Plastic Surgeons Urged to Quit Posting Procedures to Instagram

It's not uncommon for doctors to tape their surgeries and share the footage for educational purposes. But there's a disturbing, growing trend of plastic surgeons promoting silly, circus-like environments during procedures and posting the videos to social platforms like Snapchat and Instagram. Thankfully, we might be one step closer to stopping that from happening: In a paper published today in Plastic and Reconstructive Surgery, Northwestern Medicine authors propose a new code of ethical behavior for posting footage while patients are under the knife.

Surgeons are increasingly using social media for entertainment purposes, compiling surgical footage, adding captions and emojis, and overlaying images and videos with Snapchat filters. This trend began a few years ago with Michael Salzhauer, aka Dr. Miami, a Florida-based plastic surgeon who started posting provocative videos to his social accounts. In one video, 2Chainz is in the operating room while Salzhauer performs a Brazilian butt lift. He looks at the camera and says, "Makin' that booty!" 2Chainz responds, "That sh*t gon' make me f*ckin' throw up."

"Online media seems to be an amplifier for the best and worst of human nature," says Clark Schierle, a board-certified plastic surgeon and the paper's lead author. "In plastic surgery, we're really no exception."

Several copycats have emerged over the years, posting footage ranging from disturbing to potentially disrespectful. One post shows footage from a liposuction surgery followed by an image of the extracted fat in a clear cylinder with the caption Making our own jamba juice. Another video shows two surgeons dancing to trap music while the unconscious patient lies on the operating table, her (new) naked butt exposed. To make matters worse, only 18 percent of plastic surgery-related content on Instagram is posted by board-certified surgeons, according to another of Schierle's reports.

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"We're in an era where social media does provide incredible transparency and horizontal information transmission," he says. "There are lots of good side effects to that, but then there are also some bad things too, where you have this focus on viral content and memes and such." That utter transparency led Schierle and his colleagues at Northwestern University to propose more specific guidelines for surgeon's social media presence.

The American Society of Plastic Surgery, the largest group of board-certified plastic surgeons in the country, has its own ethical committee and a code of ethics that ASPS surgeons agree to conduct themselves by. "We have a very clear code of ethics placing patient safety and privacy as a top priority," says David Song, the immediate past president of ASPS. The current code of ethics states that surgeons may be subject to disciplinary action if they engage in any communication containing a "false, fraudulent, deceptive, or misleading statement or claim." Physicians may not "reveal a patient's confidence" or "any observed characteristics of the patient," and they should strive to "render services to humanity with full respect for human dignity."

The current code is vague enough that surgeons can argue that their social media content meets the ethical guidelines. It doesn't specifically address absurd behaviors like playing with people's extracted tissue, poking fun at their fat, or booty-poppin' while a patient lies open on the operating table. Let's take the "jamba juice" example: "It's not really clear to me that our code of ethics would even prohibit that," Schierle says. The doctor could argue that the team didn't compromise patient care, they didn't identify the patient, and the caption was added by a staff member who was expressing their right to free speech. There's simply too much gray area.

Schierle's paper, which will be presented at the ASPS annual meeting next week, marks the first effort to stop this behavior by outlining more specific guidelines for what does and does not constitute "ethical" behavior regarding social media. He points out two of the paper's main messages: First, the physician's primary focus should always be on the patient. "If you have a patient that you're operating on, it's probably not really appropriate to be singing, dancing, or mutilating or juggling their body parts while they're unconscious," he says. Second, the physician should always have the patient's best interest in mind, "today and for the future." Twenty-one-year-old Brittany might think it's awesome to have her Brazilian butt lift broadcast to the world, but ten years later when Brittany's looking for a new job, she might not be happy that content is out there.

"It is incumbent on the surgeons in my opinion to make sure that patients and prospective patients are fully aware of the lasting impressions these types of shared videos can have in the world of social media," Song adds.

The focus in the operating room should be patient safety, patient comfort, and patient care—not Instagram fame and Snapchat views. "You want to conduct yourself in a way that keeps the privacy of the physician-patient relationships in mind and respects the decorum and the sanctity of that relationship," Schierle says. "That should always be a guiding principle, regardless of the medium."

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