Investigation of Patients’ Motivation for Cosmetic Surgery in a Nationwide Cosmetic Surgery Group

Abstract

Background:

Recently, cosmetic surgeons in Japan have used social media to advertise their procedures. We analyzed the influence of social and other media on patients’ motivation to visit our clinic using the aggregated results of a questionnaire distributed to our cosmetic surgery group.

Methods:

We obtained the data of 146,108 patients from our database between September 2018 and February 2023. To understand changes in patient motivation over time, patient motivation was compared between the opening (September 2018–February 2020), growth (March 2020–August 2021), and expansion (September 2021–February 2023) periods.

Results:

Most patients were motivated to visit clinics by the internet (53.7%) and Instagram (17.3%). Between the opening and growth periods, the internet [odds ratio (OR) 1.28; 95% confidence interval (CI), 1.14–1.43] and referrals (OR, 1.48; 95% CI, 1.08–2.01) significantly increased. Between the opening and expansion periods, there was a significant increase in TV (OR, 4.86; 95% CI, 3.09–7.65) and TikTok use (OR, 24.9; 95% CI, 3.50–177.0). There was more variability in the motivation to visit our clinic during the expansion period than during the other periods, and patients’ motivation differed by procedure and region. In addition, TikTok was used primarily by patients in their late teens and early twenties, whereas TV was used by those in their twenties and forties. YouTube, referrals, and review websites were distributed bimodally.

Conclusions:

Patients choose information from various media sources. To attract more patients to our clinics, it is important to disseminate information on both the internet and social media.

Takeaways

Question: Recently, cosmetic surgeons in Japan have used social media to advertise their procedures. To understand the influence of social and other media on patient motivation, we analyzed the aggregated results of a questionnaire survey in our cosmetic surgery group.

Findings: Especially, in the recent period, there was more variability in the motivation to visit our clinic, and patients’ motivation differed by procedure and region.

Meaning: We revealed that patients choose information from various media sources. To attract more patients to our clinics, it is important to disseminate information on both the internet and social media.

INTRODUCTION

In 2017, nearly one-third of the world population, including four-fifths of the US population, used social media.^1,2 Sorice et al³ reported that, compared with a practice’s website, social media played a minor role in influencing patients to choose a practice and providing information on what to expect on the day of the appointment. However, the situation has changed in recent years. As of 2023, social media users now account for over half of the world’s population. In Japan, two-thirds of the population use social media.^4,5 In real clinical practice, we often meet patients who have chosen to visit our clinic after checking case photographs and videos on social media. This rapid increase in social media use may have a great impact on patients’ motivation to visit our cosmetic surgery clinic.

In 2010, only 30% of plastic surgeons in the United States reported using social media as a source of advertising, whereas 92% of plastic surgeons reported using their practice websites. However, 62% of plastic surgeons believed that social media could benefit their practice.⁶ In recent years, many cosmetic surgeons in Japan have used case photographs and videos on social media to advertise their procedures. There is foreign literature that analyzes whether social media affects new patients who visit cosmetic surgery clinics.³ However, the types of data with which we can analyze the influence of social media on the motivation of these patients do not exist in Japan. In addition, to our knowledge, no studies have investigated the influence of other types of media.

Our cosmetic surgery group is the fastest-growing and largest cosmetic surgery group in Japan. Our efforts to manage and operate our media, including social media, have contributed to our group’s rapid expansion. Japan has several cosmetic surgery clinics and clinical groups; thus, to develop into a large group and continue to grow, it is necessary to provide procedures that both meet the needs of the patients and communicate effectively with new patients to attract them to our clinic. However, cosmetic surgery is a field in which trends change over time. Therefore, we must constantly collect new information and keep up-to-date with current trends. Currently, our group has an overwhelming number of patients; therefore, our large-scale data reflect the current state of cosmetic surgery in Japan to some extent. In this study, to understand the influence of social and other media on patient motivation, we analyzed the aggregated results of a questionnaire survey distributed to patients in our cosmetic surgery group.

METHODS

Data Acquisition

We obtained the data of 274,763 patients from our database between September 2018 and February 2023. Cases in which the patient’s personal data, including age, gender, occupation, registered date, treatment details, or motivation for visiting the clinic, were unknown were excluded. In total, the data of 146,108 patients were included in this study (Fig. 1). To understand changes in patients’ motivation to visit clinics over time, the periods from September 2018 to February 2020, March 2020 to August 2021, and September 2021 to February 2023 were defined as the opening, growth, and expansion periods, respectively. Patient motivation was compared among the three periods.

