I read the paper by Dorfman et al1 with great interest. The authors evaluated 1,789,270 Instagram posts using hashtags related to plastic surgery. It is an endeavor that required a great deal of labor, and I congratulate the authors for this wonderful work. However, I think that the paper is biased in its representation of the importance of board certification, which was not convincingly supported by either the results of this study or those of the references. In the sixth paragraph of the Discussion section, they presented the results of the study by Mioton et al.2 They stated that this study compared the complication rates after panniculectomy operations between board-certified plastic surgeons and nonplastic surgeons. However, Mioton et al2 compared nonplastic surgeons and plastic surgeons in their study, not board-certified plastic surgeons. No mention of board certification was made in the referenced paper. The current authors misrepresented the results of Mioton et al’s paper to support their own goals.2 In addition to this, I wonder whether they have made changes in their own results for similar purposes: For example, a reader is left to wonder whether all plastic surgeons in the United States get board certification. If all plastic surgeons in the United States get board certification, this should be clarified. If not, which group did the authors include them in? It was unclear in the paper. The authors present the same results both in the last paragraph of the Results section and Table 2; however, the groups compared with board-certified plastic surgeons differed in these sections. In last paragraph of the Results section, a comparison is made between board-certified plastic surgeons and nonplastic surgeons. However, in Table 2, this comparison is made between board-certified plastic surgeons and nonboard-certified plastic surgeons. It is unclear whom board-certified plastic surgeons were actually compared with, creating confusion. The same confusion regarding the compared groups is seen between the first paragraph of “How Can Plastic Surgeons Unite to Educate the Public?” and Table 2. It appears to me that the authors only compared board-certified plastic surgeons and nonplastic surgeons (including nonboard-certified plastic surgeons), and have most likely used other comparisons to better support their assumptions. In the paragraph before the Limitations section, they advise the American Society for Aesthetic Plastic Surgery to inform the public about the danger of high postoperative complication rates for nonplastic surgeons, which was based on the results of only a single study (Mioton et al2). Making such a suggestion needs more strong references than a nonrandomized study that is also deficient in methodology. Mioton et al2 compared the complication rates after panniculectomy operations between plastic surgeons and nonplastic surgeons. However, patients in the nonplastic surgeon group were significantly older and more obese than those in the plastic surgeon group. Additionally, the nonplastic surgeon group had a greater number of comorbid conditions that might affect the frequency of postoperative complications. To eliminate these preoperative risk factors between groups, the authors obtained a propensity-matched group within the plastic surgeon group. They provide a detailed table comparing the propensity-matched plastic surgeon and nonplastic surgeon groups. However, this table only contains detailed characteristics and comorbidities of this comparison with related P values. There is no information about the postoperative complication rates of these matched groups nor their P values. In the Results section the authors give the results of the comparison of propensity-matched plastic surgeon and nonplastic surgeon groups. However, they only state that they found high overall complication and wound infection rates in the nonplastic surgeon group, and also do not provide any P values for these comparisons. A table detailing the comparison between matched groups, with P values, would give more reliable information than the comparison table that was made between unmatched groups. It raises questions as to why Mioton et al2 did not include this kind of table in their paper. If an article such as that by Dorfman et al1 emphasizing the importance of board certification is to be accurately carried out, plastic surgeons in the United States should be separated into two different groups: board-certified plastic surgeons and nonboard-certified plastic surgeons, and only after that can comparisons be made. In this situation, potential comparisons between board-certified plastic surgeons and nonboard-certified plastic surgeons and between board-certified plastic surgeons and nonplastic surgeons would provide more reliable information. Thus, a more reliable assumption could then be made regarding the importance of board certification. 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. 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 . 2. Mioton LM , Buck DW 2nd , 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 . © 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/open_access/funder_policies/chorus/standard_publication_model)
Aesthetic Surgery Journal – Oxford University Press
Published: Jun 2, 2018
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