Episode 36: Sunday March 14

Drs. Sam Jejurikar @samjejurikar, Salvatore Pacella @sandiegoplasticsurgeon, and Sam Rhee @bergencosmetic tackle a growing influence in plastic surgery - social media and apps such as Instagram, Snapchat and Tiktok. Whether it is marketing a plastic surgery practice, educating potential patients, or simply entertaining viewers, what are the benefits and potential issues associated with the growth of social media within plastic surgery?

Full Transcript (download PDF here)
2021.03.127 S02E07 SOCIAL MEDIA Show 37 TRANSCRIPT
Dr. Sam Jejurikar: [00:00:00] Welcome everyone to the latest edition of three plastic surgeons and a microphone. I am Dr. Sam Jejurikar in Dallas, Texas Instagram handle @samjejurikar  as always. I'm joined by my illustrious colleagues. Dr. Sam Rhee on our far right from Paramus New Jersey. His Instagram handle is @bergencosmetic and uh, Dr. Salvador Pacella extraordinary plastic surgeon from San Diego. His Instagram handle is at San Diego plastic surgeon. And before we get into the meat of today's topic, which is going to be social media and its influence on plastic surgery, I just want to read our generalized disclaimer. This show is not a substitute for professional medical advice, diagnosis, or treatment.
The show is only for informational purposes, treatment and results may vary based upon the circumstances, situation and medical judgment after appropriate discussion, always seek the advice of your surgeon or other qualified health provider. With any questions you may have regarding medical care and never disregard professional medical advice, or delay seeking advice because of something we may have said on this show, and with that, I'm going to turn it over to Dr. Rhee who's gonna lead our discussion today about social media. 
Dr. Sam Rhee: [00:01:07] How are you gentlemen? Very good. Thank you. Excellent. All right. This is really funny because social media in plastic surgery has changed so quickly over the past several years.
I just want to wrap first start by saying it's almost a given, obviously that if you're in plastic surgery, you're going to be engaged in social media, but even as short as 10 years ago, this is a 2011 article by Out of the aesthetic surgery journal by Rourke and Mathis. They basically surveyed plastic surgeons and only 28% in those of those surveyed those plastic surgeons were using social media and 28% is insanely low.
Now I would imagine that if you actually looked at plastic surgeons now, Nearly everybody is using social media in their practice. It's crazy how much social media has influenced plastic surgery because it's influenced our lives, obviously nearly a hundred percent of millennials are using some sort of apps such as.
Facebook is almost antiquated now, but Instagram or Twitter or a tick talk to get their information. And you can see that in the articles that I took a quick look at social media and the plastic surgery patient. You can see how we're basically following our patients. If our patients are going to be on social media, we're going to have to be on social media.
To advertise. So let me just start by asking both of you, what do you do in terms of your social media engagement for your practice? 
Dr. Sam Jejurikar: [00:02:46] You want to take that first out? 
Dr. Salvatore Pacella: [00:02:47] Sure, sure. I feel like social media can be a crutch sometimes. I don't have a brisk marketing.
Division or a marketing program or a third party marketing venue. So unfortunately I have to do most of the social media by myself and I'm in a somewhat of a partial academic type of program. I'm part of a big multi-specialty group. And my philosophy of social media is that I do want to maintain my brand or develop my brand, but I don't want to take away from the larger brand that I'm affiliated with such as scripts or scripts, MD Anderson. But and I feel this, I look at this like a co-branding. Okay. So if I'm dancing around on social media with my shirt off, that may be great for you to guys to see, but it's not some, it's not an image that I want to project as a professional, as a surgeon necessarily.
Okay. And I'm not discounting those that do that sort of stuff. It's just, I'm not in that kind of world. So my. I really have my social media that I usually do is really strictly, almost strictly a before and afters with patients educational, maybe a little bit of human interest here and there, I may show pictures of my dogs, or my kids or whatever.
So that's about the extent of it. 
Dr. Sam Rhee: [00:04:10] I think I have seen you topless on your social media when you go surfing though. 
Dr. Salvatore Pacella: [00:04:14] That's actually not true at all. I usually wear a wetsuit. Oh. 