Fig. 1.

A flow chart of the patients included in this study.

Procedures

To evaluate the impact of media in each procedure, the procedures were classified into categories. Double eyelid procedures with or without incision, blepharoptosis, epicanthoplasty, and lower eyebrow lifts were categorized into “eyes.” Removal of dark circles under the eyes, with or without incision, was referred to as “dark circles under the eyes.” Rhinoplasty, philtrum shortening, reduction of the nasal alar, and nasal protuberance were categorized into “nose.” Facial procedures that did not include the eyes or nose were classified as “other.” Acne vulgaris, freckles, high intensity focused ultrasound, and tattoo removal were classified as “skin.” Treatment for erectile dysfunction, androgenetic alopecia, cosmetic products, injections/infusions, internal and external medicines, injections for dark circles under the eyes, piercings, and armpits/hyperhidrosis were categorized as “other.”

Motivation for Visiting Clinics

Patients’ motivations for visiting clinics were extracted from the results of a questionnaire survey at the time of the visit. Patients selected only one representative media in this questionnaire. Social media is defined to be a type of two-way media that allows individuals to transmit and exchange information on the internet. Representative examples include blogs and social networking services such as Facebook and Twitter, video-sharing sites such as YouTube, and messaging apps such as Line. In our group, doctors regularly posted photographs and videos of patients on Instagram, YouTube, and TikTok. Platforms other than Instagram, YouTube, and TikTok were classified as “other” social media platforms. As a premise, these motivations could be influenced by our marketing strategies in each media. In our group, the advertising method in each media has been changing according to the Japanese popularity of media, and TV commercials were used during the expansion period when our group rapidly expanded.

Statistical Analyses

All statistical analyses were performed using the R software (version 3.5.0). The Mann–Whitney U test was used for age when comparing the three periods. To compare sex and motivation, P values were calculated using Pearson chi-squared test. Statistical significance was set at P less than 0.05.

Ethical Statement

The present investigation was approved by our local ethics committee (ethical review board of TCB). This study was conducted in accordance with the 1964 Declaration of Helsinki (revised in Fortaleza, Brazil, in October 2013).

RESULTS

Patients’ backgrounds and motivations for visiting clinics are summarized in Table 1. The median patient age was 30 (range: 24–41) throughout the entire analyzed period. The median ages in the open, growth, and expansion periods were 30 (25–39), 29 (24–39.5), and 30 (23–42), respectively. Compared with the opening period, a wider range of age groups was present in the growth and expansion periods. Women constituted the majority of patients (88.4%); however, the proportion of men in the growth and expansion periods was significantly higher than that in the opening period.

Table 1.

Patients’ Backgrounds and Motivations

Description	Total (n = 146,108)	Opening Period (n = 1224)	Growth Period (n = 20,743)	OR (95% CI)	P	Expansion Period (n = 124,141)	OR (95% CI)	P
Median age (y)	30 (24–41)	30 (25–39)	29 (24–39.5)	–	P = 0.0213	30 (23–42)	–	P = 0.0558
Sex
Male	17,021	120	2431	1.22 (1.01–1.48)	P = 0.0421	14,470	1.21 (1.00–1.47)	P = 0.0444
Female	129,087	1104	18,312	0.82 (0.68–0.99)		109,671	0.82 (0.68–1.00)
Media					P < 0.0001			P < 0.0001
Internet	78,425	641	12,117	1.28 (1.14–1.43)		65,667	1.02 (0.91–1.14)
Instagram	25,214	183	3369	1.10 (0.94–1.30)		21,662	1.10 (0.94–1.30)
TV	9165	19	308	0.96 (0.60–1.52)		8838	4.86 (3.09–7.65)
YouTube	6954	58	1121	1.14 (0.88–1.51)		5775	0.98 (0.75–1.28)
Referral	6849	43	1058	1.48 (1.08–2.01)		5748	1.33 (0.98–1.81)
Review website	5921	105	921	0.50 (0.40–0.61)		4895	0.44 (0.36–0.54)
Other social media platforms	3672	20	444	1.32 (0.84–2.07)		3208	1.60 (1.03–2.49)
TikTok	2611	1	133	7.89 (1.10–56.5)		2477	24.9 (3.50–177.0)
Magazine	2206	40	497	0.73 (0.52–1.01)		1669	0.40 (0.29–0.55)
Advertisement/signboard	983	31	128	0.24 (0.16–0.36)		824	0.26 (0.18–0.37)
Other	4108	83	647	0.44 (0.35–0.56)		3378	0.38 (0.31–0.48)

In the growth and expansion periods, the OR (95% CI) and P values were calculated and compared with those in the opening period.

