Keywords: Social media - Plastic surgery procedures - Motivation - Ethics - Health’s judicialization
INTRODUCTION
There are records about the practice of plastic surgery since many centuries
before Christ. It was practiced to correct deformities caused by trauma or
physical punishment, as shown in the literature[1 ]. However, the consolidation of this specialty occurred after WWI,
whose conflicts resulted in seriously injured soldiers and disfigured bodies,
making it necessary for them to undergo surgical repairs[1 ].
Since WWII, plastic surgery has expanded its focus, with reconstruction
techniques covering the general population. Nowadays, aesthetic procedures are
the most sought-after. According to Gracindo[1 ], “the patient seeks with the correction to achieve perfection or a
standard of beauty, which is often imposed by society and influenced by the
media”.
Body idealization over time
Beauty standards have changed over time. The idealization and perception of
the ideal body are influenced by cultural, social, economic, and historical
factors[2 ].
Souza et al.[3 ] show that the beauty
search, although great in the contemporary era, is not a recent concern, as
human beings have sought to represent themselves through the arts for
thousands of years.
The authors trace a panorama from Antiquity, when the beauty search began to
become rational, passing through the moralism imposed by Christianity in the
Middle Ages, Modernity in the 15th century, under the effect of various
discoveries of artistic techniques, and beauty understood as an imitation of
nature. The standard of beauty was the obese body of the Mona Lisa, or
Gioconda, the famous painting by Leonardo da Vinci[3 ].
Souza et al. continue to show the drastic change in the Capitalist System,
from the 17th century onwards, in which the body proved to be both oppressed
and manipulable, since the evolution of industrial society led to high
technical-scientific development[3 ]
until reaching Contemporary times with globalization, the consumerism.
Stimulated by the media (newspapers, magazines, radio, and cinema), the body
is seen as a symbol of vigor and effectiveness, symbolized by sports and
cinema icons[3 ].
Plastic surgery today
For Kataoka et al.[4 ], plastic surgery
improves self-esteem and acceptance in a consumerist society that idealizes
the cult of the body. “The pressure of consumption and the ease of
undergoing a plastic surgery procedure ends up becoming an obsession in
these patients’ lives”[4 ].
Over the years and the proportional growth of the media, focused mainly on
the cult of the body and perfection, the demand for plastic surgery has
increased dramatically. In a scenario in which bloggers and digital
influencers are hired by professionals to attract patients who accompany
them, awakening an endless desire for body change, most of the time with
“unrealistic” promises.
According to the International Association of Plastic Surgery (ISAPS-
International Society of Aesthetic Plastic Surgery), as represented in [Figure 1 ] and [Figure 2 ], there was an increase of 19.3% in the total
number of procedures performed compared to 2020. More than 12.8 million
surgeries and more than 17.5 million aesthetic procedures were performed
worldwide in 2021, with liposuction and then primary breast augmentation
(implant placement and skin removal) being the most performed
procedures[5 ].
In Brazil, the 5 most performed surgeries were: 1 - Liposuction, 2 - Primary
breast augmentations; 3 - Blepharoplasty, 4 - Abdominoplasty, and[5 ] - Mastopexy. In total, more than one
million and six hundred thousand plastic surgery procedures were
performed.
Figure 1. Most performed plastic surgeries in the world in 2021. Source: International Society
of Aesthetic Plastic Surgery (ISAPS).
Figure 2. Most performed plastic surgeries in Brazil in 2021. Source: International Society
of Aesthetic Plastic Surgery (ISAPS).
Silva et al.[6 ] mention that “the beauty
standards imposed daily in the media by celebrities lead to the tireless
search to achieve the utopian idea of the perfect image, a fact that results
in a great challenge for the doctor to understand the patient’s perception
of themselves and what the psychological repercussions of this projection.
Body dissatisfaction can cause anguish leading to stressful mental
conditions, triggering self-destructive behaviors to achieve an adequate
image and be accepted in society, as well as low self-esteem, depression,
and anxiety. Comparing the body with other people in the same environment or
with standards established by society can exacerbate these disorders.
