Fantasies and Fallacies of ‘Aesthetic’ Instagrammers

Abstract

The influence of Instagram, as a social media platform, in shaping perceptions of aesthetic surgery cannot be understated. The idea of a more “aesthetic” self cultivates a desire for cosmetic enhancements. This article underscores the profound impact of Instagram on aesthetic surgery, shedding light on both its fantasies and fallacies. Instagram, a medium for dissemination of content, often blurs the lines between fantasy and reality. Although the intent is to transfer credible information from the provider to the consumer, Instagram often contributes to the distortion of one's self-image and creates unrealistic expectations. Moreover, the glamorization of aesthetic surgery as a fast, effortless fix, often by commercially run enterprises, leads to misconceptions and impulsive decision-making. These fallacies are further compounded by the increase of misinformation and deceptive practices, presenting ethical challenges for influencers and surgeons alike. This study explores the ethical responsibilities of these “Aesthetic Instagrammers,” emphasizing the necessity for transparency and ethical guidelines, while analyzing all the social media stakeholders and providing suggestions for better engagement.

Keywords

aesthetic surgery - Instagram - influencers - beauty standards - digital awareness

Introduction

The unstoppable rise of Instagram as an influential social media platform has profoundly transformed the landscape of numerous industries, none more so than the field of aesthetic surgery.[1] The current era is characterized by the celebration of visual aesthetics and the pursuit of physical perfection. Instagram has emerged as a dominant player in shaping public perceptions of beauty, the desirability of cosmetic procedures, and the individuals who offer them. However, beneath the shimmering surface of filtered selfies and glamorous transformations lie the complexities of a rapidly evolving industry and the tensions between fantasy and reality, desire and ethical responsibility.

The fantasies and fallacies within the realm of aesthetic surgery on Instagram emerge as a central theme of this research. Fantasies materialize in the form of breathtaking transformations, the allure of beauty, and the promise of immediate results. Yet, these fantasies often obscure the fallacies—the misinformation, illusionary practices, and ethical issues that underscore the digital presence of the cosmetic surgery industry.

Interestingly, the fantasies and fallacies are not confined to the digital world alone but are reflected in the real world, guiding the decisions of countless individuals who seek cosmetic enhancements. The consequences, both positive and negative, of this dynamic are far-reaching. This necessitates an in-depth exploration of the psychological, emotional, and physical effects of Instagram's influence on aesthetic surgery.

This article embarks on a critical analysis of the deep and complicated relationship between Instagram and cosmetic surgery. The study illustrates the ethical dilemmas faced by surgeons and influencers, the risks and benefits of these digital discourses, and establishes that transparency, responsible practices, and patient education should guide the future of aesthetic surgery on Instagram.

Rise of Instagram

Instagram has evolved into a crucial platform for cosmetic surgeons, clinics, and influencers, surpassing traditional marketing channels by offering an extensive reach at local, national, and global levels.[2] Aesthetic surgeons share diverse and impactful content related to aesthetic surgery shared on Instagram including high-quality before-and-after photographs, Instagram stories, live sessions with patients, patient testimonials, live surgical broadcasts, and informative posts.[3] This array of content showcases surgeons' expertise and the transformative potential of aesthetic procedures, and gives patients a chance to discuss their concerns, driving engagement and excitement among the public.[4] The platform's interactive features, such as comments and direct messaging, enable a direct line of communication between patients and providers, enhancing a sense of community, trust, and personal connection that conventional advertising methods cannot achieve. This dynamic engagement allows for real-time feedback and interaction, fostering an environment where patients feel more connected and informed about the aesthetic services available to them, which was previously inaccessible through conventional advertising, substituting the traditional “word of mouth” with a contemporary alternative. Further, some aesthetic surgeons even use Instagram influencers to enhance their following.

