Ethics in Aesthetics: The Influence of Social Media Platforms on Aesthetic Procedures in Saudi Arabia

Abrar E Bukhari, Dalal A AlDosari^*, Mohammed A Almashali, Leena M.Alzakry, Yara K AlKhalid and Al-Mazidi Sara H

^*Correspondence: Dalal A AlDosari, Department of Dermatology, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Saudi Arabia, Email:

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Introduction

The demand for aesthetic procedures continues to increase. According to the American Society of Plastic Surgeons, aesthetic surgeries (such as liposuctions, rhinoplasties, and facelifts) and procedures (such as laser hair removal, fillers, and Botox) increased by 131% between 2000 to 2020 [1]. Many factors affect the decision to undergo an anesthetic procedure, such as age, gender, and culture [2,3]. Social media has recently gained popularity for promoting aesthetic procedures [4]. The reason is not only due to the promotion of beauty standards and altering self-esteem and body image but also due to plastic surgeons and dermatologists marketing for their practice on social media [5]. Some social media platforms have developed a feature called "filters," that even out the skin tone and change certain facial features, which plays an essential role in aesthetic procedures [6]. According to a study published in 2019 by Arab et al. participants who posted their pictures online without using a filter reported that they required an aesthetic procedure [7].

In this study, we aimed to assess the relationship between aesthetic procedures and social media among Saudis. We also aimed to discuss the ethical considerations of dermatologists and plastic surgeons to meet patients' demands due to social media trends.

Methods

This cross-sectional study was approved by the Institutional Review Board of Imam Mohammed bin Saud Islamic University (IRB number 74- 2021) on April 14, 2021.

A 22-item self-administered online survey using Google Forms® (Google LLC, Mountain View, CA) was prepared and administered randomly to social media users in Saudi Arabia through WhatsApp and Twitter and also sent to 5000 random cellphone numbers via short message service (SMS). The survey was conducted from May 2021 to July 2021 in both Arabic and English.

The participants were adults in Saudi Arabia aged 18 years and older. Informed consent was obtained from all participants through an introductory paragraph that explained the aim of the study and that their participation was voluntary. The consent form also ensured complete anonymity and that participants could withdraw from the study at any time.

A total of four adults were invited to participate in a pilot test of the survey and provide feedback prior to the main distribution. Minor changes were made accordingly.

The survey included closed-ended questions that assessed demographics, which included gender, age, marital status, educational level, and monthly income. The second section included information regarding social media platforms, the duration of time spent on those applications, the type of influencers they followed on social media, and the filter features. The third section included past aesthetic procedures and surgical history or preferred aesthetic procedures for which they considered opting in the future and the main reason for this decision. This section also assessed participants' satisfaction with their previous aesthetic procedure results. Patients' awareness of the potential complications of aesthetic procedures and the source of their information was also evaluated.

Statistical analysis

All data analysis were conducted using Statistical Package for Social Science (SPSS) software version 26. The results were presented as frequencies and percentages. In addition, a chisquare test and t-test were used to assess the relationship between demographic factors and the prevalence of plastic surgery.

Results

In this study, 1050 participants responded to the survey (Table 1). Of the respondents, 80.4% were females aged between 30 and 39 years and were educated with a relatively high income. Our results showed a significant positive relationship between aesthetic procedures, education, and monthly income.

Table 1: Demographic characteristics of the participants (n=1050).

Approximately half of the participants (47%) spent more than four hours a day on different social media platforms (Table 2). The most commonly used application was WhatsApp (27.7%), followed by Snapchat (22.8%) (Figure 1).

Figure 1. Most used social media application.

Table 2: Usage of social media application and the frequency of using filter while taking a photo.

Regarding aesthetic procedures, 29.3% of the participants had undergone previous aesthetic procedures, while 55.5% of the participants considered having an aesthetic procedure in the future (Figure 2).

