The circus atmosphere of plastic surgeons donning costumes, dancing and juggling breast implants during live surgery videos on social media may soon change.
A first code of ethical behavior for sharing videos of plastic surgery on social media was recently published in the Plastic and Reconstructive Surgery Journal as the foundation for ethical guidelines.
"This the first step in taking the circus tent down and developing ethical rules for making and sharing plastic surgery videos," said senior author Clark Schierle, of Northwestern University Feinberg School of Medicine. "There is increasingly vulgar content by a growing number of plastic surgeons that is not in the best interest of the patient."
Some plastic surgeons have gained large followings on Snapchat and Instagram by broadcasting live surgery videos that include theatrics such as dressing in costumes and dancing and flaunting removed body tissue such as abdominoplasty specimens. One entreated viewers to come for free booze and a DJ at a marketing event, while he was performing live plastic surgery.
A Miami-based, board-certified plastic surgeon was the first to post theatrical videos several years ago. Now copycat plastic surgeons in major metropolitan areas "are jumping on this bandwagon, trying to replicate his success," Schierle said. "The crazier, more obscene and edgy the better as far as grabbing attention on social media."
In one post, Schierle saw a plastic surgeon cradling an abdominal tummy tuck specimen in his arms like a baby and then used a Snapchat filter to put an "infant's" face on it. "This is inappropriate handling of human tissue for entertainment purposes," Schierle said.
“As board-certified plastic surgeons, I think we should have higher moral standards than a 13-year-old sexting with her boyfriend,” he told LifeHacker.
Finding the line between appropriate and inappropriate behavior isn't easy, Schierle said. "It's like pornography. I know it when I see it, but how do I define it?"
Many plastic surgeons question the ethics of broadcasts done more for the purposes of entertainment and marketing than education, the authors said, and have called for the development of more structured oversight and guidance in this area.
The surgeons are not filming the videos for educational purposes. "It's about notoriety," Schierle said. "It's about showing the most outrageous content to attract more viewers and build your business."
Even when surgeons obtain consent to post videos on social media, Schierle and Dorfman question the validity of the consent.
"The relationship between a doctor and patient still remains somewhat hierarchical," Schierle said. "The patient may feel coerced -- even if subconsciously -- to participate in being filmed in order to be a 'good patient.' There is an inherent power disparity."
Some patients may request to have their video shared on social media -- particularly those who sought out the surgeon based on his or her social media presence -- as a way to experience their own brief moment of fame, Dorfman said.
But patients risk their images being copied, manipulated and redistributed, as well as possible revelation of their identity. They may not realize that a video on Snapchat, which disappears in 24 hours, may be screenshot and posted on YouTube or any other website where it can live indefinitely, Dorfman said.
He calls for greater transparency about the risks involved including the permanency associated with posting videos on social media and the Internet.
There also is the risk to the patient of having a distracted surgeon. "Instead of focusing on providing the most efficient surgical procedure to help the patient, the surgeon is distracted by hamming it up for the camera," Schierle said.
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