Dr. Sam Jejurikar: [00:04:19] And and I'm I'm fairly used to seeing you pantless and your social media as well, but that's just in your DMS to me. Dovetailing on what you just said. It's tough where social media is concerned because social media At the end of the day is entertainment. If you look at what we do, what our kids do, you get up in the morning, during various times when we have downtime, we go to our phones, we go on a social media and we look to be entertained yet.
Yet in our mind, we've always viewed entertainment and professionalism to sometimes be at odds with one another. And we all have our relative our relative. Lines that we're going to draw in the sand about where we're going to draw the line and what's professional and what is entertaining.
And I think all of us tend to err on the side of being what we consider to be professional, what doctors are traditionally meant to do, handle themselves in a way that, that looks like a respectful authority figure. But obviously there are people out there that don't do that. I do engage in a pretty robust social media presence.
I find it to be an important way to communicate with potential patients as well as current patients. I find it to be Incredibly helpful for educational purposes. I do show some interoperative footage, not a lot, and I'm definitely not commenting on people are trying to body shame people.
I'm trying to teach people about how procedures might be performed. I show a lot of before and after pictures, because I think it's important for people to understand what's possible with plastic surgery. And so I do think social media is an important part of of our profession. It's an important way to meet new patients and educate people.
But we all have to decide for ourselves at the end of the day, what we consider to be professional and what we consider to be, the way we want to conduct ourselves, the way we want to project ourselves to the world. 
Dr. Sam Rhee: [00:05:54] It's interesting what you said, Sal about co-branding and the institutions that you're affiliated with.
And I have seen some studies that basically say the ones who engage the most in social media are the solo. Practitioners that are doing cosmetic surgery. And that's exactly what I am. I'm a solo practitioner who does primarily aesthetics. And so my set point for what Sam mentioned, where there's entertainment and where there's professionality is set differently.
And I know that because because I get some feedback from my patients. I see Feedback from my posts. And so I do inform, I do a lot of before afters because that's what patients tell me they want to see, but they also respond to knowing, I think me as a person, the human interest side that you said.
I have posted comical posts about the staff or me, doing my thing. Personally, so it's, but I do have of line. And I think that there are a lot of plastic surgeons out there that go really far on the entertainment side. And I think that is growing as an accepted form of advertisement for plastic surgeons.
I don't think informing patients or being professional is really even. A thing anymore for a lot of people, I think they really want to push the boundaries in terms of what what's acceptable for plastic surgeons. And that's a little difficult 
Dr. Salvatore Pacella: [00:07:27] right now. So we all know that, there's a generational component to plastic surgery, right?
There are the millennials, the 20 year olds and they're highly tuned into social media. There is a group of 40 to 50 year olds that are, probably not as engaged on social media. And then there's a whole group of patients older that more than likely probably don't get a bunch of their information from social media.
And so unfortunately I think, with concentrating and targeting social media, it's almost exclusively. With breast augmentation, it's almost exclusively with breast and body surgery in that millennial population. My practice is filled with patients who are older, facelift patients, rhinoplasty patients eyelid patients.
Okay. And so I don't derive a ton of value from, dancing around and showing eyelid pictures. But somebody who is doing. S a tremendous amount of breast augmentation may feel otherwise. And then that sort of begs the question with patients, what are patients really looking for?
Are they looking for a fantastic surgeon that gets great results? That's humanized that is a talented surgeon, or are they looking for the best dancer? Dr. Jejurikar from Dallas. Tell me your thoughts on that. Can you dance? I know you can. I've seen you
Dr. Sam Jejurikar: [00:08:45] as well. 
Dr. Salvatore Pacella: [00:08:48] I've seen it work before. Come on. 
Dr. Sam Jejurikar: [00:08:50] You'll never know from my social media account. So yeah, but that, we all came from the same background. We all trained out of place, the university of Michigan, as we've alluded to many times where there's a certain gravitas associated to being a surgeon we're taught in our first week of surgical residency, that it's a privilege to take care of people that people look at you as an authority figure as someone that they're going to look up to, not someone they're going to look at as being a source of entertainment. So we all have that same bias where education is. Our primary is our primary our primary focus, but ultimately At the end of the day, there are people that do facial aesthetics. One of my, one of my partners and one of our previous guests, Dr. Rod work, for instance, who has hundreds of thousands of followers and a robust social media presence who manages to put together an incorrect, I don't believe educational social media platform where he's showing lots of interoperative, maneuvers, he's teaching both surgeons and yeah.
