Plastic surgery on Instagram: where do we stand on racial diversity and inclusion?

Elaine Lin; Brooke E. Schroeder; Melissa Tran; Erin Brush; William Tian; Steven Williams; David M. Stepien; Ashit Patel

doi:10.29329/jsomer.17

Authors

Elaine Lin Duke University School of Medicine https://orcid.org/0000-0001-9078-1186
Brooke E. Schroeder Duke University School of Medicine https://orcid.org/0009-0002-0945-7712
Melissa Tran Duke University School of Medicine https://orcid.org/0000-0002-6956-5478
Erin Brush Duke University of Medicine https://orcid.org/0000-0002-3743-3534
William Tian Division of Plastic Surgery, Department of Surgery, Northwestern Medicine https://orcid.org/0000-0002-5621-9568
Steven Williams Tri Valley Surgery
David M. Stepien Division of Plastic, Maxillofacial and Oral Surgery, Duke University
Ashit Patel Division of Plastic, Maxillofacial and Oral Surgery, Duke University https://orcid.org/0000-0002-8384-190X

DOI:

https://doi.org/10.29329/jsomer.17

Keywords:

Instagram, Aesthetic plastic surgery, Patient engagement, Diversity, Racial equity

Abstract

Plastic surgeons use Instagram to expand their practices to accommodate growing interest in plastic surgery. Thus, it is important to assess whether the depiction of plastic surgery on Instagram is inclusive. This study aimed to analyze the racial representation of posts by United States (US) board-certified plastic surgeons and its impact on engagement with the content. Instagram accounts of US board-certified plastic surgeons active from February 1, 2023 – April 12, 2023, were randomly chosen. For procedural posts, the engagement and race of both the patient depicted and the surgeon were collected. ANCOVA was performed to explore whether patient race influenced engagement. Additionally, patient-surgeon racial concordance was investigated. 2,157 posts from 120 accounts were analyzed. White patients were overrepresented compared to the reported demographics of plastic surgery patients. Asian and Hispanic patients were underrepresented. Posts featuring Black patients in our sample had significantly more views, likes, and comments than White patients in the Southeast when controlling for other covariates. However, race was not a significant predictor of engagement per follower. Hispanic plastic surgeons were underrepresented compared to the demographics of practicing plastic surgeons. 88 of 120 accounts had > 50% patient-surgeon racial concordance. 23 had 100% concordance, all featuring White patients/surgeons. The depiction of plastic surgery on Instagram of patients and surgeons can become more racially inclusive. This will likely bring more engagement to this content, resulting in the growth of plastic surgery as a field and increased perceived accessibility to plastic surgery.

References

Alotaibi, A. S. (2021). Demographic and Cultural Differences in the Acceptance and Pursuit of Cosmetic Surgery: A Systematic Literature Review. Plastic and reconstructive surgery. Global Open, 9(3), e3501. https://doi.org/10.1097/GOX.0000000000003501

Arab, K., Barasain, O., Altaweel, A., Alkhayyal, J., Alshiha, L., Barasain, R., Alessa, R., & Alshaalan, H. (2019). Influence of Social Media on the Decision to Undergo a Cosmetic Procedure. Plastic and Reconstructive Surgery. Global open, 7(8), e2333. https://doi.org/10.1097/GOX.0000000000002333

Bhat, D., Kollu, T., Ricci, J. A., & Patel, A. (2021). What's in a name? implicit bias affects patient perception of surgeon skill. Plastic and Reconstructive Surgery, 147(6), 948e-956e. https://doi.org/10.1097/PRS.0000000000008171

Bureau, United States Census (2023). QuickFacts https://www.census.gov/quickfacts/fact/table/US/PST045222

Center, Pew Research (2024). Americans’ social media use. https://www.pewresearch.org/internet/wp-content/uploads/sites/9/2024/01/PI_2024.01.31_Social-Media-use_report.pdf

