In 2004, Anthony Youn, MD, had his first brush with fame — a three-minute spot on Dr. 90210. At the time, he was pursuing a plastic surgery fellowship with his mentor, a star of Dr. 90210’s season one. After the filming, but before the segment aired, Dr. Youn returned home to Detroit, a rookie surgeon launching a fledgling practice. After months of attempting to drum up business the old-fashioned way — “Bringing bagels to family doctors’ offices, giving local talks to the Lions Club, just hoping to get someone to consider me for their doctor,” he recalls — his episode aired. The next day, Dr. Youn booked 14 new consultations. Says the board-certified plastic surgeon, “My practice exploded from there.”

Over the next decade, Dr. Youn split his time between the operating room and TV studios, serving as a medical expert on shows such as The Rachael Ray Show and The Doctors. He then pivoted to social media, well before it was customary for physicians to do so. Still, it wasn’t until 2020, when the pandemic shuttered his practice, that he fully embraced the medium. “I started creating content that wasn’t necessarily meant to entice people to come to my office, but to educate them, and even moreso, to entertain them and supply them a chuckle during a scary time,” he says.

Dr. Youn has since become one of plastic surgery’s most illustrious (and hilarious) social media stars, with more than 8 million followers on TikTok, another million on Instagram, a YouTube channel, and a Snapchat show. His brand of humor is zany and self-deprecating — yet always compassionate — and he’s known to rib other popular doctors in his posts. His mock feud with fellow plastic surgeons Richard Brown and Christian Subbio has gone viral in aesthetics circles.

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The rise of Instagram surgeons

Dr. Youn belongs to a controversial club of “Instagram surgeons”: high-profile doctors who’ve built massive, impassioned followings across several platforms. They share their work, their patients, and their personal lives. They tout their philosophies, techniques, and tricks for recovery. They proselytize about procedures, react to outrageous TikToks, debunk medical myths, connect with patients, and speculate about the work being done in Hollywood. They invite us into their exam rooms and operating rooms. And sometimes…they dance.

Occasionally, this penchant for attention-seeking crosses a line. In July, board-certified plastic surgeon Katharine Roxanne Grawe (“Dr. Roxy”) lost her Ohio medical license after several patients suffered life-altering complications following their surgeries, parts of which had been live streamed on TikTok. Much of the outrage surrounding Grawe’s case has focused on her filming the procedures, but the State Medical Board of Ohio actually revoked her license for “failure to meet standard of care.”

Broadcasting surgery may seem taboo, but it’s entirely legal, assuming the patient has given written consent. And Grawe was hardly a trailblazer in this realm: Remember the rise of the “Snapchat surgeons” in 2016? Nevertheless, when medical problems occur in the setting of a social media performance, the optics are damning.

Unsurprisingly, the term “Instagram doctor” has become mostly pejorative, implying a lack of repute (and often punctuated with an eye roll). While plenty of surgeons defy this stereotype, some do embody it. They’re generally the ones who are wildly famous online yet largely unknown in the field itself, explains Joseph Jericho, a social media marketing director for aesthetic medical professionals in Beverly Hills. (Many doctors now have digital strategists on staff; others hire freelancers, like Jericho, to run their accounts.)

The social media personalities Jericho describes aren’t collaborating with peers or lecturing at plastic surgery meetings. “They wouldn’t even be invited to those conferences,” Jericho says. The most unsavory of the bunch acquired early notoriety by “doing ridiculous things online,” like freestyle rapping over unconscious patients during BBLs or performing breast lifts from behind Swarovski-encrusted sunglasses.

Steven Teitelbaum, MD, a board-certified plastic surgeon in Santa Monica, California, likens these types of physicians to former presidents whose crude antics demean the Oval Office. He believes certain social media-famous surgeons have contributed to an “erosion of decorum” in plastic surgery. “By making it look like a circus, they create fear among serious thinkers considering having surgery,” he says. Dr. Teitelbaum frequently has to reassure patients that the practice of plastic surgery is far less flippant and infinitely more delicate than what the “Brobdingnagian breast implants and rough-looking liposuction” they see online may suggest.

No doubt, “you’re going to have plastic surgeons who embarrass our specialty on social media,” adds board-certified Beverly Hills plastic surgeon Kelly Killeen, MD. The cringe potential climbs as more and more log on. In 2010, only 30% of plastic surgeons reported using social media to advertise their practice. By 2019, that figure had more than doubled. The next year, Jericho says, as TikTok took off, doctors joined in droves, eager to engage during lockdown.