Most digital influencers and bloggers awaken fantasy in society through the
search for cosmetic procedures and aesthetic plastic surgery by showing
realities on their digital platforms that, in most cases, contradict the
natural processes of life, as if they were a magical change. The posts of
photos that show perfect body curvatures, perfect skin, and immediate
post-operative surgery “like a magazine cover”, cause an immense desire in
people to look like that body shown at all times.
The role of the media in plastic surgery: leveraging pre-and
post-operative care as commercial tools
Contemporary plastic surgery is a dynamic and constantly evolving field,
driven by technological advances, societal aesthetic demands, and, notably,
the growing influence of the media. The intersection between plastic surgery
and the media has played a significant role in shaping patient perceptions
and expectations, as well as the commercialization of surgical procedures.
This integration has been increasingly evident in the emphasis given to the
dissemination of pre- and post-operative results, highlighting the promise
of aesthetic transformation and improvements in quality of life.
In the contemporary context, the ubiquitous presence of social media and the
proliferation of digital platforms have created a scenario in which
visibility and accessibility to information about plastic surgery have
reached unprecedented levels. Potential patients are exposed to a plethora
of images and testimonials that highlight the perceived benefits of
aesthetic procedures, often depicting dramatic results and stunning
transformations. This constant exposure fuels a growing expectation
regarding plastic surgery’s ability to achieve ideal results, shaping
individual perceptions of beauty and self-image.
The promotion of these procedures as a quick and effective solution for
correcting physical imperfections or for aesthetic enhancement has further
boosted the demand for plastic surgery services.
In this digital era, the media plays a crucial role in building the image and
reputation of plastic surgery professionals, directly influencing their
patient base and financial success. Marketing strategies aimed at promoting
impressive results and positive patient experiences are often employed to
attract new customers and establish a competitive advantage in the
market.
OBJECTIVE
The objective of this study is to investigate the influence of content constantly
displayed on social media, especially those related to beauty and cosmetic
procedures, on individuals’ decisions to undergo plastic surgery. Furthermore,
we seek to evaluate the variables that may affect the choice of professional and
understand patients’ expectations concerning obtaining results, considering
their perception and objectives in relation to body image.
METHOD
The present study adopted a quantitative approach, using a sample composed of 62
patients of both sexes, aged between 22 and 61 years, all residing in the state
of São Paulo. These patients were selected based on specific inclusion and
exclusion criteria and had already undergone plastic surgery procedures and/or
were planning to undergo plastic surgery and cosmiatry procedures.
It is important to highlight that data collection and analysis were carried out
during a pandemic period, characterized by significant changes in society’s
behavior and medical practices. The COVID-19 pandemic, with its mobility
restrictions, social distancing measures, and impact on health services, may
have influenced patients’ perceptions and decisions regarding plastic
surgery.
In this context, it is necessary to consider that the exceptional circumstances
imposed by the pandemic may have changed patients’ motivations, concerns, and
expectations regarding plastic surgery procedures. Therefore, the results
obtained in this study must be interpreted taking into account the pandemic
context in which they were collected, recognizing the possible influence of this
extraordinary period on the participants’ responses and behaviors.
The selection of patients was subject to the following inclusion criteria:
patients who have already undergone a plastic surgery procedure or are about to
undergo it, aged over 18 years. Patients under 18 years of age were
excluded.
Patients who underwent surgery underwent psychological assessment and monitoring
throughout the surgical process, and patients who have not yet undergone surgery
are undergoing psychological monitoring in the pre-operative period.
Some patients in the study have already undergone surgery with other plastic
surgeons and turned to the team to undergo a new surgery due to various
complaints that will be explained in the article.
Patients were invited to participate in the study, having received the
questionnaire “The influence of social media on plastic surgery”, containing 20
questions asking:
If the patient has already undergone an aesthetic surgical procedure,
what resources were used to look for a surgeon (Instagram, WhatsApp
groups with before and after photos);
The evaluation of positive comments on Google; a recommendation from
another patient; which content generates more confidence in choosing a
professional;
If the experiences of other patients with plastic surgery, knowing
someone, or seeing photos of results and before and after photos
influenced their choice;
The results of plastic surgery on digital influencers, famous people,
content generators, or people close to them interfere with the choice of
professional;
If the media influences the search for aesthetic procedures; if the
photos presented cause expectations for the result of the surgery that
will be performed.