Chen, J., Chow, A., Fadavi, D., Long, C., Sun, A. H., Cooney, C. M., & Broderick, K. P. (2021). The Zoom Boom: How Video Calling Impacts Attitudes Towards Aesthetic Surgery in the COVID-19 Era. Aesthetic Surgery Journal, 41(12), NP2086-NP2093. https://doi.org/10.1093/asj/sjab274

Colleges, Association of American Medical (2021). 2022 physician specialty data report https://www.aamc.org/data-reports/workforce/data/2022-physician-specialty-report-data-highlights

Economides, J. M., Fan, K. L., & Pittman, T. A. (2019). An analysis of plastic surgeons' social media use and perceptions. Aesthetic Surgery Journal, 39(7), 794-802. https://doi.org/10.1093/asj/sjy209

Furnham, A., & Levitas, J. (2012). Factors that motivate people to undergo cosmetic surgery. Canadian Journal of Plastic Surgery, 20(4), e47-50. http://dx.doi.org/10.4172/plastic-surgery.1000777

Gray, M. C., Gemmiti, A., Ata, A., Jun, B., Johnson, P. K., Ricci, J. A., & Patel, A. (2020). Can you trust what you watch? an assessment of the quality of information in aesthetic surgery videos on YouTube. Plastic and Reconstructive Surgery, 145(2), 329e-336e. https://doi.org/10.1097/PRS.0000000000006463

Hassan, A. M., Chappell, A. G., Ketheeswaran, S., Joshi, C., Boyd, R. M., Wan, R., Carabano, M., Koko, D., Perez, L. C., Ellis, M. F., & Galiano, R. D. (2021). Representation of African American patients in social media for breast reconstruction. Plastic and Reconstructive Surgery, 148(6), 1214-1220. https://doi.org/10.1097/PRS.0000000000008584

Heiman, A. J., Nair, L., Kanth, A., Baltodano, P., Patel, A., & Ricci, J. A. (2022). Defining regional variation in nasal anatomy to guide ethnic rhinoplasty: A systematic review. Journal Plastic, Reconstructive & Aesthetic Surgery: JPRAS, 75(8), 2784–2795. https://doi.org/10.1016/j.bjps.2022.04.058

Kaplan, V. (2021). Gender sensitive psychiatry and feminist therapy. Kıbrıs Türk Psikiyatri ve Psikoloji Dergisi, 3(3), 211-216. https://doi.org/10.35365/ctjpp.21.3.22

Khetpal, S., Lopez, J., Redett, R. J., & Steinbacher, D. M. (2021). Health Equity and Healthcare Disparities in Plastic Surgery: What We Can Do. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS, 74(12), 3251–3259. https://doi.org/10.1016/j.bjps.2021.05.026

Khosla, N. N., Grullon, K., & Rosenblatt, A. E. (2021). Prevention of racialized medicine in pediatric dermatology: A call to re-examine skin tone typing. Pediatric Dermatology, 38 Suppl 2, 167-169. https://doi.org/10.1111/pde.14739

Kim, J. H. J., Lu, Q., & Stanton, A. L. (2021). Overcoming constraints of the model minority stereotype to advance Asian American health. The American Psychologist, 76(4), 611-626. https://doi.org/10.1037/amp0000799

Kinney, J. R., Kim, E., Friedman, R., Bustos, V., Hassell, N., Elmer, N., Lee, B. T., & Lin, S. J. (2023). Which Groups of Plastic Surgery Patients are Impacted by Social Media Use: An In-Depth Review of Social Media Engagement. Plastic and Reconstructive Surgery, 153(4), 824e–837e. https://doi.org/10.1097/PRS.0000000000010641

Kwak, E. S. (2010). Asian cosmetic facial surgery. Facial Plastic Surgery, 26(2), 102-109. https://doi.org/10.1055/s-0030-1253497