Patients at all times on a social media platform. And I think ultimately that's what most patients respond to. There are these patients in their late, in our late teens, early twenties who may look for something a little bit more, a little bit more entertaining, but ultimately I think we can thread that needle and be educational and still have a robust presence.

Dr. Salvatore Pacella: [00:10:05] Dr. Rohrich's social media account, I find exceptionally respectful he's, he is all about education and that, that has been his goal from when, back years ago, even before social media. And so that, that's just a natural evolution of how he's maintained his practice.
But it's it you make a great point Dr. Rhee from New Jersey about just, do you. As a practitioner in social media, do you want to be a surgeon to great, to educate patients and get patients to come in and see you? Or do you want to be a social media star? Do you want to be an influencer?
And that line is very much blurred. I think in today's day and age 
Dr. Sam Rhee: [00:10:46] it is. And I've played around with it some, I'll post memes about, I'm so glad that I have my Botox so that people around me can tell what I'm thinking about them, a little menial jokes or I'll do a us, I've done the dancing around, not, my staff has in the clinic and with boxes of Juvederm or, stuff like that.
And that's not necessarily informational or But I think patients do respond to it to a degree. When I wasn't doing social media a couple years ago, patients would wonder how, they would find me through word of mouth, but they'd be like, what? I didn't, they didn't know anything about me, but now when patients come and see me, they know me, they ha they, they know my staff, our approach to stuff.
They know we're lighthearted with a lot of things and we're not. And we're really friendly, I think. So it helps shape our persona to people beforehand. And then what, 
Dr. Sam Jejurikar: [00:11:42] what's an example of something that you would consider to be over the line then? Dr. Rhee? 
Dr. Sam Rhee: [00:11:46] That's a good question and I think I'm going to show you some Tik TOK videos of a plastic surgeon out in Beverly Hills. And I would say to me, this would not be anything I would do, but. Again, like you said, I think there is a set point that everyone has within themselves in term internally, what is entertainment and what's acceptable for them.
And what's not. I talked 
Dr. Salvatore Pacella: [00:12:07] to Dr. Rhee. I think what I would love to see on social media is, with all your work with with CrossFit, you should just get rid of the scrub top and just do a full. Scrubbed down with your whole chest. 
Dr. Sam Rhee: [00:12:20] I have posted myself working out a lot actually. And 
Dr. Salvatore Pacella: [00:12:24] it's intense. I love it. It's a lot for the full head to toe scrub. Yes. 
Dr. Sam Jejurikar: [00:12:30] I think you're missing the homoerotic undertones of what he's asking you. He wants you. Glistening shirtless on your profile. 
Dr. Sam Rhee: [00:12:39] I am not phased by Sal's homoeroticism at all. It's pretty normal. 
Dr. Sam Jejurikar: [00:12:46] Save the baby. I personally think it, I personally think it would be good for business, but it'll be interesting what you think in terms of professionalism, but I think it'll be good for business.
Dr. Sam Rhee: [00:12:54] I think I have posted on occasion, not. Me in scrubs, but yeah. With my, working out and I work out without my shirt and all that. Yeah. And I've done that on occasion. I don't feel like if I did a lot of that would be very representative of me or my practice because ultimately I have to show some of my personal life just Sal shows himself or whatever else is in your life your family or your pets or whomever.
And I see a lot of plastic surgeons who. Who highlight what's important in their lives. But at the end of the day, like Sam says, I that's a peripheral part of it. And most of what I want to post is that patients know that I'm helping them, that this is right. It's focused on them. And if all I did was have glisteny  shirtless pics, then I'm only servicing Sal 
I'm not servicing anyone. Okay. 
