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Why it could be risky to find a plastic surgeon on Instagram

An Instagram employee takes a video using Instagram's new video function at Facebook's corporate headquarters during a media event in Menlo Park, California on June 20, 2013. AFP Photo /Josh EDELSON

Instagram isn’t just for selfies: Many plastic surgeons promote their work on the social media app, and some users search the app to find surgeons.

Yet picking your next plastic surgeon on Instagram can bring some serious health risks if that surgeon is not board-certified, according to a pilot study published Wednesday in the Aesthetic Surgery Journal.

Only 17.8% of plastic surgery-related Instagram posts in the United States and Canada might come from board-certified plastic surgeons, according to the study, which analyzed posts uploaded on a single day in January.

The majority of the posts were from physicians not trained in plastic surgery or professionals who were not even licensed physicians, such as dentists or spa aestheticians, said senior study author Dr. Clark Schierle, a board-certified Northwestern Medicine plastic surgeon and faculty member at Northwestern University Feinberg School of Medicine.

“Finding your surgeon on Instagram isn’t necessarily a problem,” Schierle said, adding that his own practice has accounts on Instagram and other social media sites.

Rather, a public health problem can arise when non-certified professionals market invasive procedures on the social media app and prospective patients may not ensure that the person behind the marketing is board-certified for that surgery, he said.

To be certified by the American Board of Plastic Surgery, a physician must have at least five years of approved surgical training, including a residency in plastic surgery, and must pass comprehensive written and oral exams in plastic surgery, according to the American Society for Aesthetic Plastic Surgery.

Certification is a voluntary credential, but by choosing a board-certified plastic surgeon, patients can be assured that the surgeon completed at least five years of additional training as a resident surgeon and graduated from an accredited medical school, according to the board.

The Royal College of Physicians and Surgeons of Canada also follows a similar process for certification.

“We’ve all heard these headlines in recent years of some terrible things that have happened in association with surgery that was not being done in the safest possible manner,” Schierle said.

As for those on Instagram, “some of these are doctors practicing outside of their scope of practice. Some of these are non-physicians just doing crazy stuff, like injecting silicone building material from Home Depot into people’s bodies without a medical license,” Schierle said. “These days, with the Internet and social media, these people have more of a voice and more opportunity for horizontal information transmission than ever before.”

‘Social media takes it to yet another level’

The new study involved more than 1 million Instagram posts that were uploaded January 9. Each included at least one of 21 plastic surgery-related hashtags such as #plasticsurgery, #plasticsurgeon, #breastlift or #nosejob.

On Instagram, hashtags help aggregate and categorize uploaded photos or videos that fall within similar categories of content. Additionally, a consumer might search for a hashtag — such as #facelift — to find a surgeon.

Among the hashtags in the study, “the use of colloquial or layperson terminology for cosmetic surgical procedures seems to be much more popular than the use of technical terminology,” Schierle said, such as #tummytuck over #abdominoplasty.

The researchers analyzed the Instagram posts to find the top nine associated with each of the 21 hashtags, and they recorded data on who did the posting, referring to the Instagram profile associated with each post.

“The Instagram app itself automatically categorizes the top nine posts. Whenever you do a given search, the first nine results that show up are identified as top posts,” Schierle said. “The top nine are based on how many followers the person has and how many likes the particular post has.”

The researchers found that, in the United States and Canada, just a few of the top posts came from a plastic surgeon board-certified by the American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

The researchers wrote that the online presence of surgeons who are not board-certified in plastic and reconstructive surgery in the US and Canada often comes at the expense of patient safety and dangerous outcomes.

Globally, the majority of the top posts for each hashtag came from surgeons outside the United States, including Turkey, Russia, Brazil, Colombia, the Dominican Republic and the United Arab Emirates, the researchers found. However, those posts were not analyzed to determine the poster’s board certification status.

Plastic surgeons have long warned against traveling internationally for unsafe plastic surgeries, and Schierle said he has corrected some botched procedures from overseas among his own patients. Now, however, consumers should be warned of unsafe procedures being promoted on social media, he said.

“Social media takes it to yet another level in terms of the impact that people can have and how rapidly they’re able to kind of establish themselves as something that they may or may not actually be,” Schierle said.

Still, the new study comes with limitations, including that it involved only one day’s worth of Instagram data — all the posts were from January 9 — and that the data were pulled from a single social media platform.

“The study was well-designed but serves only as a snapshot of an ever-expanding problem in the field,” said Dr. Wright Jones, a board-certified surgeon in Atlanta and founder of Muse Plastic Surgery, who was not involved in the study.

The researchers plan to conduct followup studies over a longer time period and across an array of social media platforms, including Snapchat, Schierle said.

“More data need to be collected in terms of seasonality, how cyclical the data are, as well as the overall trend,” he said. All in all, the study reveals that the underrepresentation of board-certified plastic surgeons among the top posts on Instagram should be something for potential patients to be aware of, he said.

Tips for finding a plastic surgeon, and questions to ask

“Instagram has become a convenient way for patients to see a surgeon’s work and get a sense of the types of procedures being performed,” Jones said.

“It is quickly becoming a go-to source for millennials,” he added. “In today’s society, patients want to get to know the surgeon before ever stepping foot into the office.”

Dr. Matthew Schulman, a board-certified plastic surgeon based in New York, has integrated social media into his practice for many years and said the new study results support his personal impression that the majority of the most active plastic surgeons on social media are not board-certified.

For consumers, it’s not always easy to determine whether a plastic surgeon on Instagram is board-certified, said Schulman, who was not involved in the study. He added that he routinely lectures plastic surgeons at national and regional meetings about the usefulness and advantages of social media.

“Some physicians have specific information in his or her bio. However, many non-board-certified plastic surgeons are not forthcoming about specific training,” Schulman said.

“Some may be outright deceitful, but most deceive by omission. Being a board-certified plastic surgeon takes many years of training, examinations, certifications, and is something to be proud of,” he said. “I can assure you that if a physician is a board-certified plastic surgeon, this will be prominently featured on his or her bio.”

Jones said patients can verify a plastic surgeon’s credentials using the American Board of Plastic Surgery’s website.

Also, the American Society for Aesthetic Plastic Surgery offers an online, searchable database of board-certified plastic surgeons by location in the United States.

For surgeons outside the US, the International Society of Aesthetic Plastic Surgery offers a database of board-certified or equivalent plastic surgeons by country.

Along with ensuring that your plastic surgeon is board-certified, the American Society of Plastic Surgeons recommends asking the following questions before going under the knife:

  • Are you certified by the American Board of Plastic Surgery?
  • Are you a member of the American Society of Plastic Surgeons?
  • Were you trained specifically in the field of plastic surgery?
  • How many years of plastic surgery training have you had?
  • Do you have hospital privileges to perform this procedure? If so, at which hospitals?
  • Is the office-based surgical facility accredited by a nationally or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
  • How many procedures of this type have you performed?
  • Am I a good candidate for this procedure?
  • Where and how will you perform my procedure?
  • How long of a recovery period can I expect, and what kind of help will I need during my recovery?
  • What are the risks and complications associated with my procedure?
  • How are complications handled?
  • What are my options if I am dissatisfied with the outcome of my surgery?
  • Do you have before-and-after photos I can look at for each procedure, and what results are reasonable for me?