Has a Cosmetic Surgery Circus Come to Town?
There’s talk these days about the negative impacts of social media, including the way platforms like Instagram and Snapchat tend to amplify society’s absorption with celebrities, fads and other superficial aspects of life at the expense of what’s true, lasting and genuinely important. Today, cosmetic surgeons are challenged to figure out how to leverage these outlets to reach prospective patients in an appropriate way (while some are unclear on the “appropriate” part).
The task is not an easy one. Many cosmetic surgeons want to share videos of surgery on these platforms because Instagram and Snapchat are both ubiquitous and inexpensive. The goal should be to educate prospective patients and highlight the appeal of a practice without making light of the more serious aspects of plastic surgery, or worse, creating a so-called “circus” in the operating room.
As a practice focused on cosmetic surgery in New York, the challenge is one we don’t take lightly. That’s why we applaud the efforts of a team of plastic surgeons at Northwestern University for taking some first steps toward ethical guidelines—read an article summarizing their project here.
In considering what’s right for our New York cosmetic surgery practice, here are some observations we’ve made.
Why Video Sharing Platforms Are a Draw for Cosmetic Surgeons
• We agree with the lead plastic surgeon for the Northwestern study: as times change and society’s view of what’s acceptable changes, so should we. We are no longer at all surprised by tattoos, for instance, nor by before and after plastic surgery photos of body parts. It follows that sharing videos online can be a reasonable way to educate people nowadays.
• Like it or not, reality TV and social media have triggered growing interest in cosmetic procedures, and doctors aiming to create a thriving practice would be shortsighted not to respond to the demand.
• Attracting patients in a noisy, competitive market is increasingly challenging. It makes sense to use every reasonable option open to a practice.
Why it’s Important to Tread Carefully
• The Northwestern team considered the four principles of medical ethics in their research: respect for the patient’s autonomy, promoting what’s best for the patient, “do no harm” and justice. These principles, along with the notions of full disclosure and informed consent, form the basis for an ethical medical practice.
The researchers pointed out some current obvious violations of these principles, including videos of cosmetic surgeons operating in costume, dancing and displaying removed tissue to the camera. Less obvious possibilities include a patient agreeing to be filmed due to the natural “hierarchical” doctor-patient relationship. Coercion may happen without either party realizing it.
• There’s another reason plastic surgeons should be wary of utilizing new media platforms—doctors aren’t usually Internet experts. The Northwestern plastic surgeons noted that most doctors aren’t well versed enough in the fine details of various platforms, nor can they influence how policies and technologies evolve. At very least the patient needs to be made aware of the permanent nature their online images and understand that future uses are nearly impossible to forecast.
• Another very real downside of creating videos to post online is the potential distraction for both patient and surgeon. When patients are drawn in by videos of cosmetic surgery, they may not realize the need to take their procedure seriously. If a patient is captivated by a dancing, costumed cosmetic surgeon, how much attention will he or she pay to preparing for surgery properly? Not to mention, will they take the necessary steps to evaluate the prospective cosmetic surgeon’s credentials? And how can a doctor avoid being distracted during an operation if he or she is playing to a camera?
Proposed Guidelines for Sharing Cosmetic Surgery Videos
Just recently, the paper published by the Northwestern team appeared in Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons (ASPS). They proposed five guidelines the ASPS should consider adopting, guidelines to help patients understand the implications of online videos, remind plastic surgeons of the ASPS standards of conduct and discourage adding to surgical time. Find the proposals here. The goals are to protect patients and surgeons, and to safeguard public perception of plastic surgery.
Assuming the ASPS membership embraces the proposed guidelines, a couple of noteworthy challenges remain. First is the inherent “gray area” nature of ethics codes. One doctor’s view of “upholding the dignity and honor” of the profession may not align with another doctor’s view. And while the ASPS’s Code of Ethics offers examples of appropriate advertising, it does not prohibit specific approaches.
In addition, there remains the age-old problem of the public’s understanding of board certification. The ASPS accepts surgeons who are certified by the American Board of Plastic Surgery only—the gold standard—and members agree to abide by the organization’s code of ethics. But dermatologists, gynecologists, ER physicians and other doctors can perform cosmetic procedures too, sometimes with little training. Furthermore, since another recent study referenced on marketwatch.com found that the huge majority of cosmetic surgery videos on Instagram are NOT posted by board certified plastic surgeons, the public’s understanding may decline instead of improve.
What do you think of all this? Have you noticed a cosmetic surgery “circus” online? What’s the right balance between reaching out to patients and safeguarding their best interests? Let us know in a comment, or you can email us here.