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Social Media and the Plastic Surgery Patient

Sorice, Sarah C. M.D.; Li, Alexander Y. B.S., M.S.; Gilstrap, Jarom M.D.; Canales, Francisco L. M.D.; Furnas, Heather J. M.D.

Author Information
Plastic and Reconstructive Surgery: November 2017 - Volume 140 - Issue 5 - p 1047-1056
doi: 10.1097/PRS.0000000000003769
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Abstract

Nearly one-third of the world, including four-fifths of the U.S. population, uses social media.1,2 No longer limited to traditional media outlets, such as television, print media, or radio, half of plastic surgeons are using these digital networks to connect directly with the public.3–6 Plastic surgeons favor Facebook,7 an excellent choice, because 23 percent of the world’s population uses it at least once a month.8,9 With their heightened need to attract patients, aesthetic plastic surgeons and those in solo practice are the most likely in the specialty to be on social media.7,10–12 At a time when social networks are becoming indispensable tools for many medical organizations,13,14 plastic surgeons have an increasing interest in their use for medical education, thought leadership, disseminating and reading scientific articles, patient education, and building a private practice.3,5,11,13,15–24

Reports on social media’s impact on drawing patients to a plastic surgery practice vary. Most surgeons agree that social media enhances marketing efforts and can increase patient volume,7,8,16 with 33.8 percent of aesthetic plastic surgeons in one study reporting a positive practice impact and only 1.5 percent reporting a negative impact.7 However, plastic surgeons in another study credited social media with increasing practice volume by only 1 to 10 percent, despite 89 percent of those same plastic surgeons indicating that social media helped in “practice development.”12 Likewise, in a separate study, 70 percent of plastic surgeons surveyed attributed Facebook with referring less than 5 percent of their new patients,11 yet the majority of respondents felt that their Facebook presence had a positive impact on their practice. These conflicting reports may result from the absence of quantitative measures. Social media’s true impact on practice growth has remained elusive, as previous studies have focused on qualitative measures, such as perceived increased practice exposure and patient feedback.12 Even published tips on how to maximize social media marketing efforts are based on opinion, with patient-attracting claims unsupported by objective evidence of practice success.25

Social media articles based on quantifiable information focus on objectives different from practice building. For example, Twitter is described as an excellent platform for academic plastic surgeons and for those wishing to find and disseminate journal articles.20,23,26 However, attracting patients to a private practice is an objective with a distinctly different target audience. Although previous studies have investigated plastic surgeons’ perspectives through surveys or analyzed responses to a series of Twitter polls,7,10,11,23 none have looked at the social media practices and interests of patients themselves. Learning from patients what their own favorite networks and their preferred type of content are may help improve a plastic surgeon’s success in building a practice through social media.

The purpose of this study was to better understand how the plastic surgery patient interfaces with plastic surgeons online by looking at four factors: (1) the social media networks patients use most (and least); (2) a comparison of social media and the practice Web site on influencing patients; (3) the level of interest in different types of social media posts; and (4) the type of Web site content most important to patients. These factors can all potentially help plastic surgeons reach, engage, and attract patients to their practice.

PATIENTS AND METHODS

To investigate patient social media preferences, a cross-sectional study was conducted in a single aesthetic practice of two plastic surgeons. A cohort-tested patient survey addressing social media use and preferences was administered to 100 consecutive, unique, consenting new and established patients as they arrived for appointments between March 31 and May 2, 2016.

Patients were asked to indicate their activity level on the six popular social media networks used by the practice: Facebook, Instagram, Pinterest, Snapchat, Twitter, and YouTube. The practice’s choice to use these six platforms was based on their popularity according to published statistics on worldwide use. Activity level was divided into five categories: “I don’t use it,” “monthly or less,” “weekly,” “daily,” and “several times a day.”

To assess the level of the practice’s social media and Web site influence, the survey asked patients to indicate (1) whether they checked any of the practice’s six networks and/or the Web site before coming into the office and (2) whether any of the six networks or Web sites influenced the patients’ decision to choose the practice. To better understand the plastic surgery social media content patients wanted to see, patients were asked to indicate their level of interest in 13 types of posts on a four-level Likert scale (i.e., “very interested,” “interested,” “not interested,” or “a real turnoff”) (Table 1).

