Critics are concerned that viewers and potential patients may not be getting a full picture of the risks involved.
Plastic surgeons have been advertising their services for years with before and after photos.
Since May 2016, Toronto plastic surgeon Dr. Martin Jugenburg has been using his Instagram account to increase business by showing the steps in-between.
Jugenburg, whose Instagram handle is @realdrsix, shares videos and photos of liposuction, breast augmentations and the increasingly popular Brazilian butt lifts in grisly detail on his Instagram and Snapchat accounts.
He has almost 74,000 followers on Instagram — and 80,000 on Snapchat. Many of them post comments on his photos and videos and, more importantly, reach out to him with their questions.
Jugenburg says he is providing an educational tool. But critics are concerned that viewers and potential patients may not be getting a full picture of the risks involved with plastic surgery and worry online postings could easily cross ethical lines.
“My goal is to educate the public, and make my patients better understand what they are getting into,” said Jugenburg, who believes seeing real plastic surgeons at work on Instagram is far less dangerous than watching non-qualified people at work.
“I see social media as the new Discovery Channel or TLC,” Jugenburg said. “Millennials don’t watch TV anymore. They are online.”
Jugenburg isn’t the only plastic surgeon to operate on social media, but he was the first Canadian to do so and he has the largest following among Canadian plastic surgeons.
The videos can be jarring and hard to watch at first. On the lower end of the ick spectrum is seeing the fat collected from liposuction. Higher up is seeing kilograms of flesh removed from tummy tucks weighed on a scale. Higher still is seeing the inside of a breast during lift surgery while the nipple is still in place.
If you can get past the ick factor, it’s educational and informative, said Tania Isnor, a 32-year-old mother of two, who watched Jugenburg’s videos of breast lifts before going to him for the same procedure as well as implants in November.
“The first or second time that I saw it I was like, ‘Whoa! That’s a lot,’ but then it kind of grew on me and became more interesting,” said Isnor, adding that one of the main reasons she chose Jugenburg was his social media presence.
“He shows exactly what’s happening, so I knew when I went into surgery what they were doing, so there were no surprises,” she said.
Isnor gave Jugenburg consent to share her procedure on social media to inform others about what the surgery entails.
“I told all my girlfriends I’ll be on Snap and Insta. This is the time. This is the day. So they all watched,” she said. The video was very technical, with Jugenburg explaining everything as he did it. He shared her before and after photos in his Instagram and Snapchat stories.
A recent study in the Aesthetic Surgery Journal found plastic surgeons who are eligible to be members of the American Society for Aesthetic Plastic Surgery created almost 18 per cent of the top posts on Instagram with hashtags related to plastic surgery. The rest were by doctors not trained in plastic surgery and people who aren’t doctors at all, but offering services they’re not necessarily trained to do.
The study also found certified plastic surgeons were much more likely to post educational content under the hashtags than nonplastic surgeons.
Dr. Giancarlo McEvenue, a plastic surgeon at the McLean Clinic in Mississauga who also posts surgeries on his Instagram accounts, wrote a paper about social media activity among Canadian plastic surgeons in the Aesthetic Surgery Journal.
He chose the topic because “no one knew what plastic surgeons were actually doing online,” he said.
McEvenue found plastic surgeons typically do not have a strong online presence and thinks that is disconcerting.
“I think it’s important for plastic surgeons to be leaders online in social media because we have the education and the expertise to inform patients correctly,” he said. “If we’re not going to do it, other people will, and it may put people in danger because of misinformation out there.”
Though the social media content is popular amongst patients and prospective patients, it can be an ethical grey area.
Not only do doctors need a patient’s consent to share photos online — even when taking care to cover identifying features such as faces and tattoos — there are concerns that surgeons may misrepresent their results by altering photos and not explain the risks of surgery thoroughly.
When it comes to sharing surgeries, McEvenue asks patients to sign a disclaimer. “Once something has been posted online in any format there’s no guarantee of privacy,” he said.
Regarding representation, Karyn Wagner, the executive director of the Canadian Society of Plastic Surgeons, said the organization’s code of ethics states that members are not allowed to give deceptive or misleading information, which includes before and after photos or images of patients “with different light, poses or photographic techniques to misrepresent the results achieved by the individual.”
But this can be hard to police.
The society does not have a section specifically addressing conduct on social media, nor does it have any plans to, Wagner said.
Kerry Bowman, a bioethicist at the University of Toronto, said it’s hard to know if all the stipulations plastic surgeons are required to follow are being met.
“Anything with before and after pictures where there’s any alteration of the photographs or the lighting or anything else would be considered unethical,” he said. “I’m not saying there is, but I wouldn’t know either.”
Neither do the doctors’ followers — they just have to hope the doctors are acting ethically.
As does the Society of Plastic Surgeons, which does not monitor its members’ postings on social media to see if they follow the ethics code, Wagner said.
However, Bowman also believes that social media can help to educate patients.
“I do think the strength of it is the amount of detail you get as to exactly what goes on in the procedure, but I wouldn’t say that’s full-informed consent because you don’t see what the risks could possibly be or the range of outcomes.”
In conventional medicine he would see “a whole lot of red flags,” in terms of the self-promotion by doctors and hard-to-find information on risk and benefits, he said. But the defence of that is the culture of plastic surgery — a very visual specialty — is so radically different, he added.
McEvenue agrees.
“We’re not dealing with sick people, we’re dealing with healthy people that are concerned with beauty,” he said. “So, we’re in a grey area of the fashion industry and medicine.”
The phenomena of sharing videos of surgeries on social media began with Dr. Michael Salzhauer, better known as Dr. Miami, an American plastic surgeon who has been sharing videos and pictures of procedures on Instagram since 2014. His two Instagram accounts combined have more than one million followers and his Snapchat account has around two million with an average daily viewership of up to one million, he said in an email.
His popularity on social media even snagged him an unscripted TV show called Dr. Miami.
“I started doing it to show my prospective patients and their families how plastic surgery works,” he said.
“It is the very best way to provide ‘informed consent.’ If a patient is able to see how an actual tummy tuck is performed, they are in a better position to decide if it is right for them. In addition, there are thousands of students that watch and are able to learn more about medicine, surgery and anatomy.”
One of McEvenue’s Instagram accounts, @topsurgery, has become a hub for his transgender patients to discuss their experience with each other.
“They’ve actually created a whole community on that page where they love being posted and talk to each other on the account and make friends and they’re all very supportive of each other,” he said.
Many of the same millennial-age patients ask to have their surgery recorded on their iPhones and shared on his Instagram account dedicated to the procedure, McEvenue added.
“In the future, probably we’ll have somebody full-time filming because it’s what patients want,” he said.
And it isn’t just millennials who’re flocking to social media for their plastic and cosmetic surgery research.
Sonia Totten, a 42-year-old nurse from Mississauga, chose Jugenburg to do her lower blepharoplasty (eyelids) in large part because she’d watched him operate on social media. She consented to broadcasting her surgery live on Snapchat and Instagram so that other people could learn.
During her surgery, her husband, Jason, who is also a nurse, could watch the procedure live on Snapchat.
“I was able to get instant updates on how my wife was doing and how everything was going in the surgery,” he said. “It was amazing.”
Though he was nervous, seeing his wife was comfortable and knowing everything was going fine helped, he said.
When the couple got home, they watched the procedure together.
“It just put my mind at ease,” said Totten of Jugenburg’s technique and professional demeanour. “It actually comforted me after and I was appreciative for that.”
Sumber : https://www.thestar.com/life/health_wellness/2018/02/04/plastic-surgeons-sharing-procedures-on-social-media-raises-ethical-concerns.html