The internet (53.7%) and Instagram (17.3%) inspired the majority of people to visit clinics, followed by TV (6.3%), YouTube (4.8%), and referrals from acquaintances (4.7%). Compared with the opening and growth periods, the internet and referrals increased significantly (the internet: OR, 1.28; 95% CI, 1.14–1.43; referrals: OR, 1.48; 95% CI, 1.08–2.01). Between the opening and expansion periods, there was a significant increase in TV (OR, 4.86; 95% CI, 3.09–7.65), TikTok (OR, 24.9; 95% CI, 3.50–177.0), and other social media platform (OR, 1.60; 95% CI, 1.03–2.49) use. There was a significant decrease in the rate of patients who visited a clinic after viewing magazines (OR, 0.40; 95% CI, 0.29–0.55) or advertisements/signboards (OR, 0.26; 95% CI, 0.18–0.37).

Figure 2 shows patients’ motivations for visiting clinics in terms of procedure and region. There was more variability in the motivation to visit a clinic during the expansion period than during the opening and growth periods. Social media accounted for a higher proportion of visits for eye procedure than for other procedures, regardless of the period (opening and growth period: 39.3%; expansion period: 40.2%). Compared with the opening and growth period, there was a significant increase in social media inspiring visits for procedures pertaining to dark circles under the eyes in the expansion period (OR, 1.26; 95% CI, 1.08–1.47). During the expansion period, social media accounted for a low proportion of visits for moles/warts (12.0%), gynecological plastic surgery (16.9%), hair removal (15.5%), and skin procedures (16.9%).

Fig. 2.

Graphs showing patient motivation to visit clinics in each period. A, Motivation by procedure, B, Motivation by region.

Regarding regions, there was more variation in the reasons for visiting clinics during the expansion period than during the opening and growth periods. In Hokkaido/Tohoku, there was a rapid increase in social media inspiring visits to clinics during the expansion period compared with the opening and growth periods (OR, 2.39; 95% CI, 1.08–1.47). During the expansion period, the ratio of social media use was low in large cities, such as Tokyo and Osaka (Tokyo 24.4%; Osaka 24.2%) and high in regional cities (Hokkaido/Tohoku 39.6%; Kinki/Chugoku/Shikoku 28.0%; and Kyushu/Okinawa 29.8%).

Figure 3 shows the age differences in patients’ motivation to visit clinics. The majority of people were motivated by the internet and Instagram (70.9%) to visit clinics, and their age distribution was similar. TikTok use was concentrated in patients in their late teens and early twenties, whereas TV, YouTube, referrals, and review websites were distributed bimodally between those in their twenties and forties. Although there was little difference for magazines according to age, the numbers were small.

Fig. 3.

Graphs showing age distribution in patient motivation.

DISCUSSION

In Japan, the number of social media users increased from 64.88 million in 2015 to 82.41 million in 2022, whereas the percentage of internet users who use social media rapidly increased from 65.3% to 83.3% during the same period.⁷ Social media has become a representative tool of modern communication. With the spread of social media, the number of patients visiting plastic surgery clinics after checking case photographs and videos on social media has increased, highlighting social media’s important role in plastic surgery. Recently, an increasing number of studies have been published on how to effectively use and manage social media to minimize the risk of litigation.^8–10 Although such rapid changes in the use of social media have had a significant impact on patients’ motivation to visit clinics, there are no reports examining this impact in Japan. In this study, to understand patients’ motivation to visit clinics and apply this information to management strategies, we analyzed changes in patients’ motivation to visit clinics over time.