Table 1.
Table 1.:
Patients’ Level of Interest in 13 Types of Social Media Posts They Would Like to See on a Plastic Surgeon’s Social Media Feed*

To assess the relative importance of various elements of a plastic surgery practice Web site, patients were asked to choose, among five topics, the content category of greatest importance to them. As this was a nonclinical, nonexperimental, cross-sectional marketing survey study, institutional review board approval was not required.

Data are presented as frequency, percentage, and means with associated standard deviations. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Inc., Cary, N.C.).

RESULTS

Patient Characteristics

This survey, which was administered in the office, had a response rate of 100 percent. The average age of surveyed patients was 44.48 years (range, 17 to 78 years), and all but one was female. Two-thirds (68 percent) had children. The majority of patients were already established in the practice (81 percent), and the procedural interests they came in for included breast (20 percent), body (20 percent), face (59 percent), and genital (4 percent), with some having more than one interest (Table 2).

Table 2.
Table 2.:
Characteristics of the 100 Consecutive Patients Surveyed in the Two–Plastic Surgeon Aesthetic Practice

Social Media Use among Patients

Facebook had the greatest patient engagement, with 53 percent of participants using it once or more daily, followed by Instagram, with 30 percent using it once or more daily (Fig. 1). The oldest networks had the most users, with 76 percent of all patients using Facebook and 72 percent using YouTube. Unlike Facebook, however, YouTube did not attract high engagement, with only 6 percent of patients using it once or more daily.

Fig. 1.
Fig. 1.:
To assess their level of activity on the six popular social media networks used by the plastic surgery practice, patients were asked to indicate their level of activity by choosing one level of frequency, from “I don’t use it” to “several times a day.” The vertical axis indicates percentage of patients, and the horizontal axis indicates the six popular social media networks used by the practice.

Although only 11 percent of patients used Pinterest once or more daily, 56 percent of all patients used it on a weekly or monthly basis. Only 26 percent of patients used Snapchat, but users were highly engaged, with 54 percent of patient users checking the network once or more daily. The least popular network, with the fewest followers and the least engagement, was Twitter, with only 13 percent of patients using it at all, and no one using it more than once a day.

Influence of Social Media and Practice Web Site: A Comparison

In comparison with the practice’s social media networks, the practice Web site remained the most popular and influential source of information for patients. Over half of patients (54 percent) reported being influenced by the Web site when choosing the practice (Fig. 2), whereas only 8 percent were influenced by the practice’s Facebook page, 6 percent were influenced by Instagram, and 9 percent were influenced by YouTube, and the other networks had no influence at all. On the day they took the survey, an even greater majority of patients (62 percent) checked the practice Web site, whereas only 20 percent checked the practice’s Facebook page, 5 percent checked Instagram, 1 percent checked Pinterest, and no one checked the other networks.

Fig. 2.
Fig. 2.:
Patients were asked to choose all online platforms that influenced their decision to choose the practice (blue) and the ones they checked before their appointment (red). The vertical axis indicates percentage of patients, and the horizontal axis indicates online platforms.

Patients’ Preferred Content on a Practice’s Social Media Feed

The top three most popular types of posts generated interest among four-fifths of patients (Table 1):

  • Contests to win a free treatment or product (31 percent very interested; 49 percent interested).
  • Before-and-after photographs (24 percent very interested; 56 percent interested).
  • Information about the practice (13 percent very interested; 68 percent interested).

Approximately three-fourths of patients (70 to 77 percent) expressed interest in six types of posts:

  • Announcements of office events (26 percent very interested; 51 percent interested).
  • Special offers available only through social media (26 percent very interested; 46 percent interested).
  • Real patient testimonials (21 percent very interested; 53 percent interested).
  • Short videos of actual treatments (19 percent very interested; 53 percent interested).
  • Doctor’s own educational videos (15 percent very interested; 57 percent interested).
  • Doctor’s own blog posts (11 percent very interested; 59 percent interested).

Slightly more than half (57 to 59 percent) of patients expressed an interest in casual photographs and freely accessible article links:

  • Casual photographs of the doctor and staff (7 percent very interested; 52 percent interested).
  • Lay articles about plastic surgery (10 percent very interested; 47 percent interested).
  • Scientific articles with free access (9 percent very interested; 48 percent interested).

Four-fifths of respondents expressed a negative sentiment toward only one type of post:

  • Links to scientific articles accessible for a fee, as for scientific journal nonsubscribers (69 percent not interested; 10 percent checked “a real turn-off”).