Ligh, C. A., Lett, E., Broach, R. B., Enriquez, F. A., Jordan, A., Percec, I., Serletti, J. M., & Butler, P. D. (2020). The Impact of Race, Age, Gender, Income, and Level of Education on Motivations to Pursue Cosmetic Surgery and Surgeon Selection at an Academic Institution. Plastic and Reconstructive Surgery, 145(5), 932e–939e. https://doi.org/10.1097/PRS.0000000000006734

Lin, E., Schroeder, B. E., Tran, M. M., Brush, E. S., Tian, W. M., Stepien, D. M., & Patel, A. (2024). What are board-certified plastic surgeons posting on Instagram? Aesthetic Plastic Surgery, 48(19), 4051-4058. https://doi.org/10.1007/s00266-024-04144-5

Meta. (2021). Giving people more control on Instagram and Facebook. Meta. https://about.instagram.com/blog/announcements/giving-people-more-control

Moore, C., Coates, E., Watson, A., de Heer, R., McLeod, A., & Prudhomme, A. (2023). "It's important to work with people that look like me": black patients' preferences for patient-provider race concordance. Journal of Racial and Ethnic Health Disparities, 10(5), 2552–2564. https://doi.org/10.1007/s40615-022-01435-y

Morris, M. P., Christopher, A. N., Patel, V., Broach, R. B., Fischer, J. P., & Butler, P. D. (2021). Assessing disparities in reduction mammaplasty: there is room for improvement. Aesthetic Surgery Journal, 41(7), NP796–NP803. https://doi.org/10.1093/asj/sjab138

Moss, W. D., King, B. W., Memmott, S., Pires, G., Rosales, M., Kwok, A., & Tenzel, P. (2023). An evaluation of racial disparities in online marketing of academic plastic surgery practices. Annals of Plastic Surgery, 90(2), 114–117. https://doi.org/10.1097/SAP.0000000000003212

Obeid, F. M., Mortada, H., Alsulaiman, M., & Faisal AlSwaji, G. (2022). The use of social media and its influence on undergoing rhinoplasty. Plastic and Reconstructive Surgery-Global Open, 10(6), e4375, 1-7. https://doi.org/10.1097/GOX.0000000000004375

Padley, R. H., & Di Pace, B. (2022). The psychological impact of remote communication on body-image perception: cosmetic surgery on the rise. Aesthetic Plastic Surgery, 46(3), 1507-1509. https://doi.org/10.1007/s00266-021-02554-3

Payment for Instagram Ads. Meta. https://help.instagram.com/1060398584390711

Reels. (2024). Meta. https://help.instagram.com/270447560766967

Restrepo, D. J., Boczar, D., Huayllani, M. T., Sisti, A., Gabriel, E., McLaughlin, S. A., Bagaria, S., Spaulding, A. C., Rinker, B. D., & Forte, A. J. (2019). Influence of race, income, insurance, and education on the rate of breast reconstruction. Anticancer Research, 39(6), 2969-2973. https://doi.org/10.21873/anticanres.13428

Rhemtulla, I. A., Vonderhaar, R. J., Mauch, J. T., Broach, R. B., Familusi, O., & Butler, P. D. (2019). Improvement in racial disparity among patients undergoing panniculectomy after bariatric surgery. American Journal of Surgery, 218(1), 37–41. https://doi.org/10.1016/j.amjsurg.2019.01.002

Robinson, S. G., Mandel, A., Nicosia, J., Siegel, J., & Hamidian Jahromi, A. (2023). Racial disparity in gender affirming surgery: a comparative study on plastic surgeon social media use. Plastic and Reconstructive Surgery-Global Open, 11(5), e5009. https://doi.org/10.1097/GOX.0000000000005009

Shauly, O., Marxen, T., Goel, P., & Gould, D. J. (2023). The new era of marketing in plastic surgery: a systematic review and algorithm of social media and digital marketing. Aesthetic Surgery Journal Open Forum, 5, ojad024. https://doi.org/10.1093/asjof/ojad024