Dr. Salvatore Pacella: [00:13:47] And the reason I mentioned that is when you w with all kidding aside, I when you post that kind of stuff, it tells me that, you're the kind of physician that is not just worried about. Getting patients to come in, you're worried about health and fitness and how that affects your whole kind of personality.
So the fact that you're like deep into health and fitness, I think is a fantastic attribute to tell patients, or to show patients because, you're gonna, you're gonna treat them that same way, hey and abdominoplasty is not a catch all thing. You've got to incorporate this into your health, your food, your diet.
And then your daily life. I think your social media is very tasteful. I, I'm just simply joking. 
Dr. Sam Rhee: [00:14:25] Obviously. I appreciate that. I want to get into this wired article, which sort of shows some pretty high profile celebrity style, social media, influencer, plastic surgeons, but I just wanted to reiterate one more time that we are not the ones who are deciding as plastic surgeons, what to do, we're following our demographics and what are our patients are doing.
And it was amazing to me that I saw that some of these stats from a 2019 article from PRS where 71% of millennials engage multiple times a day on Snapchat, 68% of adults on Facebook. And. They actually equate yeah. Presence and activity on social media with depth of experience and competence.
So if you're actually a surgeon not posting in social media, they might actually think that you're less experienced or you're less competent. Which is mind blowing to me because I think generationally, we never thought that anyone who was prem prominent on social media was actually someone who that, that related to how good they were as citizens.
Dr. Salvatore Pacella: [00:15:34] It's exceptionally counter-intuitive to me, because I find that in my practice, the busier, I am the less I post on social media. Because If I'm operating 12 hours a day and seeing 40 patients a day, how could it possibly take a minute to post a selfie? I'm going to take a selfie, 
Dr. Sam Rhee: [00:15:51] Isn't it crazy, but that's exactly what w what patients are thinking.
Dr. Sam Jejurikar: [00:15:56] Yeah. So I get a ton of patients from social media, predominantly Instagram. I get as many patients from Instagram as I do from Google. And I try to post something every day. I have people that helped me with this as well. It's not me, that's actually doing it. And I'm going to challenge the traditional way that we think about things.
I would say that where. Social media platforms, particularly Instagram in today's day and age and YouTube are that that's what our patients are going through. That's the platform that they get news from. That's the platform. They get entertainment from, that's where they spend all of their time.
And if you don't directly put yourself on that platform, which is what is viewed as being in our patients an important source of getting information and entertainment. That they're going to view you as being out of touch with what they're looking for, ultimately. The days of word of mouth are not over, like having patients refer their friends and family are still incredibly important, but there's multiple channels by which you get new patients and social media and the internet is an important channel.
And similarly, I think. You can showcase your work on these social media platforms. Social media gives you the opportunity to show your before and after photos to show what you're actually capable of achieving. And you can fine tune the message you want to deliver to a patient.
Like here's what you can accomplish with this procedure. And it really allows you to communicate with them where they're actually sitting. So if you're not engaging in these platforms, You're missing out on a way to communicate with potentially new patients to your practice. 
Dr. Sam Rhee: [00:17:24] Let me ask you this Sam.
It used to be that Facebook was a prime social media app, but it seems and I know for many of the younger. Demographics. They don't use Facebook as much anymore. That's what, aunt Sally uses or whatever now it's Instagram, but now they're also migrating to other apps. For example, Snapchat is huge obviously, and Tik TOK is now becoming the app for.
Younger potential patients. Are you also going to start moving? Do you use those apps? Do you advertise on those apps or feature yourself on those apps or will you in the future? 
Dr. Sam Jejurikar: [00:18:01] I do not, and I will not. And it's simply for this. I know myself. I know that when I'm in the operating room, my, my focus needs to be on doing surgery.
I focus on the procedure on the patient and I'm not worried about filming things in real time while I'm doing surgery. So for me personally, I generally feel like the quality of work that I will do. We'll go down if I'm focused on filming things. So I w it's not something for me I'm comfortable with where I'm at right now, using things that allow me to showcase some before and afters and some isolated video clips of things.
But I don't want to start filming surgery. That's just for me not, I'm not a performance artist. I'm a surgeon. 