These days, the majority of cosmetic plastic surgeons, particularly those in private practice, are active on one or more platforms. It has almost become a professional requirement. Says Jericho, “I'm now getting contacted by doctors who, years ago, told me they don't need social media. They realize they were wrong.”

The perks of social media fame

Exposure is an obvious boon — and one that can create unexpected rewards. In 2018, the Aesthetic Surgery Journal published a finding that “Google ranking of plastic surgeons values social media presence over academic pedigree and experience.” The analysis shows that doctors with more followers dominate first-page Google search results. This is no small thing: Google is usually the first place people look for plastic surgeons.

Beyond prime billing for their websites, surgeons with a robust following enjoy a bounty of patient referrals via the platforms they frequent. Mike Nayak, MD, a board-certified facial plastic surgeon in St. Louis, calls social media “the new word of mouth.” It’s his richest source of referrals — two-thirds come from Instagram, one-third from Facebook — with the lion’s share flying in from out-of-state or abroad.

Dr. Nayak has seen social media trounce conventional forms of advertising. For nearly a decade, some of his billboards appeared along I-70 in St. Louis, but he recently gave them up. “It didn’t make sense to keep them,” he says. These days, by the time most patients see them, they’re already in town for surgery.

Social media success like Dr. Nayak’s is hard-earned. His Instagram feed is an ever-evolving clearinghouse of compelling info: patient Q&As, recovery journeys, and easy-to-grasp insights on trending treatments. He says he produces it all in-house, devoting around seven to 10 hours a week to content creation, occasionally enlisting his clinical team to help take photos or interview patients. There’s evergreen content too, created not to woo future patients but to serve existing ones by easing post-op anxiety or demo’ing recovery instructions, such as nose taping post-rhinoplasty or exercises to speed healing after eyelid surgery. Instagram is where Dr. Nayak has found his fanbase. He describes his IG following as “the nicest, with the lowest percentage of trolls or keyboard warriors.”

Dr. Killeen prefers TikTok. As she’s ramped up her posting over the past couple of years, she’s seen a dramatic increase in patient inquiries that come from the platform. The quality of referrals she gets through TikTok is on par with those generated by her happiest patients, she says, because these newcomers arrive in her office having a sense of who she is. “They already know me — my personality, what I stand for, how I communicate,” Dr. Killeen explains. “I end up with a bunch of like-minded patients, and there’s a comfort level the first time [we] meet.”

She clicks with Gen Z’ers on TikTok, who have “a consistent desire for information and authenticity,” she says. “They don't like the traditional, wealthy, playboy plastic surgeon.” Rather, they crave camaraderie and interact freely with doctors who seem approachable and unscripted in their videos.

Most days, Dr. Killeen notes, “I just pick up my phone and answer people's questions. Or I'm looking a mess right after I get out of the OR, going ‘Oh, my God, I did something cool! Let me explain what happened today.’” Dr. Killeen’s practice, Cassileth Plastic Surgery, employs a social media expert to assist all four surgeons on staff, but she declines those services, choosing to create her own content “quickly and organically.”

Sometimes, through this digital discourse, the teacher becomes the student. “I’m learning from these interactions,” says Dr. Killeen. “I get a window into what people really want to know about procedures, and that helps me be a better doctor.”

Dr. Killeen credits social media with changing the power dynamic between patients and physicians and, above all, humanizing plastic surgeons by showcasing their individuality. Jericho, the social media marketer, urges his clients to post about themselves, not just their work. People are drawn to doctors who “mesh with their personality,” he says. It’s an evidence-based strategy: In a latest cross-sectional study of the top global plastic surgeons on Instagram, personal posts garnered the highest average engagement.

Of course, there’s more than one way to attract followers. The document-your-life-all-the-time approach never felt comfortable for Gary Linkov, MD. The New York City facial plastic surgeon uses his Instagram grid as a gallery for before-and-after photos, but he focuses most of his efforts on his YouTube channel and its 685,000-plus subscribers. Clocking millions of views, his long-form videos are educational, with a non-judgy celebrity spin. Dr. Linkov has done detailed facial analyses of Madonna, Simon Cowell, Michael Jackson, and others, in which he hypothesizes about the procedures they may have had through the years.

“It’s like fancy gossip,” says Dr. Linkov, sort of sheepishly. “You have to be engaging and dress up the information, but I’m not a clown on screen. I have boards to answer to — I always keep that in mind.” (Dr. Linkov is referring to the American Board of Otolaryngology – Head and Neck Surgery, which certifies him in his specialty, and the New York State Medical Board, which licenses him to practice medicine in his chosen state. He’s also careful to adhere to the ethical standards outlined by the American Academy of Facial Plastic and Reconstructive Surgery, or AAFPRS.)

