Your Villa Magazine - Foothill Cities - May - June 2024

Facial Artistry Gregory J. Vipond MD, Inc. Facial Artistry Gregory J. Vipond MD, Inc. Dr. Gregory VIPOND For this editorial, I thought I would discuss the growing trend of online and social media “experts”. Without a doubt, social media is a rapidly g owing phe omenon in health care and is here to stay. Unfortunately, it is very easy to come across as an expert if you are skilled at making videos and have an engaging personality. I joke with patients that everyone sounds like an authority on social media. The reality is that, just like marketing, there is no content verification or need to prove your statements. Social media is intended to be used as entertainment, but it is increasingly used as a marketing tool for providers and diffe ent technologies. I read once that we, as human beings, are motivated by incentives. So, if there is an incentive to increase your followers or grow your brand and business, people are likely to do whatever they can to achieve this, regardless of the honesty of the posts. In a previous editorial, I discussed the growing involvement of corporations in the medical field and in medical education. When I first started medical school, there was very little in the way of marketing medical treatments or practices. There was also significant sc utiny of any statements or research papers by the academic community and results were required to be objectively proven. This system of checks and balances not only encouraged actual research with validated methods but reduced the influence of so-called “expert opinions” on driving medical progress. As I journeyed through my residency, fellowship, and private practice, I have seen the emergence of sponsored medical journals with articles that are basically advertisements for diffe ent treatments without any objective data. While plastic surgery journals still remain that have a peer-reviewed process and scientific overvie , it is my belief that the majority of aesthetic medicine providers do not read them. Even when reading such journals, it is imperative that one reads critically and does not just accept everything that is published as being fact. Along those lines, another issue that has always been around in cosmetic medicine but is becoming increasingly prevalent is the quality of before and after photos in social media posts, online, and even in peer-reviewed journals. I read an interesting article in Allure magazine that expanded on this increasing phenomenon. One of the surgeons interviewed warned, “Beware the surgeon who isn’t fastidious enough to take consistent photos. It shows they are lazy, not careful, or intending to manipulate you.” He then referenced several examples of using diffe ent lighting, changing the position of the patient, as well as taking photos at the end of a surgery and calling them “after photos” when the true results are not usually seen until at least 6 months after surgery. There was a study published in Plastic and Reconstructive Surgery Global Open in 2022, where researchers reviewed and graded more than 2,000 before-and- after images of facial cosmetic procedures posted to Instagram by aesthetic medicine practitioners, and “showed that the average before and after is medium-to-poor quality, with as many as 40% being potentially deceptive,” wrote lead author Danny Soares, MD, a board-certified facial plastic surgeon in Fruitland Park, Florida. Photos taken with cellphones are especially easy to manipulate prior to uploading to social media. Filters are almost ubiquitously employed as well as favorable lighting, makeup, and angulation. When I first completed my Facial Plastic Surgery training, I worked for the now-defunct company, LifestyleLift. They were experts in embellishing after photos to make their results seem extraordinary. Before photos were taken with overhead lighting, chin tilted down, a somber or grim facial expression, and little or no makeup. The after photos were taken with the patient looking up, smiling, wearing full makeup and having their hair down, and with full lighting on the face. The diffe ences were certainly striking, but if you looked past the manipulation, there was, at best, a mild improvement. One of the surgeons under whom I trained was meticulous in trying to ensure consistency between the before and after photos. He emphasized that, not only was it more honest, it allowed the surgeon to properly evaluate his or her work in order to continue to perfect their craft. Over the years, I have tried my best to be consistent in my photo-taking and have also become critical when evaluating photos of others. Even in peer-reviewed, prestigious journals, there is often inconsistency. That is especially frustrating for me when a new surgical technique is presented and it is difficult to judge its merit because o the “smoke and mirrors” effect. When looking at medical procedure posts on social media sites, the use of “selfies” should be viewed as entertainment rather than an accurate documentation of the result. Most users will only post those photos that best demonstrate whatever they are trying to present. Filters, makeup, lighting, and facial expressions can all be manipulated to achieve the desired result. The use of AI technology will likely only add to this problem. Before concluding, I would like to return to the concept of social media experts. I find it amusing how many young influencers p oclaim expertise in techniques that take years to fully evaluate. My wife showed me a Tik Tok video where one younger injector was stating that getting Botox at a young age only made you look older. I’m not sure how this result was achieved as I have never observed this in any of my patients, but I’m also unsure of how such a long-term statement can be made by someone who cannot have long-term experience. Not to generalize, but I think many people, when starting their careers, quickly form opinions based on short-term results as well as trendy statements said by others. True evaluation of techniques comes from carefully observing patients over the long term. When I worked for LifestyleLift, I was only allowed to see my patients for up to 3 months after surgery. Because of the high volume of surgeries I performed and my limited long-term follow-up, I developed a false sense of my own expertise. I remember going to a Facial Plastic Surgery Conference and skipping all the lectures on facelift and eyelid surgeries because I thought that I was one of the best and wouldn’t learn anything new. I look back on my younger self and smile because it was only by watching patients for at least one year that you truly begin to see if you are as good as you think. After 16 years in practice, I am more experienced but am by no means the expert I thought I was when first starting out. I am always eading articles and assessing new techniques while being critical of my own results and continue to learn each day in practice. By doing so, you begin to realize that there are few true experts in cosmetic medicine. Most senior practitioners are not dogmatic and over-confident but a e thoughtful and consider alternative methods to their own. Many of these social media posts are done in such a manner as to make the poster seem like a worldwide authority on the subject matter. When I was a medical student doing my neurology rotation, I worked under a resident who would answer every question confidently and without hesitation. I thought he was one of the smartest people I had ever met until one of my fellow medical students started researching his answers and found that the resident was often incorrect. However, by sounding confident in his answers, he was very believable. This experience also served to teach me to never take something at face value but to be critical before forming an opinion. In conclusion, this article is not meant to be a pessimistic assessment of the current reality of cosmetic medicine. Instead, I am hoping that it will encourage readers to not blindly believe what is seen online but to question and challenge it and to form your own opinions. Many “experts” are either receiving or hoping to receive compensation for the procedures and products they’re endorsing as well as to increase their followers so that they can receive more compensation in the future. Gregory J. Vipond, M.D., F.R.C.S.C. Board Certified Facial Plastic and Reconstructive Su geon