Fantasies of Instagram

For Aesthetic Surgeons

Instagram serves as a vibrant platform for aesthetic surgeons to showcase their skills and the transformative impact of their work. By meticulously curating their feeds, surgeons can create compelling visual narratives highlighting their technical proficiency and the profound effects of aesthetic procedures on patients' lives. These stories evoke awe and admiration among viewers, fostering a sense of trust and connection. Transparent insights into the surgical process, addressing common concerns, and offering personalized guidance empower individuals to make informed decisions and demystify misconceptions about cosmetic procedures.[5] Social media seemingly also provides surgeons with a fast track to fame, money, and power, previously attainable only through years of building relationships and delivering consistent results. A recent Forbes article showed that a review from a trusted social media figure is the equivalent of a word-of-mouth relay.[6] The platform also allows patients to share their reviews and testimonials, contributing to the reputation and credibility of surgeons and clinics.

Through these rich and immersive resources, aesthetic surgeons harness the transformative power of Instagram to inspire, educate, and connect with their audience on a profound and deeply personal level. This is shaping the future of patient care and fostering a culture of empowerment.[7]

For Patients

Instagram can serve as a fantasy for patients by presenting a seemingly attainable ideal of beauty through curated, flawless images. This platform inspires users to envision their potential transformations, fostering a sense of hope and aspiration for achieving similar aesthetic results through cosmetic procedures. It gives patients a chance to be more well informed and empowered to act in their best interests. Surgeons can directly address questions and concerns, reduce stigma, revise attitudes toward procedures, and provide insights into their practices, enhancing trust and transparency. Peer engagement on the platform helps patients connect with others who have undergone similar procedures, offering emotional support and practical insights.

Fallacies of Instagram

For Surgeons

The platform's fallacies from an aesthetic surgeon's perspective include the pressures and ethical dilemmas associated with maintaining an Instagram presence. Surgeons may oversimplify procedures or highlight only their most successful outcomes, risking misrepresentation and undermining patient autonomy. Edited or filtered photographs can exaggerate results, and exaggerated claims about the benefits of certain procedures can raise false hopes ([Fig. 1]). Personal narratives and testimonials, while emotionally compelling, may not always reflect the full range of surgical experiences and outcomes. Collaborations with influencers can be far-reaching, but these often come with financial incentives, which can lead to information manipulation.

Fig. 1 “Visual effect”: impact of Instagram on aesthetic surgery.

The competitive environment may compromise ethical integrity, as surgeons might prioritize self-promotion over patient care, and the pressure to maintain a strong online presence can lead to neglecting core professional responsibilities ([Fig. 2]).[8] Additionally, plagiarism and unethical practices on social media are rising due to insufficient regulation. Misuse of Instagram by surgeons or influencers can harm individual patients and damage the profession's overall reputation.

Fig. 2 Image representing the rising trend of social media behavior being dictated by the number of likes and followers. (This image is provided courtesy of Kashyap, 2023, online.)

For Patients

Instagram often presents a world of idealized perfection, showcasing individuals with flawless features and bodies. These curated images can lead viewers to measure their self-worth against these standards, fostering a strong desire for perfection that aligns with the images seen on social media.[9] [10] However, these beauty standards are frequently edited, filtered, or digitally altered, creating an illusion of perfection that is rarely attainable in reality. Instagram can create the illusion that aesthetic procedures are quick, routine, and virtually painless, downplaying the risks and challenges involved. This immediate gratification fantasy bypasses the reality of postoperative healing and the gradual nature of achieving final results. The platform can instill a fear of missing out (FOMO) on beauty, pushing individuals to chase unattainable ideals and leading to feelings of inadequacy, insecurity, and envy.[11] Instagram's content can create unrealistic perceptions of what is achievable through surgery, fostering unattainable beauty ideals.[12] Repeated exposure to seemingly perfect images may erode self-esteem and trigger body dysmorphic disorder in susceptible individuals.[13] The platform's culture of comparison can lead to feelings of envy and inadequacy, and the instant gratification it promotes can encourage impulsive decisions without adequate research, resulting in dissatisfaction or regret. Additionally, sharing surgical journeys publicly can induce anxiety due to potential negative comments and judgments, highlighting the varied psychological impacts of Instagram on patients.