RESULTS
This study included 62 patients, 60 of whom were women (96.8%) and 2 men (3.2%),
aged between 22 and 61 years. Of these, 65.8% had already undergone plastic
surgery and cosmetic surgery procedures, and 34.2% would still undergo the
procedures.
Considering the resources used by patients when searching for a plastic surgeon,
29 patients (48.33%) responded that it was recommended by other patients, 12
patients (20.0%) consulted the Sociedade Brasileira de Cirurgia Plástica
website, 9 patients (15.0%) claim to be influenced by WhatsApp groups and photo
groups of before and after results, while 7 of the patients (11.67%) look for
results on Instagram and only 5 patients (8.33%) check positive ratings and
comments from Doctorlaria, as shown in [Figure 3 ].
Figure 3. Resources used when searching for a plastic surgeon.
Regarding the influence of the media in the search for plastic surgeries, related
to posting photos with procedure results and/or before and after photos on
patients who made up the sample, 27 (43.5%) said that photos influence 61 to
100%. In the percentage of influence, 12 patients (19.35%) feel 31 to 60%
influenced, 7 patients (11.29%) 11 to 30%, while the remaining 16 patients
(25.8%) are divided into two egalitarian groups in which the media has an
influence of 0% and 1 to 10%, respectively ([Figure 4 ]).
Figure 4. Influence of results photos and before and after photos on the
search for plastic surgery.
When asked about their motivation for carrying out a plastic surgery procedure,
43 patients (69.4%) responded that they feel more motivated when seeing photos
of results before and after procedures, while 19 patients (30.6%) responded they
feel indifferent. However, when asked about the possibility of photos of plastic
surgery results being modified by Photoshop or other means, 57 patients (91.9%)
said they would not undergo surgery and 5 patients (8.1%) said they would still
operate with the professional ([Chart 1 ]).
Chart 1.
Photos of results and before and after photos of plastic surgery
When looking at before and
after photos on social media
If only they knew that the
before and after photos were modified by Photoshop, lights, and
other means of modification
More motivated to
carry out the procedure
Se sentem
indiferentes
Operariam mesmo
assim
Não operariam
N
%
N
%
N
%
N
%
43
69.4%
19
30.6%
5
8.1%
57
91.9%
Regarding plastic surgery groups and their influence on the choice of a plastic
surgery specialist, 14 patients (45.2%) responded that the groups influence 61
to 100%, 14 patients (22.6%) responded that the media influences 31 to 60%, 9
patients (14.5%) responded that the groups influence 11 to 30%, 5 patients
(8.1%) responded that plastic surgery groups influence 1 to 10%, and 6 patients
(9.7%) %) responded that plastic surgery groups do not influence their decisions
regarding the choice of a plastic surgeon ([Chart 2 ]).
Chart 2.
The influence of (unknown) patients and plastic surgery groups interferes with the
choice of plastic surgeon
Influence of plastic surgery groups in percentage
Quantity of patients in numbers who responded
Quantity of patients in percentage
0%
6
9.7%
1
a 10%
5
8.1%
11 a 30%
9
14.5%
31 to 60%
14
22.6%
61 to 100%
28
45.2%
Regarding the questions related to the absence of before and after photos, as
well as the lack of recommendation of a certain professional by someone close to
them, 41 patients (66.1%) said they would not undergo surgery, 17 patients
(27.4%) would undergo surgery, and 4 patients (6.5%) would undergo surgery, but
it would depend on the amount charged by the plastic surgeon ([Figure 5 ]).
Figure 5. Absence of comments and before and after photos from
patients.
In the answers related to the final result of plastic surgery, whether 100% would
be achieved after choosing the plastic surgeon, 39 patients (62.9%) said no, and
23 patients (37.7%) said that the result of the surgery would reach 100% ([Figure 6 ]).
