Three hundred posts related to plastic surgery on 3 different popular social media sites, including Facebook, Instagram, and YouTube, were analyzed during the second working week of November 2017.
The distributions of the posts' authors are presented in Figure 1. Sixty-three percentage of the posts on Instagram were published by plastic surgeons compared with only 18% on Facebook and 13% on YouTube (P < 0.01). Combining the 3 social media sites, plastic surgeons published 31% of the total posts versus 49% by commercial companies (P < 0.01).
Subject of the Posts
As seen in Figure 2, the majority of posts on Instagram were self-promotional (83%) in contrast to only 29% on Facebook and 6% on YouTube (P < 0.01). YouTube posts were more personal in nature compared with Instagram and Facebook [39%, 7%, and 9%, respectively (P < 0.01)]. Educational content accounted for only 16% of the total posts, and study results were rarely mentioned (2%); P < 0.01.
Online shaming, in which targets are publicly humiliated and criticized, is common and seen in 21% of the posts, mostly in Facebook (39%), and mainly relating to a public figure (more commonly referred as celebrities; 25%); P < 0.05.
For example, post with a picture of a famous man laughing at his many failed plastic surgeries, or posts against plastic surgeons by patients.
Posts Involving a Reality Star
Reality stars are mentioned in 7% of the posts, mainly in Facebook (17%; P < 0.01). It seems that reality stars do get a lot of "likes", but may not attract attention as effectively (measured by number of comments and views) as other public figures do (Figs. 3, 4).
"Social Media Currency"
As shown in Figure 5, posts involving celebrities received more attention in every aspect (views, likes, comments, and shares). Celebrity posts averaged 28,000 "likes" compared with 1,000 for plastic surgeons, 4,000 for commercial companies, and 6,400 for individuals ("private person").
Based on the data, the "private person" title may be less accurate, because the degree of exposure that some of these private individuals receive suggests that they are well known within their social media networks and may be more accurately labeled "social media celebrities."
What Attracts Attention?
Celebrities are not the only ones to get attention in social media. There are several ways in which a post can generate interest. For example, images of women in advertisements, which despite being controversial, are also widely used in social media posts about plastic surgery (68% of all posts). Without addressing the problematic nature of this phenomenon, it appears that from a business perspective, the use of a woman's image is an effective way to attract attention on social media also. This is evident in the enormous amount of views, 336,600 on average, that posts containing images of women received. As for the effectiveness of public education, which will be discussed below, it seems that the educational information regarding surgical procedures was substantially less effective in attracting attention compared with photographs of attractive women (Figure 6).
As shown in Figure 7, posts that choose to include videos (22%) are generously rewarded; worth noting is the substantial number of shares obtained (763, mean).
As demonstrated earlier, posts about plastic surgery that included shaming (public humiliation, which may refer to a public figure, a plastic surgeon or a private person) also attracted more attention (likes, comments, and views) but less shares. The majority of shaming posts were on Facebook (39%), and they were mainly about a public figure (25%). It should be noted that plastic surgeons are no strangers to the negative phenomenon of shaming, although mostly occurring in the comments section of the posts and not published directly as a post, hence was not recorded.
The posts have been analyzed and categorized according to the topic that we believe has yielded their broad publicity (may be several topics in each post), as seen in Table 1. Except for an anecdotal invitation for a lecture that gained about 12 million views, the 10 most powerful motives that have gained the attention of the social media audience were jokes, attractive female plastic surgeons, celebrities, personal stories, provocative surgeries, videos or photos of surgeries, sex, shaming, and patient education (Figure 8).
Plast Reconstr Surg Glob Open. 2018;6(12):e1958 © 2018 Lippincott Williams & Wilkins