Plastic surgeons can get a lot of business through social media , but some surgeons take the entertainment aspect to extremes: dancing on camera during surgery, for example, or cradling someone’s excised tissue like a baby. The American Society of Plastic Surgeons wants to crack down.
Take this doctor, for example. On the webpage of New York City’s Cameo Surgery Center, he’s Scott M. Blyer, MD. He’s a cosmetic surgeon with a list of awards and achievements, bylines on “over one hundred” magazine articles and medical studies and degrees from both SUNY Stony Brook’s medical and dental schools. “He retains one additional key advantage that sets him apart from the rest: compassion,” his bio states. “Dr. Blyer genuinely cares about each and every patient he touches.”
But on Twitter, Instagram and Snapchat, he’s “Dr.Bfixin.” He loves his “job, [his] patients, & being LIT!” He posts videos in which he and his staff dance to pop songs in the midst of operations, tagging the artists. With a newly removed mound of pink fat resting on his forearm, Blyer, in full surgeon regalia, shakes to “Bag on Me” by A Boogie and Don Q, as an anesthetized patient lays still. In another video, a liposuction tool pounds back and forth into an unconscious body, as the camera pivots from a boogying Blyer to four of his staffers dancing in a line. The song is “Mi Gente” by J Balvin and Dr.Bfixin posts it to congratulate the reggaeton singer for topping a Spotify chart. He tweets at celebrities offering boob jobs and declares his enthusiasm for partying and 40s.
He’s one in a subset of plastic and cosmetic surgeons who use tawdry, attention-grabbing tactics on social media, says Clark Schierle, MD, PhD, a plastic surgeon and faculty member at the Northwestern University Feinberg School of Medicine. “They are regularly crossing the line to see how crass their content can be and gain attention,” says Schierle.
Schierle is a co-author of a new online code of ethics for plastic surgeons, set to be presented at the American Society of Plastic Surgeons’ annual meeting in Orlando this week. Currently, the society has no code for internet behavior.
The new standards would dictate that patients give “informed consent” about the use of footage from their surgeries. This specifies they get not just “adequate information” about their surgeries about also the “potential risks and benefit” of videos of the procedures online. It would also ban society members from “trivializing situations where patients are under anesthesia and are at risk of serious harm.”
Schierle says that plastic surgeons have long asked patients’ permission to document their procedures. In some cases, this is for educational purposes. They videotape operations as a teaching tool for medical students and so that potential patients can better understand a procedure they are considering. In other cases, the use of images is promotional. In a competitive field, cosmetic surgeons seek “before and after” photos displaying their work.
In the last few years, videos posted online became popular to a crowd just looking for the thrill of seeing a body cut open and manipulated, says Schierle, and some surgeons, vying for social media followers, were happy to engage them.
Snapchat, which allows users to share content that will be erased shortly after it’s viewed, helped facilitate this. The app is notoriously helpful for users sharing sexually explicit images while reducing the risk they’ll be stored, leaked and/or used as revenge porn. “It encourages the sharing of content that is more racy and naughty and the idea that I can get away with anything because it will be gone within 24 hours,” says Schierle. “As board-certified plastic surgeons, I think we should have higher moral standards than a 13-year-old sexting with her boyfriend.”
The behavior of certain surgeons on Snapchat is a degree more scandalous and silly than it is on Instagram or Twitter, says Schierle. While difficult to document, because of the nature of Snapchat, he says he has seen surgeons flaunting abdominoplasty specimens to a camera and juggling breast implants. Schierle says one invited viewers to a promotional event, enticing them with free booze and a DJ, while he performed surgery.
Schierle showed us a Snapchat image he said he saved from the account of Dr.BFixin. In it, Blyer and another person in a surgical outfit cradle lumps of tissue with emojis of baby faces on them. “Happy Mother’s Day,” it reads. “I don’t think dr.bfixin is the baby daddy tho.” Blyer is white, while the emoji baby face on the lump he’s holding is brown. (Blyer did not return a call seeking comment.)
The proposed ethical guidelines have two general principles. The first: Plastic surgeons should not perform an action solely meant to entertain while a patient is under anesthesia. “When you’re doing a Brazilian butt lift, there’s no reason to stop what you’re doing, put down the tool and do a booty dance,” says Schierle. Every aspect in a video posted online should have some educational value, he says.
Secondly, given that the doctor-patient relationship is one of “power imbalance,” surgeons should do what’s best for the patient, beyond getting their consent to be videotaped while anesthetized. If it’s not actually in the best interest of a patient to be in the centerpiece of a dance routine or a video invite to a party, surgeons should refrain, he says, even if the patient gave their okay.
“Plastic surgeons are always keeping patients from things that would not be good for them” in the long term, says Schierle. “Part of our job is protecting 40-year-old you from 20-year-old you.”
Schierle thinks some plastic surgeons have gone so far off the rails because the procedures are elective so there is a need to promote oneself that doesn’t exist in other specialties. Also, “the field has a celebrity vibe,” he says. “The patients are often celebrities, so the doctors try to appear as celebrities as well.”
Perhaps no plastic surgeon has ridden social media to a state of celebrity more effectively than Michael Salzhauer, MD, a.k.a. “Dr. Miami”. He has more than 83,000 followers on Twitter and 661,000 on Instagram. He told Vanity Fair that a peak of one million people tuned in on Snapchat to view one of his operations. Schierle calls him “patient zero of this phenomenon.”
Despite this, Salzhauer says he read Schierle’s ethical recommendations and says he doesn’t object. “If they come up for a vote, I’ll vote for them,” Salzhauer says from his Florida home.
The Dr. Miami Instagram account doesn’t have the operating-room theatrics of that of Dr.Bfixing. Salzhauer does dress his staff in elaborate theme costumes, such as these from the movie Aladdin. He also poses with recording artists and other Snapchat celebrity surgeons who come by his office.
But his operating room videos tend be limited to operations. They are quick and often contain a gross-out factor. In one, he empties out the tissue in a cyst as someone makes a gagging sound. In another, he shows the fat removed from a breast reduction in a video of a few seconds and encourages fans to tag a friend to “educate them today about breast reductions or ruin their lunch.” In a recent video, the “dancing hotdog” filter is imposed over a tummy tuck.
“The dancing hot dog is a very funny meme,” Salzhauer says, “which like bitmojis can be superimposed on any photo or video with a swipe. I’ve never had a patient complain about any filter or bitmoji over the last three years.” He says the person under the knife in the video found the hot dog funny.
He says he wants his social media to reflect the “fun vibe” of his office and it’s a misconception that operating rooms are always solemn or intense places. His is “more what you see in the TV show Mash,” he says.
This week, plastic surgeons are voting on the notion that a patient’s okay is not enough to justify putting their discarded fat in a gross-out video or in a shout-out to a pop star. Salzhauer, who adds that his practice is booked for the next two years, says patients should be trusted with the decision to decide what kind of surgery experience they want — even if it’s one that might seem goofy to others.
“I think people who come in have seen our social media and know what they are getting into,” says Salzhauer. “It attracts a certain clientele, because they’ve seen what we do. It’s the ultimate in informed consent.”