Dr. Salvatore Pacella: [00:18:35] Yeah. That's a great question. I I am oftentimes videotaping surgery with patient's consent. But it's rarely if ever used for social media, it's really used for education.
I am very robustly involved with our professional societies giving talks multiple times a year and documenting kind of new and interesting types of surgeries. And in, in, in taping those surgeries, It is stressful to do that because you not only do you have to concentrate on the type of work you're doing, you have to concentrate on the lights, the camera the venue, or the mechanics of what you're doing.
It's just, it takes, it adds time to the operating room. And it's just not something that, and that, that is helps with patient care. One question I have for you guys is, did you ever think about maybe Say, responding to traffic court while you're operating. Have you heard that, that I just heard about that.
Dr. Sam Jejurikar: [00:19:31] Yeah. 
Dr. Sam Rhee: [00:19:32] Go ahead and tell him. 
Dr. Salvatore Pacella: [00:19:34] So there was a surgeon this week, I don't know where it was. But as a plastic surgeon and he was summoned to traffic court virtually, and he did it, he signed in to the traffic court while he was operating and the judge just completely admonished him and said, what are you doing?
It was, it's just like ridiculous, 
Dr. Sam Rhee: [00:19:55] Yeah, the judge said we don't want to compromise your patients, or we're just going to postpone the court date, but he showed up on zoom saying, I'm ready. But he was in the middle. Like he was with a patient in an OR. It was con it was, I think borderline I think it was inappropriate, especially if I was the patient under.
Dr. Sam Jejurikar: [00:20:12] Yeah, exactly. If the patient got wind that the surgeon was simultaneously engaging in traffic court, they're not going to feel like they got their surgeon's undivided attention. 
Dr. Sam Rhee: [00:20:22] Yeah, I think the issue is this to me also is where we see this going because obviously our mentors would never engage in social media the way we do now, and I know exactly how they feel about it, but the younger surgeons that are starting their careers now, or will be starting their careers.
Now, I think they're going to have to grapple with this. Social media and if they are not on Snapchat or on Tik TOK, I think they're going to feel tremendous pressure to be on it. And I just saw an article in New York times. And last year, basically it says for doctors turned influencers that Tik TOK learning curve can be steep.
And there was a plastic surgeon in New York, Dr. Matthew Shullman who said Snapchat has been vital to us. Private practice drove, it drove 80% of his consultations. A post he made on Tik TOK drew over 6.8 million views. And when you're getting that kind of visibility, I think every young plastic surgeon out there is going to have to look at it and say, this is.
Something I'm going to have to do as well in order to be successful. And that's where we keep pushing it even farther down this path. 
Dr. Salvatore Pacella: [00:21:39] Bob Baker, who is our aesthetic society, corporate counsel I know Bob fairly well from just some educational stuff. He articulated a very interesting.
Prediction. He said that this is what will happen with social media. It will not change. It will continue to go up and up. But what you will see is you will probably see independent and frequent more frequent episodes of patient undergoes, cardiac arrests. While Tik TOK video is going on in, in operating room.
You will start to see litigation. Coming out of patients who are going to Sue their doctors, because Hey, they weren't concentrating on the surgery at the time they were doing this tick tock video. And with everything that's on social media, you're going to see pinpointing, Hey, at this time at 9:30 AM, when this occurred in the operating room, he was logged in on his Facebook account or on his Instagram account, et cetera, blah, blah, blah.
And so that, that's what we're going to see. Unfortunately But it won't change 
Dr. Sam Jejurikar: [00:22:38] anything. There's so much, there's so much data. There's so much data that shows that when we multitask, we're unable to accomplish everything efficiently, like servery, ultimately, not to be sanctimonious, but we are it's, even when we're doing what patients consider to be a simple cosmetic procedure, there are potential life and death consequences involved with surgery.
And being able to focus on the job at hand is really important. And I'm not saying that sometimes. You can't film a video clip here or there, or film something for educational purposes and all that. But when you're constantly live streaming, everything you do, when it turns into a performance art and the surgery is just part of what you're doing and social media is your focus, things are gonna happen.
The, things will happen that are going to have negative consequences for patients. 
