“Impressing your social media followers is fine, but engaging with them is even better.” – Foad Nahai, MD1 Social media platforms have become an integral part of the interactions that plastic surgeons have with the public and with other plastic surgeons. As the authors point out, Twitter allows the free flow of scientific papers and ideas across continents.2 Many plastic surgeons from around the world are on Twitter, and they actively follow many of the influencers noted in the paper. The authors are to be commended for identifying the top 100 plastic surgery influencers on Twitter, albeit using data for only one month (July 2017).2 The authors’ stated purpose in identifying influencers was to better understand those who inform the public about plastic surgery, and they chose to limit their study to Twitter. The authors state that “Twitter was the most important platform to identify plastic surgery influencers,” and that “social media influencers on one platform are likely influencers on other platforms as well.” However, in the case of Twitter, those statements may best reflect academic plastic surgeons with an interest in sharing articles rather than plastic surgeons as a whole.3–5 Many plastic surgeons with a large social media influence have almost no presence at all on Twitter. Facebook (2 billion monthly active users)6 and Instagram (800 million monthly active users)7 provide a much wider platform for plastic surgeons than does Twitter (330 million monthly active users).8 Actual plastic surgery patients are also more apt to use Facebook and Instagram than Twitter.3 A further limitation of Twitter is that it is rife with fake accounts.9-18 As many as 15% of all Twitter accounts are estimated to be fraudulent or controlled by bots.10 In an effort to verify the identities of the plastic surgery influencers, the authors made sure that each of the top 100 accounts was tied to an individual. Unfortunately, a plastic surgeon can have a perfectly “clean” Twitter account, but that same plastic surgeon can simultaneously have multiple rogue accounts that are not associated with his or her name. Those accounts can then be tied to bots for the purpose of amplifying one’s influence or can be manually used by that individual to comment, like, or retweet without having his or her identity known. Not requiring every account to be tied to an individual makes Twitter the most easily gamed of social media apps.9-18 The New York Times has recently published a series of articles on fake Twitter accounts that detail the market for fake followers and the rush to become an influencer across many industries by buying followers.17-19 One can buy a fake follower for as little as a penny. The Atlantic9 and Slate17 both followed up with supporting evidence of the race for the fake fame and fake influence that Twitter appears to have generated by emphasizing statistics on users’ followers and engagement. Nahai1 warns about trying to “out-post” the competition for the sake of impressing one’s social media followers. Investigation by Congress and the Attorneys General of New York and Florida is just beginning18 and many high profile public figures are now condemning the issue of fake followers and stolen identities that are used to create fraudulent accounts. In what promises to be an ethical dilemma for the American Board of Plastic Surgery as well as all membership committees of the plastic surgery societies, one can now identify accounts where fake followers are bought for the sake of influence. Websites like socialblade.com and twitteraudit.com are starting to shed light onto the hidden world of fake influence. As anyone with an interest can discover, Twitter activity from plastic surgeons includes fake followers, purchased followers, and amplification of posts by the use of bots. Should our societies and journals be concerned with plastic surgeons who buy fake followers, use bots and, at the same time, write papers and lecture about social media influence at plastic surgery meetings? Despite its limitations, Twitter remains a powerful way to distribute information for public education as well as a way to disseminate information at plastic surgery meetings worldwide. The authors have given us a start by enumerating whom to follow on Twitter. By limiting their study to only one month on Twitter in the year of 2017, the study can also be faulted for skewing results by using a very limited time window on only one social media platform. Nonetheless, the study provides a start on identifying the long-term influencers in the field of plastic surgery. Their study may inspire others to look at the more widely used social media platforms. In the meantime, following both @ASAPS and @ASPS_News, as well as @ASJrnl and @prsjournal, would be the best advice for a neophyte to plastic surgery social media. 