In this article, the authors provide a relevant and interesting study of the top utilized hashtags on Instagram, a largely visual social media platform with 400 million monthly users.1 Several important findings were identified; first the utilization was higher for hashtags related to lay language for procedures compared to medical terminology, except for rhinoplasty and liposuction. This may represent a byproduct of the fact that most of the posts are tailored to the general public, as Instagram is a platform for general consumption with a young demographic and younger plastic surgeons are more likely to have Instagram and social media accounts.2 What happens on Instagram may be broadly considered as direct-to-consumer marketing in this context. This may contrast with the platform Twitter where the posts are often targeted to the expert community or amongst plastic surgeons or other medical experts.3 Undoubtedly all forms of social media represent a valuable tool for plastic surgeons in expanding their influence and practice4 as well as in improving the exposure of their research interests and the impact of their work.5 Hashtag Utilization is Dominated by Non-Board Certified Practitioners The majority of top posts came from foreign surgeons, and this made them difficult to sub classify or to really analyze the background of the practice and surgeon. Only 17.8% of the top posters were board certified plastic surgeons. Top posts came from those who identify as “cosmetic surgeons” and are gynecologists, family medicine doctors, ER doctors, general surgeons, and dermatologists. There was a group of top posts that came from dentists, spas without associated doctors, and in one case a hair salon. These are alarming findings, though they are not surprising, as Branford already exposed the imbalance of posts on twitter most coming from the public, as opposed to coming from professionals.6 Thankfully in this case 80% of posts came from licensed physicians, and this differs from Branford’s findings in Twitter. Hashtag Utilization is Mostly Associated With Advertisements Over Educational Content Importantly, 67.1% of the material on Instagram was found to be self-promotional and not educational. Many posts were utilizing Instagram as an advertisement platform for their practice and procedures. Some of the top posts are educational; however, the portion is relatively low. Advertisement on these platforms is critical to practice growth, however it should not be overdone.7 The proportion found in this article of educational material to advertisements is incongruent with the recommendations proposed by Branford, Gould, and others, in which the main purpose should be education and advocacy5,6 and the number of advertisements should be roughly one in ten posts at most.8 A Call to Action The authors highlight several concerns, including that quality is provided by board certified surgeons that have undergone intensive training in aesthetic and reconstructive surgery. They cite the fact that others have shown a 3-fold increase in complications in panniculectomy when not performed by a plastic surgeon.9 They argue that board-certified practitioners should contribute content to better occupy the space in Instagram. They advocate doing this through a surge in hashtag use, which we agree with. We can mirror Branford’s efforts in the social network Twitter here in the platform Instagram to improve visibility of board-certified experts, to improve the brand of #plasticsurgery and to improve hashtag utilization by plastic surgeons. This should be executed carefully with a focus on educational content and not advertisement. Also, we agree there should be appropriate patient consent guidelines and we strongly urge The American Society for Aesthetic Plastic Surgery leadership and ASJ to help to formulate a task force for the creation of guiding principles for social media for plastic surgeons, including a universal consent form for use in clinic with patients. A uniform approach may improve the image and the consistency of the messages we send in social media. We would also argue that there should be refocused efforts in training of residents to teach appropriate use of social media and to prevent violations that may affect the future board certification of residents. Efforts should focus on education in this regard and not necessarily on regulation. These issues are core to the ethical principles that guide plastic surgery and they should be a focus of development. Overall, we would like to provide a strong commendation to the authors for their efforts in exposing yet another area where plastic surgeons need to contribute to the dialogue to ensure patient safety and the future of plastic surgery. Disclosures Dr Nazarian is a speaker for Zeltiq (Pleasanton, CA), Cynosure (Westford, MA), and Sciton, Inc. (Palo Alto, CA); and a speaker and on the medical advisory board member for Miramar (Santa Clara, CA) and Merz (Greensboro, NC). Dr Gould declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The authors received no financial support for the research, authorship, and publication of this article. REFERENCES 1. 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 . doi: 10.1093/asj/sjx120. 2. McEvenue G, Copeland A, Devon KM, Semple JL. How social are we? A cross-sectional study of the website presence and social media activity of Canadian plastic surgeons. Aesthet Surg J . 2016; 36( 9): 1079- 1084. Google Scholar CrossRef Search ADS PubMed 3. Wong WW, Gupta SC. Plastic surgery marketing in a generation of “tweeting”. Aesthet Surg J . 2011; 31( 8): 972- 976. Google Scholar CrossRef Search ADS PubMed 4. Camp SM, Mills DC2nd. The marriage of plastic surgery and social media: a relationship to last a lifetime. Aesthet Surg J . 2012; 32( 3): 349- 351. Google Scholar CrossRef Search ADS PubMed 5. Cress PE. Using altmetrics and social media to supplement impact factor: maximizing your article’s academic and societal impact. Aesthet Surg J . 2014; 34( 7): 1123- 1126. Google Scholar CrossRef Search ADS PubMed 6. Branford OA, Kamali P, Rohrich RJet al. #PlasticSurgery. Plast Reconstr Surg . 2016; 138( 6): 1354- 1365. Google Scholar CrossRef Search ADS PubMed 7. Reissis D, Shiatis A, Nikkhah D. Advertising on social media: the plastic surgeon’s prerogative. Aesthet Surg J . 2017; 37( 1): NP1- NP2. Google Scholar CrossRef Search ADS PubMed 8. Gould DJ, Grant Stevens W, Nazarian S. A primer on social media for plastic surgeons: what do i need to know about social media and how can it help my practice? Aesthet Surg J . 2017; 37( 5): 614- 619. Google Scholar CrossRef Search ADS PubMed 9. Mioton LM, Buck DW2nd, Gart MS, Hanwright PJ, Wang E, Kim JY. A multivariate regression analysis of panniculectomy outcomes: does plastic surgery training matter? Plast Reconstr Surg . 2013; 131( 4): 604e- 612e. Google Scholar CrossRef Search ADS PubMed © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: email@example.com
Aesthetic Surgery Journal – Oxford University Press
Published: Mar 1, 2018
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