Finding the Right Balance

Role of Individual Surgeons

Individual surgeons play a crucial role in shaping the online discourse around aesthetic surgery ([Table 1]). By maintaining an ethical online presence,[14] they can build trust and credibility. They must share content in a way that empowers patients to make informed decisions. Safeguarding patient privacy and engaging professionally with followers further enhance trust.[15] [16]

Table 1 Role of surgeons to ensure ethical use of social media

Role of surgeons
1. Maintain an ethical online presence by accurately portraying work and avoiding exaggerated outcomes
2. Prioritize educational content and transparent information about risks and benefits
3. Safeguard patient privacy and engage professionally and respectfully with followers
4. Disclose potential conflicts of interest and adhere to ethical guidelines when promoting services
5. Surgeons and influencers should be transparent about their qualifications and affiliations
6. Clearly label edited or filtered photographs
7. Encourage second opinions and consultations with certified professionals
8. Share diverse experiences, including less successful outcomes
9. Promote content focusing on the full process of aesthetic procedures, including pre- and postoperative care and long-term outcomes
10. Approach collaborations ethically, providing valuable information rather than merely promoting services. Avoid financial incentives that could compromise honesty and transparency

Role of Patients

Patients must take an active role in their health care journey, particularly in the digital age where information is abundant but not always accurate ([Table 2]). Using their voice at the right place and time helps maintain standards and accountability within the industry. Making informed decisions involves thorough research and critical evaluation of the information available online. Patients should be wary of sensationalized claims and seek second opinions when necessary. Empowering themselves with knowledge and choosing the best-suited surgeon can lead to safer and more satisfactory outcomes.

Table 2 Role of patients to ensure ethical use of social media

Role of patients
1. Verify the treating doctor's qualifications and affiliations with professional organizations
2. Report malpractice to professional organizations
3. Find the best-suited surgeon and make informed decisions, based on rapport, budget, qualifications, and credibility

Role of Professional Organizations

Professional organizations have a responsibility to establish clear guidelines and codes of ethics for their members in upholding the profession's integrity ([Table 3]).[17] They should instill a culture of ethical behavior by well-planned educational initiatives,[18] and ensure adequate monitoring.[19] Such proactive measures will promote optimal patient safety and care, thus minimizing over-regulation or draconian measures being imposed by the government or courts of law.

Table 3 Role of professional organizations to ensure ethical use of social media

Role of professional organizations
1. Establish clear guidelines and codes of ethics for its member practitioners to follow. Consequences in cases of serious or repeated violations could include penalties or debarring from membership
2. Educate and promote best practices and transparency within the aesthetic surgery community
3. Develop standardized content creation guidelines for practitioners, especially for patient/surgical photographs and videos
4. Discourage sensationalism and the glorification of procedures
5. Monitor members' activities on social media for compliance with regulations
6. Educate the public on differentiating authentic from misleading information
7. Hold influencers accountable for misrepresentation and misinformation
8. Liaise with government bodies to report unregulated or unqualified providers. Such communication should be shared in the public domain to increase the credibility and responsibility of the professional bodies

Role of Law

In the digital age, the law should play a crucial role in dispelling fallacies of “aesthetic” Instagrammers by enforcing advertising regulations, ensuring transparency, and penalizing unethical practices ([Table 4]). It should mandate accurate representation of medical procedures, hold influencers accountable for misinformation, and protect consumers from deceptive marketing. A legal framework will help foster a more informed and truthful online environment.

