The recent media coverage of the serious patient safety and regulatory issues associated with the cosmetic surgery industry has been long overdue. The exposure of truly appalling practises within the cosmetic surgery industry should be an eye-opener for any prospective patient. The utter disregard for patient safety or high quality practice within the clinics of various individuals is both symptom and cause. It is symptomatic of the total failure of regulation by AHPRA and the various medical boards, and it is quite obviously the cause of a great deal of patient harm.
As a revision surgeon, whose practice is focused on the correction of the many issues association with breast implants, I think I have a degree of insight into what passes for "cosmetic surgery", but I have to say that the footage and other material shown by '60 minutes' has shocked even me.
I have a long-standing position that I believe social media use by surgeons must be subjected to greater oversight to ensure ethical behaviour is observed. I also have a long-standing opinion that the professional societies and regulators including AHPRA have failed entirely in fulfilling this role.
Anyway, watching this most recent story unfold has been interesting (albeit, a bit of a train-wreck). I genuinely wonder where we will end up.
All of this has certainly prompted me to spend a bit of time thinking about the concerns I have with the field I practice in, and my own role in ensuring that I play no part in perpetuating a corrupted, broken industry.
The thing that has bothered me most over the last few years has been the conversion of certain cosmetic doctors and surgeons from clinicians to "influencers". We can't blame social media for the current issues in the industry, but we can certainly consider the role social media has had in providing some of the more dangerous individuals with a platform for their self-aggrandisement.
The consistent characteristic of these "influencer-surgeons" is the shameless “selling” of their personal brand. Now, hang on a sec, you say, every surgeon with an Instagram account is selling their personal brand, right? Well, yes that is true to an extent. When social media in medicine is used well (by which I mean, ethically), it is designed to educate, but it would also be ridiculous for me to suggest that Instagram is anything other than a form of advertising at the end of the day.
I would however argue that Instagram (or any other platform) can be used to help patients understand my approach to surgery, and the rationale for why I do certain things, with standardised before and after images as a means of justification for that approach. I am not trying to sell an image.
What we see with the influencer-surgeons is the promotion of the individual over the operation. It is an appeal to a sort of cult of personality, rather than a patient-first approach to achieving the best outcomes. It is the knowing departure from the ideals and ethics of medicine in the quest for personal advancement, whilst creating a pastiche of what it means to be a surgeon.
In other words, it is medical practitioners stooping to the level of ‘influencer’, with every negative thing that connotes.
I have commented before on aspects of social media use by cosmetic surgeons in particular, and the worrying quality of what we see. There have been numerous claims over the last few years by professional societies that there will be a “crackdown” on unethical behaviour, and always the promise to institute some kind of boundaries on how social media is used. This has predictably come to naught.
And why would anyone be surprised. As was widely reported a few years ago, a past president of the Australian Society of Aesthetic Plastic Surgeons (a society I am no longer be a member of) was quoted in national papers as saying, immediately after a presentation on the negative impacts of social media on body image: “a (social media) post that is 100% ethical may be 100% ignored”.