Figure 2. Percent of participants who had an aesthetic procedure and who are considering having one.

More than 60% of the participants indicated they used filters when they took photos. Participants who indicated that they could not take a photo without filters were significantly more prone to undergo aesthetic procedures (36.3%) (p < 0.005) and were more likely to consider them in the future (77% ) (p < 0.005) compared to those who did not use filters or did not frequently use them. Interestingly, 58% of the participants who had used social media for only one year believed that they did not need any aesthetic procedures. However, this percentage dropped to 41% for those who had been using social media for more than three years. We also found that 34.4% of the participants who used social media, even for less than two hours a day, had an aesthetic procedure.

Although 86.7% of the participants indicated that they were aware of the potential complications associated with aesthetic procedures and surgeries, 30% underwent at least one procedure, and 57.4% considered having one in the future. Table 3 shows the characteristics of the aesthetic procedures and surgeries the participants underwent. More than 66% of the participants did not get a professional opinion and relied on social media and the Internet to obtain information on aesthetic procedures. Surprisingly, 59% of the satisfied participants' aesthetic procedure results depended solely on the medical specialist’s opinion. Only 3.6% of the participants who depended on professional consultations were dissatisfied with their results.

Table 3: Characteristic of aesthetic procedures and surgeries the participants underwent.

Discussion

Several factors may influence the decision to undergo aesthetic procedures, and social media use is an important factor [8]. Social media sets an unrealistic beauty standard that causes some people to feel insecure about their appearance. Hence, they use filters and photoshop to hide their imperfections [9]. In our study, most photo filter users considered aesthetic procedures if they did not already have one, which was consistent with a previous study [10].

Although most of our participants were aware of the complications of aesthetic procedures and surgeries, we found that the prevalence of participants who had aesthetic procedures or considered having one in the future was high. However, our findings were lower than those previously reported in Riyadh, which stated that 52% of the participants had aesthetic procedures, while 79% were willing to undergo an aesthetic procedure in the future [10]. The lower incidence in our study might be since our participants included both males and females and were distributed among a larger, less selective sample, whereas the other study included only females in a single center in Riyadh.

Most of the participants who had aesthetic procedures believed that they needed these procedures, while only a minority reported that they were affected by social media. Similar results were previously reported [11]. However, we found that most of the participants who thought they needed aesthetic procedures to improve their image had been using social media for more than three years. It is possible that prolonged media exposure indirectly internalized appearance ideals, which positively influenced their desire for cosmetic procedures [8].

Unrealistic patient requests are a genuine issue for clinicians. In several cases, patients present their filtered selfie images to clinicians and request them to adjust the patients’ appearance accordingly [12]. Many patients are concerned regarding a flaw that is not noticed by others [13]. What is the role of dermatologists and plastic surgeons in social media trends and patient demands? Will it be appropriate for some patients to be psychologically evaluated before specific aesthetic procedures or surgeries? Recently, a scale called the aesthetic procedure expectations (ASPECT) scale was suggested at cosmetic clinics to assess the unrealistic expectations of clients who attended cosmetic clinics [14]. In addition, patients with body dysmorphic disorder were commonly found to seek aesthetic procedures and usually had unrealistic expectations and were dissatisfied with previous procedures. These patients should be recognized and referred to a psychiatrist for a thorough psychological evaluation [15].

In our results, most patients who were satisfied with their results depended solely on the clinician’s consultation. Similar results were reported in previous studies [16,17]. This indicates that professional consultation is essential for patient satisfaction, and sometimes rejecting patient requests is ethically and professionally rewarding for both the clinicians and patients [18,19].

Conclusion

Social media is a powerful tool for promoting and idealizing beauty. This would increase the ethical obligation of clinicians towards new social media trends and patients with unrealistic expectations. Clinicians can use social media to raise public awareness of these issues, which would aid in identifying these vulnerable populations.

Acknowledgment

We thank all participants who contributed responses to the study.

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