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. Nahai F . The stress factor of social media . Aesthet Surg J . 2018 ; 38 ( 6 ): 689 - 691 . 2. Chandawarkar AA , Gould DJ , Stevens WG . The top 100 social media influencers in plastic surgery on twitter: who should you be following ? Aesthet Surg J . 2018 ; 38 ( 8 ): 913 - 917 . 3. Sorice SC , Li AY , Gilstrap J , Canales FL , Furnas HJ . Social media and the plastic surgery patient . Plast Reconstr Surg . 2017 ; 140 ( 5 ): 1047 - 1056 . 4. Humphries LS , Curl B , Song DH . #SocialMedia for the academic plastic surgeon-elevating the brand . Plast Reconstr Surg Glob Open . 2016 ; 4 ( 1 ): e599 . 5. Quinlan CS , Collins AM , Nason GJ , Dempsey M . The use of social media by plastic surgery journals . Plast Reconstr Surg Glob Open . 2016 ; 4 ( 1 ): e605 . 6. Number of monthly active Facebook users . https://www.statista.com/statistics/264810/number-of-monthly-active-facebook-users-worldwide/. Accessed February 6, 2018 . 7. Number of monthly active Instagram users . https://www.statista.com/statistics/253577/number-of-monthly-active-instagram-users/. Accessed February 6, 2018 . 8. Number of monthly active Twitter users. https://www.statista.com/statistics/282087/number-of-monthly-active-twitter-users/. Accessed February 6, 2018 . 9. Bogost I . All followers are fake followers. The Atlantic . January 30, 2018 . https://www.theatlantic.com/technology/archive/2018/01/all-followers-are-fake-followers/551789/. Accessed February 8, 2018 . 10. Gorwa R . Twitter has a serious bot problem and Wikipedia might have the solution. Quartz . October 23, 2017 . https://qz.com/1108092/twitter-has-a-serious-bot-problem-and-wikipedia-might-have-the-solution/. Accessed February 5, 2018 . 11. Newberry M . As many as 48 million Twitter accounts aren’t people, says study. CNBC . March 10, 2017 . https://www.cnbc.com/2017/03/10/nearly-48-million-twitter-accounts-could-be-bots-says-study.html. Accessed February 5, 2018 . 12. Auto Retweet . IFTTT Platform . https://ifttt.com/applets/212493p-auto-retweet. Accessed February 5, 2018 . 13. Agarwal A . How to create retweet and favorite Twitter bot. Digital Inspiration: Tech a la Carte . April 9, 2016 . https://www.labnol.org/internet/retweet-favorite-twitter-bot/28967/. Accessed February 5, 2018 . 14. Massive networks of fake accounts found on Twitter . BBC News. January 24, 2017 . http://www.bbc.com/news/technology-38724082. Accessed February 5, 2018 . 15. Sobel Fitts A . It’s easier than ever to impersonate a celebrity online—and we’ve all been duped . HuffPost. August 4, 2015 . http://www.huffingtonpost.com/entry/instagram-celebrity-impersonators_us_55bbc26be4b0d4f33a02c3d7. Accessed February 5, 2018 . 16. Klopman M . MLB network got fooled by fake Twitter account . HuffPost. July 31, 2014 . http://www.huffingtonpost.com/2014/07/31/mlb-network-fake-ken-rosenthal_n_5638418.html. Accessed February 5, 2018 . 17. Brogan J . Twitter’s Fake Follower Controversy Exposes Social Media’s Underlying Economies of Shame . Slate. January 29, 2018 . https://slate.com/technology/2018/01/the-new-york-times-report-on-fake-twitter-followers-reveals-the-mechanics-of-shame-on-social-media.html. Accessed February 12, 2018 . 18. Confessore N . New York Attorney General to Investigate Firm That Sells Fake Followers. The New York Times . January 27, 2018 . https://www.nytimes.com/2018/01/27/technology/schneiderman-social-media-bots.html. Accessed February 4, 2018 . 19. Confessore N , Dance GJX , Harris R , Hansen M . The Follower Factory. The New York Times . January 27, 2018 . https://www.nytimes.com/interactive/2018/01/27/technology/social-media-bots.html. Accessed February 4, 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/open_access/funder_policies/chorus/standard_publication_model)
Aesthetic Surgery Journal – Oxford University Press
Published: Apr 3, 2018
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