Cosmetic Surgery Advertising on Instagram Misleading

Ricki Lewis, PhD

August 31, 2017

Only 18% of practitioners advertising aesthetic surgery services on Instagram are board-certified plastic surgeons, according to a study published online August 30 in the Aesthetic Surgery Journal.

"[T]he paucity of board-certified plastic surgeons amongst the top plastic surgery-related posts on Instagram is alarming," the researchers write.

Robert Dorfman, a third-year medical student at Northwestern University Feinberg School of Medicine, Chicago, Illinois, and colleagues analyzed plastic surgery-related posts on Instagram, including the qualifications of the people offering their services as well as the hashtags used.

Many people, particularly the young, seek medical information via social media that highlight visual images, such as Instagram. "As a uniquely visual social media channel, Instagram in particular is naturally suited to plastic surgery, a uniquely visual surgical specialty," the authors explain.

Professionals qualified to provide plastic surgery services were in the minority among those posting to Instagram in that capacity. Of the top posts, only 17.8% (n = 29) were from board-certified plastic surgeons.

Another 26.4% of the posts (n = 43) were from noneligible physicians marketing themselves as cosmetic surgeons. These included otolaryngologists (12 posts), dermatologists (9 posts), general surgeons (6 posts), gynecologists (4 posts), family medicine physicians (2 posts), and an emergency medicine physician (1 post). "A cosmetic surgeon is not necessarily the same thing as a board certified plastic surgeon, and patients need to be made aware of this," Dr Dorfman said in a university news release.

The highest proportion of posts (41.7%; n = 68) were from foreign surgeons, whose scope of training was unclear.

Nine top posts (5.5%) were from nonphysicians, such as dentists (4 posts), workers at spas with no associated physician (4 posts), and one hair salon employee.

The researchers categorized 67.1% of the posts as promotional and 32.9% as educational. Board-certified plastic surgeons were significantly more likely to post educational material compared with the others (62.1% vs 38.1%; P = .02).

The researchers considered 1,789,270 Instagram posts for a single date (January 9, 2017) that responded to 21 plastic surgery–related hashtags. They qualitatively evaluated the top 9 posts for each hashtag (routinely listed at the top of each page), for a total of 189 posts, of which 163 met inclusion criteria. Included posts were either relevant to plastic surgery (such as images from procedures, advertisements, anatomical diagrams, or patient experiences) or were posted by a plastic surgeon.

The hashtags were an eclectic mix of the general (plasticsurgery, cosmeticsurgery, aestheticsurgery, plasticsurgeon, cosmeticsurgeon, and aestheticsurgeon), technical (breastlift, mastoplexy, breastaugmentation, breastimplant, rhinoplasty, rhytidectomy, abdominoplasty, and buttockaugmentation), and colloquial (boobjob, nosejob, facelift, tummytuck, brazilianbuttlift, and bodycontouring), plus one entry that fit all three categories (liposuction). The lay language hashtags attracted more viewers.

Limitations of the study included the low number of posts considered, sampling on a single date, and inclusion of physicians trained outside the United States, in some cases obscuring their qualifications to perform cosmetic surgery.

The investigators term the Instagram experience to evaluate aesthetic procedures "an important gap in the surgical literature."

"Given the volume of cosmetic surgery advertising by nonplastic surgeons and the ensuing risk this poses to patient safety and outcomes, our findings present a significant cause for concern," the investigators conclude. "It is critical that board-certified plastic surgeons use social media like Instagram as a platform to educate patients about the risks of surgery and dangers of having plastic surgery performed by those with improper training."

The authors have disclosed no relevant financial relationships.

J Aesthetic Surg. Published online August 30, 2017. Abstract

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