Dr. Sam Rhee: [00:23:24] Let me highlight yeah. Of this plastic surgeon and his name is Dr. Daniel Barrett and he's a. In Beverly Hills and I think he's a pretty well-known tick-tock guy.
That are still.
This is my recital, I think is very vital to
what is
Hey doc, how many flips do you think I can do in here? You're not flipping my arm. I'm not doing what if you're going to do. I'm not doing what you better not.
who's not flipping. What? No. I'm taking a knack to
work here.
What's a syringe 
Dr. Sam Jejurikar: [00:23:57] habit you picked up from work. 
Dr. Sam Rhee: [00:24:00] So I have this thing about breast implant.
Burst.
So what'd you guys think of that video of Dr. Barrett 
Dr. Salvatore Pacella: [00:24:08] Entertaining, and the first thing I think about is when you're jumping up on your or table with your shoes and there's a clean sheet there I hope he changes the sheets afterwards, for the next patient, because although all that staff on the ground will right.
Go right up on the Read up on the or table. So beat, I gotta say the operating room is like my church, my dojo, right? Like I, it's approached with some level of reserve, some level of respect. It's like an altar, and I just don't, I have trouble with.
Just doing whatever in the operating room, a, it's a place of sterility. It's a place of concentration. It just, it's not me, but it works for a lot of people, so yeah, go ahead. 
Dr. Sam Jejurikar: [00:24:56] I was going to say, I don't think I could be as entertaining as Dr. Barrett, so I'll give him that.
He's definitely got a, got an outgoing personality that I'm sure Pete people are really attracted to at the end of the day, why are we on Instagram? Why are we on Tik TOK? Why are we in Snapchat? It's a form of marketing, right? Ultimately plastics are in the, wouldn't be doing this, that weren't trying to get more patients.
So I make the conscientious effort to try to attract people that, that are going to view me as an authority figure, and that are going to treat surgery with some level of gravitas. We're going to ultimately. Make this decision to have an elective procedure to make themselves look better, but ultimately recognize that it's still a little surgery and there's consequences that go around that are around it.
So for me, personally, if I were dealing with Dr. Barrett was doing, I don't think I'd be able to convey that message. I think ultimately It wouldn't look like it's something that's more than just going to the nail salon or getting your hair cut. So it wouldn't work for me and my practice and what I'm going for.
Obviously it works for him. He's gotten a fair amount of notoriety, but it's not something I would ever do. Yeah. 
Dr. Sam Rhee: [00:25:58] It's funny because I bet you that 20 years ago, our mentors would say, you know what? Social media is fine. But it's not something that I would ever engage in. My work speaks for itself and I really want to get my patients through word of mouth.
And, if you want to post stuff on social media and whatever, that's something I just wouldn't do. And now we are our mentors and we're Dr. Barrett is going to be is where the future lies because it's, it was a joke where he had the three glasses of water and he poured some into the. Study hard, poured some into the amazing results.
And then he like overfilled the, the tick talk beaker. And to me it was clever. Yeah. There's a grain of truth in that, in the sense that I think as a young surgeon being trying to market yourself this is where they're going to go. This is what they see as the future.
And should we, or as a society like our society, our professional societies, should we start trying to establish guidelines about what is appropriate or what isn't appropriate? We already have some guidelines about advertising, about what we can and cannot say, should we have better guidelines that cover social media as well?
Dr. Salvatore Pacella: [00:27:13] The thing is, what the attorneys will say is, you can't. You can't legislate or you can't regulate taste, so as long as patient safety is respected, as long as patients are consented for being on social media, there's really little that I think the professional societies can do.
But the one thing I wanted to just clarify her is I think we have to understand what's happening in the local and regional environments of where these surgeons are posting, Dr. Barrett is in an exceptionally competitive market. Arguably the most competitive market. You walk down Robertson or Westwood and you throw a stone and you can hit five plastic surgeons just bouncing off their heads, sitting at lunch.
Okay. And so it's exceptionally competitive and I've been down there. I've I did a fellowship in Los Angeles. I scrubbed in with some of these docs and, they take pride and going. Out of their operating room in their scrubs, wearing their white coats, wearing their hats, just walking down the street.