Practice Web Site Content Most Important to Patients

When asked to select the one type of Web site content they most wanted to see, half of patients chose before-and-after photographs of procedures performed in the practice (Fig. 3). The second most popular choice (28 percent) was information about the procedures. Few patients chose the remaining options, with 10 percent choosing videos about procedures, 6 percent choosing real patient testimonials, and 4 percent choosing information about the practice.

Fig. 3.
Fig. 3.:
Given five choices of plastic surgery practice Web site content, patients were asked to choose the single most important one to them.

DISCUSSION

Social media networks' ubiquity makes them a powerful tool for reaching patients.1,18,23 Because the ever-evolving networks have different cultures, rules, characteristics, and audiences, a basic understanding of the most popular networks can aid in building a target audience on social media.

Following is a brief description of the networks discussed in this article. Data presented are the most current available at the time of this writing. The term user refers to an individual who has an account with a specific network. A network refers to a social media application or platform, such as Facebook or Twitter. The term engagement refers to users’ activity on a given platform by means of “likes,” comments, shares, and replies.

  • Facebook, founded in 2004,27 is the most widely used network, with 1.86 billion monthly users (nearly one-fourth of the global population) (Fig. 4),9,27–43 including 1.23 billion of whom log on at least once a day.9,27–29
  • YouTube, the video-sharing network founded in 2005, has 1.3 billion users, including 260 million in the United States.30
  • Instagram, the photograph-sharing network founded in 2010, has 600 million monthly users, including120 million in the United States.31–35
  • Twitter, a micro-blogging network founded in 2006,36 has 313 million global and 67 million U.S. monthly followers.37–39
  • Pinterest, a photograph-sharing network centered around posts of collections, founded in 2010, has 150 million users. In the United States, Pinterest has 70 million followers and is now larger than Twitter, with 66 million monthly U.S. followers.34,37,40
  • Snapchat, a photograph- and video-sharing network with fleeting posts, founded in 2011, has 150 million daily users, 15 million more than Twitter.41–43
Fig. 4.
Fig. 4.:
The number of worldwide users of the six social media networks featured in this article is indicated in millions.

Social Media Gender Demographics

As social media use has surged over the past decade, demographic differences among networks have emerged (Fig. 5).9,27–43 Although Twitter users are evenly split between sexes among 15- to 17-year-old users,44 the ratio shifts to male dominance among adult users, with 25 percent of male subjects on the Internet using the network, compared with 21 percent of online female users. Parents show an even greater disparity, with just 19 percent of online mothers using Twitter, compared with 27 percent of online fathers.44 YouTube users are also predominantly male (62 percent),30 a following that contrasts with the female-dominated networks, including Instagram, Pinterest, Facebook, and Snapchat.9,27,29,33,37,40,42,45–48 Instagram captures 31 percent of female and 24 percent of male Internet users.32,33,46 Pinterest is even more female user–dominated (70 percent).37,40 Similarly, 77 percent of female Internet users use Facebook, compared with 66 percent of male users.46 Snapchat does not share its gender statistics,47 but in 2013, Evan Spiegel, the company’s chief executive officer, estimated that 70 percent of its users were female.48

Fig. 5.
Fig. 5.:
The demographics of the six social media networks featured in this article are summarized for comparison.

Social Media Age Demographics

Initially developed for college students, Facebook has evolved into an older demographic, with only 15 percent of users between the ages of 18 and 24 years41 (Fig. 5). Younger users flock to Snapchat, with 64 percent of users falling in the 18- to 24-year age range and 41 percent of all Americans aged 18 to 34 years viewing the network at least once daily.41,42 Instagram, too, has a young following, with 90 percent of users younger than 35 years.33 Twitter’s largest demographic group is 15- to 17-year-olds, with 42 percent of Internet users among that age group on the network.44 Its use falls to 32 percent among adults aged 18 to 50 years, and then it drops off among older adults.38,44

The Patient Perspective

This demographic variability indicates that patients may favor one network over another, according to their sex or age. Knowledge of these differences may help plastic surgeons choose the best social media network to engage their target audience. The idea that the patient perspective can play an important role has been seen in patient-reported outcome measures, such as the BREAST-Q, in which the patient’s view of a surgical result has become increasingly important in determining plastic surgery outcomes, which sometimes differ from plastic surgeons’ perceptions.49,50

Similarly, although the plastic surgeon may favor a specific social media network and mount a campaign to build a practice, that network may not be a favorite of most plastic surgery patients. Twitter, for example, has been shown to be an efficacious tool for academic plastic surgeons20,21,23; however, according to this study, it was the least popular network among the patients surveyed, with 87 percent not using it at all. The study’s findings are in line with Twitter’s male-dominated demographic profile and its lack of popularity among mothers, a group that comprises a large portion of many plastic surgeons’ target audience, including two-thirds of the patients surveyed in this study.

