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Time for a Consensus? Considerations of Ethical Social Media Use by Pediatric Plastic Surgeons

Hetzler, Peter T. III, M.D., M.H.S.; Makar, Katelyn G. M.D., M.S.; Baker, Stephen B. M.D., D.D.S.; Fan, Kenneth L. M.D.; Vercler, Christian J. M.D., M.A.

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Plastic and Reconstructive Surgery: December 2020 - Volume 146 - Issue 6 - p 841e-842e
doi: 10.1097/PRS.0000000000007389
  • Free

Social media in plastic surgery have become mainstays of clinical and academic practice. However, their expansion within the clinical sphere, although often positive, has generated concerns sufficient to merit the development of guidelines that promote ethical and professional use.1 The American Society of Plastic Surgeons Code of Ethics now applies to electronic media, with clauses for social media. However, these discussions have largely eschewed addressing social media use in the pediatric population, likely because of the added complexity of ethics in pediatrics. Nevertheless, this complexity should not deter the craniofacial surgeon from social media use, given the potential for developing novel educational tools, improvement in outreach and support for patients and families, and better communication.2 Thus, we aim to highlight and address some of these ethical considerations.

Arguably, the two most critical elements of ethical social media use are maintaining privacy and obtaining consent—both of which are muddied in the pediatric population. Because these images are of patients with craniofacial differences, it is unavoidable to share images containing identifying information.3 The consent process is complex because an adult provides permission for the use of the images of the patient. However, providers must understand the distinction between consent and assent. Consent is the legal agreement of a participant who is aged 18 years or older, whereas assent is the agreement of a participant who is not legally eligible to give consent. Thus, it remains imperative to obtain both consent from the caregiver and assent from the patient when considering social media use. The latter point is critical, as the American Academy of Pediatrics supports gradual introduction of assent into the decision-making process for interventional procedures.4 Given the timing of many procedures, some infants and toddlers will not have the capacity to assent. It falls to the surgeon to assess whether the benefits of social media outweigh the risks for the patient should a caregiver consent.

This underscores the importance of surgeons remaining circumspect when opting to post identifiable pediatric material on social media, as consent is necessary, but not sufficient. They must ensure that their interests are weighed against the patient’s by recognizing and evaluating the intention of the post. This attention to competing interests is especially important given the vulnerability of the pediatric patient population. Is the post strictly for personal gratification or aggrandizement with no benefits to the patient or patient population? Or, is the post an accurate reflection of postoperative results that help inform expectations of patients and families? Drawing the line between ethical and unethical posts involves consideration of both motives and context. These assessments are difficult, as they are nuanced and can seem subjective.

Social media use in the pediatric craniofacial population can be harnessed to benefit both medical and patient communities, if curated in an ethical manner. Pediatricians are calling for their own society to implement guidelines for appropriate use of social media.5 As craniofacial surgeons, we should therefore follow suit to ensure the safety and dignity of our patients while continuing to innovate and improve our specialty by means of evolving social media platforms.


The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.


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; 143:388e–398e
2. Fan KL, Graziano F, Economides JM, Black CK, Song DH. The public’s preferences on plastic surgery social media engagement and professionalism: Demystifying the impact of demographics. Plast Reconstr Surg. 2019; 143:619–630
3. Bennett KG, Bonawitz SC, Vercler CJ. Guidelines for the ethical publication of facial photographs and review of the literature. Cleft Palate Craniofac J. 2019; 56:7–14
4. Committee on Bioethics. Informed consent in decision-making in pediatric practice. Pediatrics. 2016; 138:e20161484
5. Lonzer J, Lonzer D, Medina M, Piedimonte G. Social media in pediatrics: A call for guidelines. J Pediatr. 2015; 166:511–512


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