Figure 6. Surgery result will be achieved in 100%.
DISCUSSION
The Federal Council of Medicine recently published Resolution CFM 2336/23, which
deals with medical advertising issues, providing doctors with greater freedom in
presenting their professional practices[7 ].
However, it is essential to highlight that this freedom is not restricted only
to the exposure of positive results; any disclosure of results must be
accompanied by the exposure of possible complications and risks inherent to the
procedures performed.
When it comes to publishing photos, it is imperative that they not only highlight
the visual results but also provide information about the consequences, risks,
and benefits associated with the procedure in question, considering different
patient profiles, age groups, and possible changes resulting from the procedure.
intervention. The change in legislation reflects the growing responsibility of
healthcare professionals to provide a complete and transparent representation of
their procedures, highlighting not only aesthetic results but also aspects
related to safety and possible benefits perceived by patients.
Therefore, the flexibility granted by the new legislation requires a responsible
approach on the part of doctors, who must ensure that their disclosures are
ethical and informative, providing a comprehensive and balanced view of the
procedures performed, taking into account ethnic diversity and the
particularities of each group demographic served.
The results of the study show that the media plays an important role in choosing
a plastic surgeon, especially when the success of plastic surgery and cosmetic
surgery procedures is demonstrated through before and after photos. However, it
is paradoxical to note that, despite this influence, the patients interviewed
expressed reluctance in procedures whose postoperative photos were clearly
manipulated by Photoshop. This phenomenon suggests that before and after images
are not only a visual representation of expected results but also play an
important role in constructing patients’ expectations and forming a beauty ideal
to be achieved.
However, it is crucial to note that the decision to undergo plastic surgery is
not determined exclusively by the media. Opinions from those close to us,
experiences shared by those who have already undergone the procedure, and social
support play a significant role in shaping patients’ decisions.
The observed phenomenon, related to the impact of results images and before and
after photos in plastic surgery, can be explained by the creation of high
expectations in patients. These expectations, when not met, can lead to feelings
of frustration and negatively affect self-esteem.
The standardization of beauty ideals conveyed by the media can contribute to the
internalization of these standards and, consequently, to body dissatisfaction in
certain populations.
Some psychopathologies, such as body dysmorphism, can increase dissatisfaction
with the surgical procedure. Even after achieving an excellent result, patients
living with this psychopathology are unable to see a satisfactory result with
the proposed procedure. This may be the explanation for the fact that 62.9% of
the patients in the sample stated that they had doubts about achieving 100% of
the final result.
CONCLUSION
Gonzaga & Araújo[8 ] emphasize that each
individual is unique, with the body being made up of two unequal halves.
Therefore, “predetermining certain results in the face of this natural sealing
of the human organism from bodily asymmetry would be an attack on human nature
itself”[8 ].
Medicine is not an exact science, each organism reacts in an individualized and
very personal way, there is no possibility of mathematically predicting a result
for any and all surgical practices, as results cannot be guaranteed due to the
unpredictability that can occur post-operatively.
The Consumer Protection Code (CDC)[9 ],
established by Law No. 8,078/1990, is legislation that establishes the rights of
consumers and the responsibilities of suppliers. Article 30 deals with the
obligations and responsibilities of those who convey information or advertising
and Article 37, in items 1 to 3, clearly prohibits misleading or abusive
advertising.
Many professionals display photos of plastic surgery results that have been
manipulated by the media, in addition to not explaining to patients the possible
complications, such as swelling, bruises, healing time, and body asymmetry, as
well as the relationship between the results of the procedures and the patient’s
lifestyle habits.
According to Kataoka et al., “the ‘media’ effect generates sometimes ‘surreal’
expectations or even sublimation of results”.[4 ] Plastic surgery is a medical specialty that plays a fundamental
role in the aesthetic and psychological transformation of many individuals.
Whether to correct physical imperfections, restore the function of body parts,
or improve self-esteem, plastic surgery offers a reliable and safe solution.
However, it is important to highlight the need for an ethical approach, to
ensure the well-being of patients and excellence in medical practice.
Bibliographical Record
