As if we didn’t have enough cause for stress in our busy, complicated lives, along comes social media. What started out, theoretically, as a novel way to “connect” people on a wide scale has now been implicated in social anxiety disorder, which is the third leading psychological disorder in the United States,1 as well as in other forms of stress. Granted, the cry against the stress-producing impact of technology is nothing new. Similar claims of deleterious psychological effects have been made against technological advances such as trains, telephones, radio, television, and industrial machinery.2 As we have somehow survived the assaults on our psyches perpetrated by these essential inventions, presumably we will survive social media as well. However, social media can be addictive and its effects are often insidious. All of which suggests that we need to be attentive not only to our own use of social media but to the impact of social media on our patients. It has been my observation that plastic surgeons primarily use social media as a marketing tool.3–5 While we may have “personal” social media accounts as well, they usually are far less actively maintained. However, a plastic surgeon’s professional page on Facebook, for instance, provides an opportunity to advertise treatments and procedures in a setting that, by its very nature, appears more “personal.” On the same page as an image and blurb about the latest facial filler, the doctor may post a photograph of the office holiday party or even a picture of the family dog. These elements create a humanizing effect, presumably encouraging viewers to have warmer and more receptive feelings toward the doctor and the practice. After all, who can resist a pink-tongued, tail-wagging canine? None of this is particularly insidious. Nor should it be assumed that social media activity, particularly of a professional nature, necessarily leads to stress and anxiety. But can posting on social media become an obsession, even for an otherwise “sane” individual? I’ve noticed, for example, that some of my colleagues spend a great deal of time at meetings having their photographs taken, especially while they are speaking at the podium, after which they will immediately post the pictures on one or more social media sites---almost as if there were a competition to see who can post the most pictures and do it the fastest. Is there anything wrong with this? Not really, except sometimes I can’t help but wonder if, for some, these “photo ops” have become more important than the meeting itself. Self-imposed pressure to “outdo” the posts of competitors, if taken to the extreme, could indeed become anxiety producing. If the latest posting on my Facebook page is a photo of me having a hamburger at Ed’s Diner down the street (even if Ed, wearing a big smile, happens to be a satisfied patient), surely the postings of my competitor presenting lectures in London, Paris, and Rome will steal a bit of the wind from my sails. The “compare-and-despair factor” is one of the negative byproducts of social media.6 Users of social media such as Instagram, Twitter, and Facebook have the ability to compare their number of followers, retweets, and “likes” with that of other users. When these numbers are not as large as anticipated, or compare unfavorably to those of friends or competitors, it can lead to stress.1 Aesthetic Surgery Journal recently conducted an informal (and by no means scientific) survey of its Twitter followers, asking for an opinion as to whether technology/social media causes stress. Surprisingly, 76% of respondents said “yes,” 19% said “no,” and 5% weren’t sure. I can’t say whether these responses reflect personal experience, the known or observed experiences of others, or simply a hypothesis. But it appears the human brain is “wired” to seek social approval, and social media plays right into that need. According to Matthew D. Lieberman, a professor of psychology at the University of California, Los Angeles (UCLA), the need for positive social interaction has “been there in one form or another since before the dinosaurs 250 million years ago.”7 Along the same lines, a Harvard University study asserted that people devote 30% to 40% of their speech output to informing others of their subjective experiences.8 This need to “share” is, in large part, why social media can produce positive feelings when interactions are satisfying and negative ones, such as anxiety and stress, when they are not. Frankly, I am not overly concerned about the emotional health of plastic surgeons who engage in social media. Despite the tendency to compete with one another for attention, I would be surprised if many of us are suffering from severe cases of social media stress or have the time to become true social media “addicts” (notwithstanding that addicts of all kinds are notoriously good at concealing their addictions even from those closest to them). And whether social media stress among the general public is really a huge problem remains a subject of debate. One of the better studies on the subject was conducted by the Pew Research Center. Investigators found that:1 “overall, frequent internet and social media users do not have higher levels of stress,” and2 “those users who feel more stress are those whose use of digital technology is tied to higher levels of awareness of stressful events in other people’s lives.” In other words, empathy for the subjective experiences that others share via social media may be the most frequent cause of social media stress. This effect was found to be more frequent in women than men.2 However, researchers from Germany’s Humboldt University and Darmstadt’s Technical University found that envy, not empathy, was a stress producer. Their findings suggested that social media viewing of photos depicting friends’ successes can frequently incite feelings of jealousy, unhappiness, and loneliness and that, interestingly, the worst negative reactions stem from viewing friends’ vacation photographs.9 The “compare-and-despair” effect may have an interesting and direct impact on plastic surgery practices. I have had a number of new patients come into the office saying they became unhappy with the way they look after seeing themselves on a friend’s Facebook page. While anything that provokes relatively objective self-assessment of appearance may serve as an impetus for someone to seek cosmetic enhancement, unflattering photos available for public viewing via social media may heighten a patient’s sense of urgency and anxiety. With social media in its infancy, we still have a lot to learn about both its positive and negative impact on our lives. As professionals using social media for marketing and patient-relations purposes, we should try to avoid a “keeping up with the Joneses” mentality which only creates unnecessary pressure and adds to stress. In our interactions with patients, we should be sensitive with regard to how the availability of personal images via social media, especially unflattering ones posted without explicit permission, can create self-consciousness and anxiety. A patient who expresses these feelings should be managed in the same way as any other patient who has negatively assessed his or her appearance and decided to inquire about cosmetic enhancements. Hopefully, however, we can help such patients to keep in mind that cosmetic surgery is not about looking as good as, or better than, their social media friends; it’s about looking their personal best. Likewise, as plastic surgery professionals utilizing social media for practice marketing, we should focus not on “out-posting” the competition but on making every post something of value to those who view it. Impressing your social media followers is fine, but engaging them is even better. 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. The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. REFERENCES 1. Social media anxiety disorder: causes, symptoms, treatment, recovery tips . ePainAssist. https://www.epainassist.com/mental-health/social-media-anxiety-disorder. Accessed December 28, 2017 . 2. Hampton K , Rainie L , Lu W , Shin I , Purcell K. Social media and the cost of caring . Pew Research Center . January 15, 2015 . http://www.pewinternet.org/2015/01/15/social-media-and-stress. Accessed December 30, 2017 . 3. 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 4. 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 5. Gould DJ , Nazarian S . Social media return on investment: how much is it worth to my practice ? Aesthet Surg J . 2018 ; 38 ( 5 ): 565 - 574 . Google Scholar CrossRef Search ADS 6. O’Connor M . The six major anxieties of social media . New York Magazine . May 14, 2013 . http://nymag.com/thecut/2013/05/six-major-anxieties-of-social-media.html. Accessed December 30, 2017 . 7. Felier B . For the love of being liked . The New York Times . May 9, 2014 . https://www.nytimes.com/2014/05/11/fashion/for-some-social-media-users-an-anxiety-from-approval-seeking.html. Accessed December 30, 2017 . 8. Tamir DI , Mitchell JP . Disclosing information about the self is intrinsically rewarding . Proc Natl Acad Sci U S A . 2012 ; 109 ( 21 ): 8038 - 8043 . Google Scholar CrossRef Search ADS PubMed 9. Goldsmith B . Is Facebook envy making you miserable? Reuters. January 22, 2013 . https://uk.reuters.com/article/us-facebook-envy/is-facebook-envy-making-you-miserable-idUKBRE90L0N220130122. Accessed January 1, 2018 . © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: email@example.com 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: Jan 9, 2018
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