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Conceptualizing Professionalism in Social Media: A Framework for Evaluation

Hetzler, Peter T. III; Wang, Jessica M.D.; Fan, Kenneth L. M.D.; Song, David H. M.D., M.B.A.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1318e-1319e
doi: 10.1097/PRS.0000000000005675

Yale University School of Medicine, New Haven, Conn.

Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C.

Correspondence to Dr. Song, 3800 Reservoir Road, First Floor PHC, Washington, D.C. 20007,

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The treatise of ethical and professional conduct in plastic surgery social media requires unique consideration.1 The combination of self-imposed pressures to outdo similar content and the public’s hunger for “medutainment” creates a milieu whereby patient interests may be compromised.2 Several frameworks, including the American Society of Plastic Surgeons code of ethics, have addressed the ethical requirements of social media content.1,3,4 Professionalism, as Preminger et al.5 aptly pointed out, transcends rules prescribed by ethical guidelines. Its inclusion of the manner by which surgeons conduct themselves on the Internet is frequently overlooked. The evolving use of new forms of media via SnapChat, Instagram stories, or Facebook Live brings another dimension requiring evaluation.

We have identified four considerations when determining the professionalism of a social media post: context, intent, content, and presentation. Context, commonly overlooked, can represent an insidious lapse in professionalism. An innocuous post, such as one commenting on the end of the workweek, can become problematic when done while performing surgery, as it can trivialize the patient’s experience. Certain types of surgical procedures, such as aesthetic cases, will inherently receive more attention due to cultural predisposition. Careful scrutiny is warranted in these situations.

Intention refers to the purpose of the post. If the purpose is to promote one’s practice or educate the public, it likely has professional intention. Self-promotion should be carried out on a separate, personal account.

The next consideration is content—the subject matter of the post. After complying with ethical guidelines (i.e., compliance with the Health Insurance Portability and Accountability Act), the surgeon should ask, “Would this picture/video be accepted for publication by a medical journal?” The post should include a simple picture or video of the result or technique being presented. Any dialogue should include professional language accessible to the public to prevent use of insensitive, colloquial, or immature language. Sensationalism with gratuitous graphic images and playful indifference to surgical specimens need be avoided. If the physician is present, he or she should use the pose or demeanor one would use when taking a professional headshot or picture for a departmental or professional website.

The final consideration is the presentation of the post. Emojis and filters should not be used, as they are playful and can trivialize the trust patients have bestowed upon the surgeon. Hashtags and other commentary should be put in the description or comments section of the social media platform in the style of a journal figure legend or table title, and professional language should be used (#liposuction instead of #losethefat!; “Video of fat tissue removal during liposuction,” instead of “Look at all the fat sucked out during liposuction!”).

Ultimately, the public expects professional conduct from their plastic surgeons. In a public survey, we recently found that graphic surgical images and personal posts used with the intention of drawing more followers can in fact alienate certain demographics (Fan et al., unpublished data). Though we have offered a framework for maintaining professionalism, it is an interative process, as technology, especially #SocialMedia, outpaces codified ethical and professional guidelines. Thus, they should be examined regularly and frequently.

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Dr. Song is a prominent user of social media in plastic surgery. He also receives royalties from Elsevier for Plastic Surgery: Volume 4. Lower Extremity, Trunk, and Burns, third and fourth editions, and Biomet Microfixation for the SternaLock. None of the other authors has any financial interests to disclose. No funding was received for this article.

Peter T. Hetzler IIIYale University School of MedicineNew Haven, Conn.

Jessica Wang, M.D.Kenneth L. Fan, M.D.David H. Song, M.D., M.B.A.Department of Plastic SurgeryMedStar Georgetown University HospitalWashington, D.C.

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1. Bennett KG, Berlin NL, MacEachern MP, Buchman SR, Preminger BA, Vercler CJ. The ethical and professional use of social media in surgery: A systematic review of the literature. Plast Reconstr Surg. 2018;142:388e–398e.
2. Bennett KG, Vercler CJ. when is posting about patients on social media unethical “medutainment”? AMA J Ethics 2018;20:328–335.
3. Dorfman RG, Vaca EE, Fine NA, Schierle CF. The ethics of sharing plastic surgery videos on social media: Systematic literature review, ethical analysis, and proposed guidelines. Plast Reconstr Surg. 2017;140:825–836.
4. ASPS Ethics Committee. Code of Ethics of the American Society of Plastic Surgeons. Arlington Heights, Ill.: American Society of Plastic Surgeons. 2017. Available at: Accessed October 14, 2018.
5. Preminger BA, Hansen J, Reid CM, Gosman AA. The divergence of ethics and professionalism in the social media arena. Plast Reconstr Surg. 2018;141:1071–1072.
Copyright © 2019 by the American Society of Plastic Surgeons