More than half of Dr. Linkov’s referrals now come from social media. “Maybe 40% of my patients are from New York, but the rest fly in from all over the world,” he says. “It’s all because of YouTube — it’s such a big reach.”

As his social media stock has soared, so too has demand for his services. “To manage the volume of patients,” he recently doubled his prices while narrowing the scope of his practice to the two procedures he’s most passionate about: lip lifts and hair-restoration surgery (which currently start at $11,000 and $16,000, respectively, but are subject to change, Dr. Linkov says). He's also been able to monetize some of his YouTube content through ads that the platform runs within his videos.

Dr. Youn is similarly compensated by YouTube as well as TikTok, Facebook, and Snapchat. These earnings, which originally went to furloughed employees during the shutdown, now support Dr. Youn’s social habits, which take time away from paying patients. (He’s given up injecting on Tuesday and Thursday afternoons to dedicate more time to his social media pursuits.) Aside from an in-house video producer, who edits his YouTube content, he runs everything himself. “People ask me, ‘How do you have time to do all this?’” he says. “My answer is: ‘I don’t golf.’ My hobby is creating content.” To that end, he spends three weekday afternoons, plus most weekends, overseeing multiple feeds to maintain his social standing.

Meanwhile, Dr. Youn tells me, he knows of other “big-name” plastic surgeons seeking shortcuts to fame by buying followers, likes, and comments — “trying to exhibit they have clout when they really don’t.”

Why some doctors avoid social media

Social media represents only the latest crisis of conscience in the long, fraught history of medical marketing, which dates back to 1847, when the American Medical Association forbade physicians from advertising their practices, declaring it “derogatory to the dignity of the profession.” When laws loosened in 1975, many doctors still considered it gauche to promote their business; the more progressive types took out ads in the yellow pages. In the ’90s, some surgeons launched websites, sparking scandal. In the early aughts, plastic surgery reality shows roused ire for making a spectacle of the speciality. Then came social media, in all its ethical ambiguity.

Some doctors shy away from social, deeming it distasteful. Dr. Teitelbaum is on Instagram, but he rarely posts about surgery or patients. He prefers that people visit his website for an overview of his experience, aesthetic, techniques, and results (he constantly updates his photo gallery with standardized, long-term “afters”). The website, he says, “is thoughtfully organized to be digested as a whole,” like a properly balanced meal. What Instagram offers, in his opinion, is usually more akin to “junk food” — insubstantial, often artificial, sometimes sickening.

There are exceptions, of course. “Many accomplished surgeons have created highly educational social media programs,” Dr. Teitelbaum acknowledges, not wanting to paint his Insta-famous peers with too broad a brush. “My beef is with the surgeons of little accomplishment, who’ve propelled themselves to ‘stardom’ by making misleading posts, some of which denigrate the dignity of the profession through sophomoric humor, dishonest photography, and by falsely inflating their expertise.”

Currently, Dr. Teitelbaum doesn’t feel a need to amplify his digital presence, despite the economic incentives, which aren’t lost on him. “I see total unknowns charging exorbitantly high fees,” he says, presumably because they found stardom on Instagram or TikTok. “As with any economic exchange, I believe that whatever an individual charges for non-emergency, elective aesthetic surgery is reasonable,” adds Dr. Teitelbaum. “It just annoys me that a few surgeons whose notoriety is based primarily upon amusing and often misinformative social media posts have climbed to the top of the fee structure.”

He continues, “My career-long assumption had been that high fees would be the realm of surgeons who earned their reputation through bona fide accomplishments in quality care, innovation, and education, but regrettably that notion is largely quixotic.” (Quick context on plastic surgery pricing, which is insanely variable: The going rate for a tummy tuck, including anesthesia and facility fees and maybe a little lipo, ranges from $10,000 to $20,000, but a star surgeon could command upwards of $50,000. A facelift can be had for under $30,000, all-in, but there are Instagram giants charging 10 times that.)

Still, Dr. Teitelbaum contends, plastic surgeons who abstain from the apps may appeal to a certain class of patients, namely those who relish privacy and propriety. Other holdouts say the same. Even Jericho thinks there’s something to this: “It becomes very intriguing when someone doesn’t have an online presence, yet they’re booked out and their results are amazing,” he says.

