Patient Representation and Diversity in Plastic Surgery Social Media

Goals/Purpose: Plastic surgeons increasingly use social media as a mainstay of patient engagement, research distribution, and trainee education. Various networking platforms provide far-reaching, valuable opportunities for information dissemination; however, disparities in patient representation within social media content exist. As the use of social media by plastic surgeons continues to expand, it is critical to evaluate and advance the representation and diversity of patients on these platforms. Appropriate patient diversity is integral to promote interaction with all patients and ensure the adequate training of plastic surgeons to work with diverse populations. This study aimed to assess patient representation, particularly of racial and ethnic groups, among plastic surgery Instagram accounts.

Methods/Technique: The Instagram accounts from 9 plastic surgery professional organizations and journal accounts were analyzed for posts containing patient images between April 2015 and June 2020. Each unique patient image and its corresponding caption was analyzed for demographic factors, including skin tone, biological sex, age, and transgender identity representation. Skin tone was assessed as a proxy for racial identity, using the Fitzpatrick Scale to categorize as white (1-3) or non-white (4-6). Univariate analysis was performed to determine differences in representation among posts and to compare patient representation on Instagram with the United States (US) Census Bureau data on race and ethnicity and the American Society of Plastic Surgeons (ASPS) Annual Report data on race and ethnicity of plastic surgery patients.

Results/Complications: A total of 6719 posts from 5 journals and 4 professional organization accounts were found to contain 2547 unique patient images. 88.14% of patient images depicted white skin tone, while only 11.86% displayed non-white skin tone. Only 0.31% of images represented transgender patients, all of whom were transfemale individuals. Cosmetic plastic surgery patient images had a higher frequency of white skin tone as compared to reconstruction surgery images (89.93% vs. 81.98%, p<0.001). From 2016 to 2020, non-white skin tone representation improved from 10.34% to 18.60% of posts (p=0.003). However, when compared to the US Census data and the ASPS Annual Report data on race of patients undergoing plastic surgery, our data revealed substantial underrepresentation of patients of color on social media (p<0.001).

Conclusion: Our study highlights the underrepresentation of patient populations, notably racially and ethnically diverse patients, within plastic surgery social media imagery. Though people of color comprise 30% of patients undergoing plastic surgery procedures, only 12% of patient images on Instagram represent this population. Active efforts to ensure equitable representation of patients on widely accessible social media platforms is essential to decrease patient barriers to healthcare and improve physician training to engage with diverse patient populations.