It's a lot of visibility. And to some extent, if you're not in that game, you're just going to be marginalized. Whereas in other venues, San Diego, Chicago, the Midwest, it's not. You don't have to engage completely in social media to be competitive. And so th there's some extent of, what's happening in your regional community as well.
Dr. Sam Jejurikar: [00:28:38] Yeah. And yeah. And looking at, going back to your question to Dr. Rhee about, should our professional societies be be involved. Dr. Baird's videos are goofy and they're meant to be funny and entertaining. They're not violating patient confidentiality. They're not showing. They're not degrading people there.
I was interested in the breast implants in that hyper volt and the, they were a gun. I was hoping it's actually be an assessment of the two guns because I have both. And I'm trying to figure out like, yeah, which I like better, but ultimately he's not hurting anyone by it, so it's just it's entertainment and he's not violating any professional standards.
It's just silly and goofy and he's entertaining. And that's what he's trying to be. 
Dr. Sam Rhee: [00:29:19] I think that's what, more and more of our plastic surgery colleagues are going to be doing. Yeah. It's funny that you mentioned location because the wired article that I want to talk about with about this particular influencer doctor, the real doctor, six or six, I'm not sure how you would say that is in Toronto, which you wouldn't necessarily think is the hotbed for cosmetic surgery, he.
Dr. Salvatore Pacella: [00:29:41] Very competitive market, very competitive 
Dr. Sam Rhee: [00:29:43] market and very competitive. Ask 
Dr. Salvatore Pacella: [00:29:46] as Dr. Kusan. Okay. Can you see him on social media? He would be just entertaining. He'd be accepted. 
Dr. Sam Rhee: [00:29:53] I think he'd do great. I think he'd do really well. His persona translates really well to social media. So basically this article was written by Catherine Laidlaw and it was published out in January.
And it was your body, your self, your surgeon, his Instagram. And basically the title was social media, gave the real doctor six a stage in which to show off liposuctions and breast lift. But when cosmetic surgery becomes entertainment, who owns the story? Now I think this a surgeon is under multiple Charges for which she's currently on in the legal process of dealing with.
But I just wanted to pull out a couple quotes and have you guys think about, or. Comment on this. His name is Dr. . And it basically follows a story of a particular patient named Laura who saw his post on Instagram. This Dr. Martin, you Ginsburg, who's a clinic Toronto cosmetic surgery Institute.
Had a ton of satisfied customers on online reviews. Had a sizable following on Instagram and Snapchat and Basically underwent breast augmentation with he said he, during her consultation, he asked if he could stream her surgery on Instagram live. And the article says she remembers the moment the tenor changed, how it first felt like a medical appointment and then like a sales pitch quote.
Everyone does this. Don't worry about it. She didn't want to say yes, but she felt there was no room to say no. And so whether it was the nerves of impending surgery or some desire to please the man who'd be wielding the scalpel on her body, she acquiesced.
What do you think of that?
Dr. Sam Jejurikar: [00:31:33] Obviously, no, one's going to feel good about coercing.
You can go ahead. Go fine. Okay, go ahead. 
Dr. Salvatore Pacella: [00:31:39] Go ahead. Go ahead, please. Go ahead. 
Dr. Sam Jejurikar: [00:31:41] Okay. Yeah, so the way the article is written, Sam. The PA the patient basically says that he feels coerced into having her video film live for Instagram. And the article also goes on to say later on that the doctor pulled pictures off of her social media feed and put it on his, which she asked him to take down.
And he wouldn't. Also, and so there's a lot of. Not even questionable ethics and volunteer, you can't coerce patients into doing things they don't want to do. And you do yield a huge amount of power as a surgeon to potentially coerce people into doing things because you're going to be operating on them.
They don't want to displease you. So it's hard to, obviously you have to feel terrible for this patient and feel if the story is true as it's written feel like there's significant unethical behavior going on.
Dr. Salvatore Pacella: [00:32:22] Yeah, I think I know several Canadian surgeons in the Toronto world and the laws in Canada, particularly Ontario are much more stringent than they are in the United States. For example you are not allowed to show before and after photos. On a public Instagram account or online for that matter, you have to S you have to be invited.