Shiah, E., Weidman, A. A., Valentine, L., Alvarez, A. H., Foppiani, J. A., & Lin, S. J. (2023). Capitalizing on social media: An evaluation of the public's preferences for plastic surgery social media content. Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS, 83, 308–317. https://doi.org/10.1016/j.bjps.2023.05.010

Silvestre, J., Abbatematteo, J. M., Serletti, J. M., & Chang, B. (2016). Racial and ethnic diversity is limited for plastic surgery clinical trials in the United States. Plastic And Reconstructive Surgery, 137(5), 910e–911e. https://doi.org/10.1097/PRS.0000000000002061

Sim, W., Lim, W. H., Ng, C. H., Chin, Y. H., Yaow, C. Y. L., Cheong, C. W. Z., Khoo, C. M., Samarasekera, D. D., Devi, M. K., & Chong, C. S. (2021). The perspectives of health professionals and patients on racism in healthcare: A qualitative systematic review. PLoS One, 16(8), e0255936. https://doi.org/10.1371/journal.pone.0255936

Smith, B. T., Egro, F. M., Murphy, C. P., Stavros, A. G., & Nguyen, V. T. (2020). An evaluation of race disparities in academic plastic surgery. Plastic and Reconstructive Surgery, 145(1), 268–277. https://doi.org/10.1097/PRS.0000000000006376

Society, The Aesthetic (2023). Aesthetic plastic surgery national databank statistics https://cdn.theaestheticsociety.org/media/statistics/2022-TheAestheticSocietyStatistics.pdf

Surgeons, American Society of Plastic (2021, April 27, 2021). 2020 Plastic surgery statistics report. https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf

Surgery, International Society of Aesthetic Plastic (2024, June 12, 2024). ISAPS international survey on aesthetic/cosmetic procedures performed in 2023 https://www.isaps.org/media/rxnfqibn/isaps-global-survey_2023.pdf

Swami, V., & Hendrikse, S. (2013). Attitudes to cosmetic surgery among ethnic minority groups in Britain: cultural mistrust, adherence to traditional cultural values, and ethnic identity salience as protective factors. International Journal of Psychology, 48(3), 300–307. https://doi.org/10.1080/00207594.2011.645480

Takeshita, J., Wang, S., Loren, A. W., Mitra, N., Shults, J., Shin, D. B., & Sawinski, D. L. (2020). Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Network Open, 3(11), e2024583-e2024583. https://doi.org/10.1001/jamanetworkopen.2020.24583

Tirrell, A. R., Bekeny, J. C., Baker, S. B., Song, D. H., & Fan, K. L. (2021). Patient Representation and Diversity in Plastic Surgery Social Media. Aesthetic Surgery Journal, 41(9), 1094–1101. https://doi.org/10.1093/asj/sjaa378

Tolson, H. C., Raikar, D. H., Morris, B. E., Ferguson, E. M. N., & Shahriary, E. (2023). Ethnic and Sex Diversity in Academic Plastic Surgery: A Cross-sectional Study. Plastic and Reconstructive Surgery-Global Open, 11(6), e4991. https://doi.org/10.1097/GOX.0000000000004991

Ullrich, P. J., Garg, S., Reddy, N., Hassan, A., Joshi, C., Perez, L., Tassinari, S., & Galiano, R. D. (2022). The racial representation of cosmetic surgery patients and physicians on social media. Aesthetic Surgery Journal, 42(8), 956–963. https://doi.org/10.1093/asj/sjac099

Ware, O. R., Dawson, J. E., Shinohara, M. M., & Taylor, S. C. (2020). Racial limitations of fitzpatrick skin type. Cutis, 105(2), 77-80. https://cdn-uat.mdedge.com/files/s3fs-public/Ware%20SOC%20CT105002077.PDF

Yom, S., & Lor, M. (2022). Advancing health disparities research: the need to include Asian American subgroup populations. Journal of Racial and Ethnic Health Disparities, 9(6), 2248–2282. https://doi.org/10.1007/s40615-021-01164-8