia. Facebook Timeline of Events . https://en.wikipedia.org/wiki/Timeline_of_Facebook. Accessed January 27, 2018 . 7. Alexa. RealSelf.com statistics . https://www.alexa.com/siteinfo/realself.com. Accessed January 28, 2018 . 8. Greenwood S . Pew Research Study: Social Media Update 2016 . http://www.pewinternet.org/2016/11/11/social-media-update-2016. November 11, 2016 . Accessed February 3, 2018 . 9. Johnson L . AdWeek. Brands Use Instagram More Than Twice As Often As SnapChat . http://www.adweek.com/digital/brands-use-instagram-stories-more-than-twice-as-often-as-snapchat. August 3, 2017 . Accessed February 3, 2018 . 10. Instagram Statistics 2017 . https://www.smartinsights.com/social-media-marketing/instagram-marketing/instagram-statistics. Accessed February 3, 2018 . 11. Jilly C . @PlasticSurgery statistics 2018 . Personal Communication. February 2, 2018 . 12. BrightLocal 2017 Consumer Review Survey . https://www.brightlocal.com/learn/local-consumer-review-survey. Accessed January 28, 2018 . 13. BrightLocal 2015 Consumer Review Survey . https://www.brightlocal.com/learn/local-consumer-review-survey-2015/#reputation. Accessed January 28, 2018 . © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: firstname.lastname@example.org This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Aesthetic Surgery Journal – Oxford University Press
Published: Apr 4, 2018
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