In South Florida, an area known for its high volume of successful and botched plastic surgeries, social media has brought a whole new level of craziness to the industry.
Plastic surgeons are blogging, posting on Instagram, and creating stories for Snapchat that often show real patients undergoing procedures in real time. These South Florida surgeons – who practice under a variety of titles – are exposing each other's mistakes, battling negative patient reviews, swiping each other's before and after photos and pushing the line between appropriate and vulgar.
"We live in the wild west when it comes to aesthetics and treatments," said Dr Adam Rubinstein, an Aventura plastic surgeon. "It's hard for people who are not in the business to make sense of it."
When it comes to plastic surgery, social media use is at an all-time high, with photos of pouty lips, big butts and flat tummies dominating Instagram posts. About 70% of board-certified surgeons maintain an active professional social media account, according to an 2018 survey of members of the American Society for Aesthetic Plastic Surgery. While doctors are building followings and luring patients, some also are fending off lawsuits and navigating the thorny digital frontier between promotion and misuse.
At the same time, people who are considering cosmetic procedures and those who have undergone them – often referred to as dolls – have their own private Facebook groups and Instagram accounts where they are asking questions, sharing photos, comparing prices and documenting their journeys – the good, the bad and the ugly.
"You can look at a pretty pictures on social media all day, but you don't know what someone went through," said Teresa Jones, a mother of four who has spent six months on social media researching plastic surgery in Florida and belongs to four of the private Facebook groups. "You learn that sometimes, it takes two or three rounds of surgery to fix what happened the first time."
While patients talk among themselves, plastic surgeons, cosmetic surgeons, dermatologists and a variety of practitioners are using social media as the new yellow pages to promote their practices. They quickly find photos and online reviews have even greater mileage than the old-fashioned word of mouth.
Rubinstein, an Aventura plastic surgeon, runs an Instagram account called @PlasticSurgeryTruths with nearly 33,000 followers where he answers questions such as how to get rid of dark spots and how to know if your skin is good for liposuction. Along with that account, Rubinstein is an active blogger and about to launch a YouTube channel where he will go behind the scenes to explain the materials used in plastic surgery procedures.
Rubinstein said he participates actively on social media "to educate the public and keep things transparent". He also uses social media to expose what he claims are bad practices in the profession and the people involved in them. He runs an Instagram series titled "Exposed", that highlights "self-proclaimed" cosmetic surgeons or clinics who have a plethora of medical malpractice lawsuits against them.
"There's so much deception going on in social media and people who are putting themselves out there as plastic surgeons who are not," he said.
Another South Florida surgeon using social media to promote his work has learned that doing so can have consequences. Dr Christopher Salgado, section chief of UHealth's LGBTQ Centre for Wellness, Gender and Sexual Health, is no longer employed by the University of Miami Health System.
Salgado ran into trouble with posts on his Instagram account called @sexsurgeon, which is no longer active. Transgender advocates complained to the university about the Instagram account's graphic photos of gender reassignment surgery and crude hashtags, including a Valentine's Day post with a photo of a penis of a transgender patient shaped in a heart with the comment, "There are many ways to show your LOVE", as reported by The Miami Herald.
Salgado, who gained recognition when he consulted with TLC star Jazz Jennings on her gender confirmation surgery on an episode of I Am Jazz, has since apologised in an email to the newspaper. Jazz is a South Florida transgender woman who has publicly documented her journey on television and YouTube.
Yet, even while social media has become treacherous, South Florida plastic surgeons say it's necessary to doing business. Plastic surgery-related hashtags have risen dramatically, appearing in nearly 1.8 million posts on Instagram, most of them promotional rather than educational, according to a January 2017 analysis published in the Aesthetics Surgery Journal. At the same time, the number of cosmetic and plastic surgery procedures has boomed. The American Society of Plastic Surgeons found more than a quarter-million more cosmetic procedures were performed in 2018 than the previous year.
Along with photo posts, South Florida surgeons are getting increasingly promotional on social media – performing live operations on Instagram, Facebook, Snapchat, YouTube and reality television shows, boosting the area's image as one of the top places in the country for new boobs and the popular Brazilian Butt Lift.
"We're in the age of consumerism," said Jeffrey Welch, CEO of Florida Medical Center in Fort Lauderdale. "If you are going to have something done, you want to go to the best and you're going to look at pictures."
Knowing this, Welch said doctors need to recognise the ethical issues that could arise, such as infringing on patient privacy and misrepresentation of results or credentials. "You have to be careful and cognizant of what you are posting," Welch said. "At the hospital, we have our own corporate guidelines."
The American Society of Plastic Surgeons also has a code of ethics that addresses the use of social media with guidelines for its board-certified members.
Miami plastic surgeon Carlos Wolf said he was one of the first in South Florida to use social networking tools to bring patients' families and the general public into operating rooms with real-time updates and videos.
"It is an important means of marketing for the practice," he said.
Fatima Coco of Fort Lauderdale said Wolf's live surgical procedures have her considering a nose job.
"Watching him do surgery gives me confidence that he knows what he is doing," she said.
Likewise, Ramona Melo of Miami found Wolf's practice by browsing Instagram while looking for photos and information on the eyelid surgery she wanted. Melo said she saw hundreds of before-and-after photos on numerous social media sites, read lots of online reviews, and spent two years trying to figure out which were real.
"This was a big life decision and I was struggling," she said. After a couple of in-person consultations with Wolf, Melo said she had the surgery and is "super happy". Now, she's back on social media, browsing photos of her next possible surgery – a tummy tuck.
For all the upside of social media as a marketing tool, Wolf also has seen "the dark side" of the digital frontier. Pretending to be Wolf, an imposter created a social account with Wolf's photo and his patients' before-and-after photos. The person behind the account tried to dupe online shoppers, doling out advice and asking for an upfront consultation fee.
Wolf said many people are overly trusting of what they see online. "The problem is with social media you could make yourself be looked at as an expert, as an unbelievable surgeon, and be a worthless piece of s**t," Wolf said. "Some people put exaggerated stuff on the Internet ... extreme makeovers that calls attention to them. It's very unsafe, but gets them out there where they can get 'likes' and attention."
The situation could get better though.
Florida Sen. Anitere Flores, R-Miami, has proposed a bill aimed at taming the unruly cosmetic procedures by requiring that anyone who operates a surgery centre register with the US Department of Health. Meanwhile, prospective patients like Jones are doing online research to protect themselves by learning whether their surgeons are board certified and hearing about patients first-hand experiences in Facebook groups.
"You read about things like double infections and multiple blood transfusions and horrible scars and it makes you want to be extra careful," she said. After researching online for six months, Jones put a US$500 (RM2,035) deposit down for a tummy tuck with the only plastic surgeon at a Miami clinic who is certified by the American Board of Plastic Surgery. But the doctor she chose for the surgery passed away and Jones is now fighting to get her deposit back. "There have been too many deaths and infections, which is why I would only use a surgeon who is board certified," she said.
Rubinstein believes plastic surgeons themselves need to protect the uninformed public.
"We are stewards of our own profession," said Rubinstein. "When people take a weekend course and open an Instagram account and call themselves cosmetic surgeons and the public can't tell the difference, the industry needs a few sheriffs and I don't mind standing up, even if I do suffer a few slings and arrows for it." – South Florida Sun Sentinel/Tribune News Service