Further reflecting global demographic trends (Fig. 4),29 Instagram was popular, with 30 percent of this study’s respondents using it once or more a day, but less so than Facebook, at 53 percent. Given the average age of this study’s patients (44.48 years), it is not surprising that no more than 26 percent are on Snapchat. Nonetheless, its growing popularity41 is reflected in its high level of engagement, with 53.8 percent of users in this study checking it once or more daily, second only to Facebook’s 69 percent.

Distinguishing differential use patterns among subdemographic groups, sorted by age, sex, or race, is beyond the scope of this study, but the parallels between this study’s results and the reported demographics indicate that the plastic surgeon can nonetheless identify global trends and use them to create a targeted social media presence.

Many of the collective plastic surgery social media efforts are aimed at education,5,13,16–18,20,21,26 but in this study, articles about plastic surgery were the least favorite type of post among patients surveyed. If we consider that the average plastic surgery patient is a layperson unaccustomed to reading articles with the density and volume of information second nature to the medical professional, it is easy to understand why they might prefer the more easily digestible before-and-after photographs and information about the practice, along with the light-hearted excitement of contests for free products or treatments.22,45 The strong negative reaction to posts featuring a link to a scientific journal article accessible for a fee may indicate the frustration such posts might engender when a patient clicks on a link that fails to reveal the article. This finding may inspire plastic surgeons to write blog posts for the lay public about the restricted articles they author. These findings reflect the findings of Wu et al. that photographs and testimonials are the most important factors patients look for in choosing a plastic surgeon.51

When choosing a practice, respondents were significantly more influenced by the practice Web site (53 percent) than by any social media network (9 percent or less). On the day they took the survey, even more patients checked the Web site (63 percent of participants), whereas only 20 percent or less of respondents checked any social media network. The fleeting nature of social media may limit their importance compared with the relative permanence and depth of information offered by a Web site. A search of archived posts on a social media network can be laborious, whereas a Web site allows ready access to in-depth content, an array of photographs, a library of videos, patient testimonials, blogs, articles, and links to other practice social media networks.22 These results suggest that the Web site should be considered the centerpiece of a practice’s online content, and social media should be viewed as an adjunct to attract and engage users, enticing them to explore the practice Web site.

Limitations

The limitations of this study include its small size and the restriction of study participants to patients of a single two-surgeon practice in a suburban setting. Race, income, occupation, and education were not identified; thus, a comparison among groups could not be performed. Results of a similar survey might vary in a setting with different demographics, geographic locations, and clinical interests. Established patients’ responses regarding what online venue influenced their decision to choose the practice may have been affected by recall bias. The quality and frequency of posts on a specific platform might also alter the results. Although the practice uses Snapchat, for example, it posts infrequently compared with other plastic surgeons whose Snapchat presence plays a nearly universal role in referring patients to the practice.45 In addition, given the fluid nature of social media, these findings should be regarded as a snapshot in time. A comparison of Web site and social media platform content, including text, links to articles, practice videos, blogs, and photographs is beyond the scope of this study, as is a comparison among different procedure-of-interest or demographic groups. To evaluate the impact on patients of demographic differences and varying Web sites and social media platforms would require a larger, multicenter study. An outcomes study investigating the association between patients’ social media use and their likelihood to schedule surgery, along with an analysis of the return on investment of specific platforms, would help define the relative benefits of social media for the plastic surgeon and will be the focus of a future study.

This small study is a first step in understanding patients’ social media habits and what they hope to find on a plastic surgeon’s social media feed. Rather than providing definitive, globally applicable results, this study may serve both as a model for other plastic surgeons to survey their own patients and as a foundation for more comprehensive investigations. Just as patient-reported outcome measures studies start by gathering data from small studies,49,50 this study may serve as a stepping stone to larger studies evaluating plastic surgery patients’ social media use habits and their preferred content so that plastic surgeons can improve their online communication success to attract new patients and to maintain the interest of established ones.

CONCLUSIONS

Content that engages plastic surgeons is different from content that engages patients. By understanding the patient perspective on social media, plastic surgeons can craft an online presence that more effectively captures the attention of their target audience.

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Copyright © 2017 by the American Society of Plastic Surgeons