So they, they won't allow you to show before and afters. But if you have an Instagram account where a patient signs up for it, a requested account that is acceptable. So the laws are really pretty stringent here. So if you're looking at the regional environment here, if our if our benchmark is here, Ontario's is over here.
So the fact that the patient felt even more coerced that, that can be a challenge, it's it's unfortunate that that's so this social media topic has gotten that far. I never want to put a patient in a situation where they feel uncomfortable with me in the exam room.
That's just. That's just unheard of. I think, 
Dr. Sam Rhee: [00:33:25] I think that this is a cautionary tale for all plastic surgeons, because you're right. We wield an incredible amount of power over our patients. And there are some patients that are more than happy to have every part of their plastic surgery journey highlighted or featured. And I've had cer certain patients who, who actually asked to do and then obviously there are many who don't feel that way at all. And, and they basically say that they say many clients are happy to play a role in Dr.  reality show, but others say they felt pressured to participate.
So I think as plastic surgeons we need. To take steps to ensure that if we do ask a patient to participate in whatever marketing that we want to have them in, that they don't feel pressured. And I'm not sure exactly the steps that we can take to do. I'm sure we could obviously the, our approach to it and how we discuss it with patients is super important.
Also there's probably some legal documentation that would be super helpful for us to make sure is completed. So that patients know exactly what they're getting into, but I'm not, I wouldn't be surprised if there are a number of patients with many plastic surgeons who might feel that way, especially if that plastic surgeon is heavy into marketing.
Broadcast surgery live frequently, does that sort of celebrity media influencing, so would it be okay for you to have this type of entertainment that this value that this plastic surgeon had, for example, he Had the rapper two Chainz in his operating room during a surgical procedure, making comments about the surgery and the results about the patient.
Is that totally fine? Is there's no, is there any sort of, do you see any issue with that? 
Dr. Sam Jejurikar: [00:35:18] I thought that was Dr. Miami that actually happened. 
Dr. Sam Rhee: [00:35:22] That's right.
Dr. Sam Jejurikar: [00:35:23] That was Dr. Rhee. Again this is a leading question, Dr. Rhee. Obviously none of us would feel comfortable with having.
People not relevant to the procedure in the operating room, but no, we've all I think made the conscientious effort to to use social media, to educate as a form of advertising as well, but tasteful and one that actually shows the gravitas that we also shared with surgery. But but there is, as Dr.
Pacella already alluded to, there are people that because of their markets, their age and the demographics of their patients, Choose to use it more for strictly entertainment purposes and blur that line between professionalism. There is going to be a catastrophic event that happens at some point to a patient, which is really going to lead to I think, a reckoning for those sorts of practices.
But I think we're all going to be on a light line of conservatism. We're not we're not doing, but it'll be tragic when something bad happens, but unfortunately at some point invariably, something is going to happen.
What do you think about the fact that this seems to be a growing trend with plastic surgeons? Doctor union Berg was actually a group of 15 surgeons called the Dr. Miami squat. This is from the wired article. There was Dr.  from long Island who had 215,000 followers. Dr. Real, the real Dr. Feelgood and fall river, Massachusetts 521,000 followers.
The real Dr. B Moore from Baltimore 36,000 followers. They pay for an affiliation, $15,000 for the initial branding and social media training with the real Dr. Miami, then 2.5, two and a half thousand dollars a month for social media promotion on the Dr. Miami platforms. So this is actually almost being franchised and becoming 
Dr. Salvatore Pacella: [00:37:04] Yeah, it's very entertaining.
He he nights his followers on live. I Knight you Dr. Sammy, Jay of Dallas, Texas, it's just an opportunity to extend the brand, it's. Some to some extent we can argue that we do the same thing with our professional societies, we apply to the aesthetic society or HSPs by nature of being accepted into that community.
We're listed on their website, we're listed as being legitimate. The same argument can be made for board certification. It's not going to stop you from practicing, but you get that kind of extra little bit of Of a certification. So you know, all the power to these guys. I th I think my judgment comes in when it affects patient safety and it affects patient patient outcomes.