But the data tells a different story: In a 2023 survey examining patients’ perceptions of aesthetic providers on social media, 41% indicated that a social media presence boosted their desire to visit a doctor; only 9% favored zero presence.

While Melinda Haws, MD, a board-certified plastic surgeon in Nashville and the president of The Aesthetic Society, isn’t anti-social media, she’s not a very active participant, mainly because her “mature” practice doesn’t demand it, she explains. “We’ve been here forever and we’re still booked three months out for consults,” she says. Plus, at 57, “I’m not looking to get busier.”

For other doctors, social media is too time-consuming, or it doesn’t feel authentic, risks patient privacy, or is frowned upon by the university or hospital that signs their paychecks.

But none of these excuses resonate with Rod Rohrich, MD, a board-certified plastic surgeon in Dallas who’s been operating since the ’80s. “You have to be in tune with social media to be a modern plastic surgeon,” he staunchly asserts. He sees it as a duty. “If you’re not on social media and understanding what patients are talking about, then you’re living in the past.”

How social media shifts attitudes about plastic surgery

For better or worse, social media has heightened the public’s acceptance of cosmetic surgery, increasing interest in procedures. Says Jericho, the social media strategist’s objective is to also generate buzz, not just profits. “We’re creating awareness, becoming part of people’s conversations,” he says. In LA, he adds, it’s not unusual to overhear friends discussing famous surgeons’ accounts over coffee or lunch. “They’re like, ‘Oh, my God, did you see Dr. Karam’s post the other day?’ We’re making an impression.”

Doctors strive to do this by dropping medical pearls or hot takes. Controversial courses — Are BBLs really deadly? Is the “liquid facelift” a scam? — are catnip for the scrolling masses. These educational posts have been shown to outperform most other types of plastic surgery content (on TikTok, especially), underscoring the public’s desire to learn about procedures from board-certified plastic surgeons.

The doctors I interviewed agree that patients today are more knowledgeable and inquisitive than previous generations, courtesy of social media. And research confirms it: In a study published earlier this year in Plastic and Reconstructive Surgery, researchers from Harvard Medical School determined that social media use appears to “positively impact” plastic surgery patients’ level of “empowerment,” which the authors correlate with more informed decision-making and better health care outcomes and experiences.

In celebrating social media’s upside, we can’t overlook its reputation for unshrouding cosmetic treatments that have long been stigmatized (despite evidence supporting their ability to transform not only appearance but body image, self-esteem, psychosocial well-being, and quality of life). However, when surveying the cosmetic landscape across social media, the objective eye can spot at least as many pitfalls as peaks. The procedural insights shared by surgeons may be biased, reductive, or fueled by an agenda. The patient anecdotes, if they glaze over risks and complications, can seem sugarcoated. The before-and-after pictures tend to be largely cherry-picked and unreliable, notorious for breeding unrealistic expectations and the kind of disappointment that spirals into additional surgery.

“A lot of posts make plastic surgery seem too fun, too colloquial, too simple,” says Dr. Teitelbaum. Indeed, there’s a difference between presenting plastic surgery as acceptable (It’s okay to do this) and portraying it as fashionable (Everybody’s doing it): The first sentiment relieves pressure, but the second applies it. If experts aren’t mindful, their messaging can easily slip from permissive to prescriptive. “My job is not to convince patients into surgery,” adds Dr. Teitelbaum, “but almost to convince them out of it” by encouraging circumspection.

In real life, plastic surgery is a nuanced specialty, propelled by debate and opposing viewpoints. But on social media, where details are edited and distilled, strong, singular opinions are voiced in black-and-white terms. Whether it’s the “best” facelift or the “safest” breast implant, “when you hear someone say something definitively, with that much conviction,” says Dr. Nayak, “it’s got to be true.” Even if it’s not — not entirely, not universally.

During consultations, surgeons are routinely revising and expanding patients’ online learnings — and urging them not to conflate social media status with real expertise. When people see Dr. Rohrich for revision surgery, they often say, “My doctor had a million followers, so I thought he really was good.” Social media stats can supply patients “a false sense of security,” he explains, “lulling them into doing surgery” with mediocre doctors.

This particularly happens when those MDs boast a Taylor Swift-like charisma and legions of adoring fans. “I always worry that patients, especially young women, are going to sign up for something because they want to be part of that glow,” says Dr. Killeen, and not because they have a real concern to make a change. She aims to dim that glow by using TikTok to reveal the unvarnished truth about plastic surgery, including the “negatives,” like hard-to-hide lip lift scars and persistent lumps from too much fat grafting.