Table 4 Role of law to ensure ethical use of social media

Role of law
1. Enforce and monitor advertising regulation compliance and professional conduct by all parties on digital platforms, ensuring honesty, transparency, and eliminating quackery
2. Impose penalties and sanctions for unethical practices or uncertified practitioners, protecting public interests. In cases of severe or repeated violations, temporary or permanent suspension of medical licensure
3. Develop user-friendly reporting mechanisms for misleading content related to aesthetic surgery
4. While the Medical Council of India (MCI) guidelines (2002) do not provide specific directives for social media usage, they outline overarching principles that apply to doctors' behavior offline and are implied online. It is imperative that taking into account the rapidly changing dynamics, the National Medical Commission (NMC; which has replaced MCI) should publish the redrafted code, which is in abeyance. This will bring more clarity on the ethics of online social media usage[21]

Note: The most important and complex task the lawmakers should address is the following. The law should create an even playing field for all aesthetic medicine and surgery providers—allopathy under NMC (ministry of health), other “pathies” (under ministry of Ayush) and salons providing medical services, e.g., injectables (under Ministry of Commerce) in terms of (1) patient/client safety standards, both setup and service provider training/qualifications; (2) advertising; (3) penalties for wrongdoing—quackery or complications.

Sample Case Report

A social media post showcasing a total facial transformation of an unfit gentleman in his 60s into a handsome man with chiseled, attractive features in his early 40s went viral globally.[20] This was credited to a Turkish aesthetic surgeon who claimed to have performed multiple major facial cosmetic surgeries on this patient. In a short while, this post was called out as a “fake” when it was proved that they were actually two different gentlemen.

Fantasies realized:

• Worldwide recognition for the surgeon.

• Turkey further highlighted on the aesthetic surgery map, and gained prominence/validation as a medical tourism destination.

• Innumerable inquiries generated, soliciting similar transformations.

Fallacies created:

• Unrealistic results are used to spread misinformation.

• The original post penetrated far more than the rebuttal fake call out. Thus, the surgeon was a net beneficiary.

• The post is promoting elevated beauty standards and creating a false illusion of easily attainable aesthetic improvements.

• This can lead individuals to make impulsive decisions about undergoing surgery.

• Many would book surgeries with similar doctors, expecting results that would not be delivered.

• Many people's trust is shaken in the specialty, some even questioning the outstanding results.

• The surgeon responsible would escape any retribution or punishment for the damages created. This would embolden more into such rogue/unethical acts.

Actions desirable:

• It is vital for professional organizations to monitor and curb such misuses to uphold the integrity of the profession.

• National bodies should have anti-quackery cells. These cells should be tasked to monitor social media to call out such acts as soon as possible and highlight the offenders. It should lead to legal action if any laws are broken or public exposure of the misdemeanors explaining why that act is endangering/compromising patient safety. Their role is important as often social media posts do not have geographic boundaries.

• The government should have ethics committees tasked to be social media watchdogs, as this is often a patient safety issue.

• It is crucial for individual surgeons to use Instagram responsibly.

• The ways in which Instagram could be misused by the aesthetic surgeons in depicted in [Table 5].

Table 5 Unethical practices of “Aesthetic” Instagrammers

Unethical behavior on social media
1. Misleading credentials and training information
2. Using filters
3. Morphing images
4. Poor-resolution pictures
5. Using different lighting to alter appearance of results
6. Differing views/angles in pre and post images
7. Pre in standing, post in lying down/intra-op/immediate post-op
8. Plagiarizing work of other doctors
9. Using stock images to depict pre- or post-op results
10. Not obtaining consent for pre-op, intra-op, and post-op image sharing
11. Not disclosing sponsored content
12. Paid promotions, without honest representation of work
13. Not sharing long-term follow-up results

Conclusion

Surgeons must balance promotion with honesty, patients must discern between aspiration and reality, and organizations and laws must evolve to ensure integrity and protect the public. As Instagram continues to shape perceptions of beauty and surgery, a delicate equilibrium between aspiration and authenticity must be sought to uphold ethical standards and empower informed choices.

Conflict of Interest

None declared.

Acknowledgment

The authors thank Dr. Atul Shah, Consultant Plastic Surgeon & Medicolegal expert, Vadodara, India.

Authors' Contributions

M.S. and A.D. contributed to data collection, data interpretation, and manuscript writing. S.S. contributed to the study design, data collection, data interpretation, and manuscript writing.

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Artikel online veröffentlicht:
23. September 2024