Our group is the fastest-growing and largest cosmetic surgery group in Japan. Therefore, the number of procedures, as well as the procedures themselves, has differed greatly depending on the growth stage,¹¹ and patients’ motivation for visits also changes significantly. In this study, the internet visits and referrals increased during our groups’ growth period, suggesting that the practice’s website was more important than social media, as reported in a previous study.³ Direct referrals from acquaintances also play an important role in motivating patients to visit clinics when the group is relatively small. Investments in TV commercials may have resulted in more people identifying TV as the reason for their visit. In addition, although our doctors’ account on Instagram was only evaluated until 2021, in 2022, the account on TikTok and YouTube was also evaluated, resulting in a significant increase in the number of people reporting that TikTok inspired their visit to the clinic. Although our management strategies might have influenced the increase in people reporting that they were motivated by these different types of media, the fact that there were variations in patients’ motivation depending on their desired procedure (and that this variation increased during the expansion period) suggests that patients not only checked the internet but also viewed information on various media. The result that patients who checked several media might have selected only a representative medium in a questionnaire survey could lead to this variation. Procedures pertaining to the eyes, dark circles under the eyes, nose, and hyaluronic acid injections are included in many photographs and videos on social media; thus, patients seeking these procedures are often motivated by social media. In contrast, those seeking gynecological plastic surgery, hair removal, and skin care procedures were primarily motivated by the internet. This may be because these procedures have a general expected outcome, and thus do not require case photographs and videos. We previously reported that the number of procedures for areas around the eyes such as the double eyelid and dark circles has increased, whereas the number of procedures related to the face line that can be covered with a mask has decreased during the COVID-19 pandemic.¹¹ Figure 4A, which shows the percentage of social media users among internet users in Japan, indicates that the expansion of social media had started before the pandemic. However, a questionnaire survey in Japan demonstrated that spending more time at home during the pandemic led to an increase in the amount of time spent using social media.¹² This change in lifestyle might have changed the trend in cosmetic procedures. During the expansion period, regional variations also became apparent. The proportion of those motivated by social media was low in metropolitan areas and high in provincial cities, especially Hokkaido and Tohoku. Thus, region-specific media strategies are required.

Fig. 4.

Demographic characteristics of social media users in Japan. A, Graph showing the change of the proportion of social media users among internet users in Japan.⁷ B, Graphs showing the number of active users by age, on Japan’s major social media platforms.⁵

Previously, we reported that age distribution differs for each cosmetic surgery procedure.¹¹ Surgery around the eyes, including double eyelids, is common in teens and those in their 20s, whereas the removal of dark circles under the eyes is common in patients in their 40s. In the present study, we found that the age distribution in each medium group differed (Fig. 3). The number of active users by age on Japan’s major social media platforms is summarized in Figure 4B. In our group, doctors were obliged to regularly post case photographs and videos on Instagram, YouTube, and TikTok, leading to the dominance of these social media platforms in motivating patients to visit our clinics. Although the shape of the histogram in patients’ motivation and the number of active users do not match, because our clinics primarily perform cosmetic surgery on those in their 20s, there was some correlation in cases in which there were many YouTube users in their 40s and 50s and TikTok users in their teens. Therefore, if a clinic is targeting patients in their 40s and 50s, TV commercials and YouTube should be the focus of their marketing. Furthermore, as the age groups of the main patients differ for each procedure, more efficient advertising can be achieved by combining the tendency of age groups in both procedures and media. However, because media are diverse, it is important to advertise using multiple types of media.

This study has several limitations. Although we summarized the patients’ motivations to visit our clinics, this study was a retrospective analysis, and the results were greatly influenced by the groups’ marketing strategy and development status. For example, TV as a motivator increased during the expansion period because our group has been focusing on TV commercials since this period. Marketing strategies related to advertisement in Instagram, TikTok, and YouTube also had an influence on patients’ motivations and the growth of our group. Additionally, in this study, three periods were defined, but a rigorous comparison was impossible because our group was rapidly growing and the number of cases differed greatly among the three periods (opening period: 1224; growth period: 20,743; expansion period: 124,141). Advertising methods and campaign content may have also changed over time, and patient demographics have changed significantly owing to our nationwide expansion from large to provincial cities, resulting in challenges concerning detailed evaluations. Because many cases were excluded due to inadequate data, strict status could not be evaluated. Patients’ motivation for visiting clinics was obtained from a questionnaire survey administered at the time of their visit, leading to the possibility of inaccurate information.

CONCLUSIONS

In this study, we investigated patients’ motivation for visiting our clinics. We found that patients examine information on various types of media when considering visiting our clinics for cosmetic surgery. To attract more patients to our clinics, it is necessary to provide information on both the internet and our social media depending on the type of procedure and the target age group and region.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.