So, where’s the line?

Adam Rubinstein, MD, a board-certified Miami plastic surgeon, posts directly from the operating room. He was among the first to Snapchat surgical procedures and prides himself on demystifying plastic surgery for the public. “They need to know what real surgery looks like,” he says, “not a glamorized version of it.”

But not everyone reporting from the OR has noble intentions. Dr. Rubinstein has witnessed the practice “go off the rails and get more risqué and less appropriate” over time, yet he still sees value in publicizing surgical footage “if it’s done with dignity and integrity, with respect for the patient, and with the main purpose being education,” he says. “It’s when you make entertainment the priority, and education secondary, that things start to go sideways.”

Dr. Rubinstein doesn’t live stream his surgeries as Dr. Roxy purportedly did. Instead, his assistant captures key moments of an operation and uploads them a bit later, with patient permission. “Going live at the time of surgery is distracting and less controlled than taking a simple clip to demonstrate what you’re doing,” he says.

As doctors are quick to point out, teaching during surgery, virtually and in-person, has long been an integral part of medical education. But social media has broadened the definition of pupil to include not just students and residents but anyone with an internet connection. Dr. Rubinstein says his patients (and their families) appreciate his on-the-table outtakes for the transparency. Many found him through social media and, ultimately, chose him because they liked how he behaves during surgery — the care he shows, the effort he puts forth.

In the wake of the Dr. Roxy case, though, some are hesitant to post surgical content. “I wouldn’t even suggest it anymore,” says Jericho. “It feels a little too risky.”

But it’s not prohibited by the American Society of Plastic Surgeons (ASPS), The Aesthetic Society, or the AAFPRS, the three professional groups to which most board-certified plastic surgeons belong. Both ASPS and AAFPRS permit live streaming while stressing informed consent and patient privacy. The Aesthetic Society doesn’t officially forbid or condone the trend, but Dr. Haws, its president, asserts that it is potentially hazardous. During surgery, “even the most routine of situations can become critical in a split-second,” she says. “The last thing you need is the distraction of a live stream.”

What role do the various platforms play in governing plastic surgery content? Allure reached out to Meta (which owns Facebook and Instagram), TikTok, Snapchat, and YouTube to find out. TikTok did not respond to Allure’s requests for comment. Meta outlines numerous policies restricting the promotion of elective cosmetic surgery via ads, branded content, and organic content, particularly to users under 18. On a broader scale, Meta regulates cosmetic procedures much like it does weight-loss products, in an effort to combat “miraculous claims” and “negative body image.”

Snapchat shares similar guidelines, prohibiting the spread of “harmful, false, or deceptive information, including unsubstantiated medical claims.” The platform also characterizes cosmetic procedures as “sensitive content,” making it “ineligible to be recommended to a large audience.” On Snap, promotional or sponsored posts featuring cosmetic surgery can’t target “anyone under the applicable legal age where the content is being displayed.”

YouTube developed its community guidelines alongside health professionals and other experts "to make sure we are drawing the line in the right place," the company says. It enforces its policies via human review and automated flagging. (In 2020, YouTube launched a health initiative aimed at prioritizing high-quality health content from credible sources, like licensed health care professionals.) It has policies against "certain kinds of medical misinformation" as well as "content that is violent or graphic or shocking," including footage of medical procedures that provides no education or explanation to viewers, according to YouTube.

Surgical footage that would otherwise violate guidelines may stay up if it has educational, documentary, scientific, or artistic context. The platform may apply warnings and age restrictions to such content. Doctors who want to live stream on YouTube must have their channels Verified and be clear of live streaming restrictions for 90 days prior.

While the other platforms also allow the broadcasting of surgery, they may censor images and videos that show blood and naked bodies. Some, like Instagram, flag them as “graphic or violent,” making you click to continue. Others, like TikTok, allow blood in an “educational context.” Accounts that violate nudity rules — by showing female nipples, for instance — may be suspended or have their posts removed or their reach limited.

Now more than ever, social media platforms seem to be cracking down on before-and-after photos, particularly those featuring the results of breast and body procedures. A number of surgeons say they’ve recently been penalized for such posts. Aiming to avoid detection, some are abandoning standardized clinical photos — which have long been used to document and analyze surgical outcomes — in favor of patient selfies and immediate “after” shots taken in the operating room. This is just one factor contributing to a dramatic surge in unorthodox and deceptive images online, which Allure will investigate in part two of this series.

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Originally Appeared on Allure

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