Table 2.

Conclusions of opinion articles

Title	Main conclusions
Can Plastic Surgeons Maintain Professionalism within Social Media?	The authority of the ASPS code of ethics is limited by restraint of trade regulations. It is key to ensure there is no coercion from surgeons to make patients take part in marketing. It is recommended to use independent videographers so surgeons focus on the tasks at hand. Identifying features should be removed and metadata scrubbed. Patient should be informed that images may not be removable in future. Surgeons ought to ensure that websites show real people with real results and should state where models have been used.
Social Media and Consent: Are Patients Adequately Informed?	Posting medical images on social media is different to academics as a surgeon is not protected by copyright and may lose control of them. Professionals should advocate for an additional level of consent known as “Use of patient information and/or photographs on social media” to ensure patients are aware their photographs may never be fully removed from the internet.
Time for a Consensus? Considerations of Ethical Social Media Use by Paediatric Plastic Surgeons	Maintaining privacy and obtaining consent are the most critical issues. This becomes nearly impossible in craniofacial surgery. As well as consent from guardians, assent is also important, which is the agreement of a participant who legally cannot consent. This is not always possible in toddlers, so surgeons must weigh up the benefits and ensure content is beneficial for the patient and not purely for personal gratification purposes.
When Is Advertising a Plastic Surgeon’s Individual “Brand” Unethical?	Deception in social media advertising is the first pitfall, carried out by removal of negative reviews or by suggesting a treatment is exclusive and scarce. This can lead to unrealistic expectations and may result in disappointment and a sense of betrayal. As the relationship of trust has been built on social media and may not be as close, this sense of betrayal may lead to withdrawing from follow-up care or self-recrimination.
When Is Posting about Patients on social media Unethical “Medutainment”?	Using patient images requires adherence to the Health Insurance Portability and Accountability Act (HIPAA). Plastic Surgeons should maintain separate personal and professional accounts and minimise online interactions with patients. Patient confidentiality must be maintained and images de-identified. Surgeons also ought to show patients their images or videos before posting them. Context is key and media content needs to be adapted to avoid sexualisation. Reassuring patients that their care will be unaffected if they refuse to share their media is also vital.
#Trending: Why Patient Identifying Information Should Be Protected on social media	Three recommendations: Firstly, all images need to be censored for anonymity, including “identifiable facial features, tattoos and other unique cutaneous features”. Secondly, inform patients that images can be “saved, manipulated and downloaded” even after deletion. Thirdly, encourage internal governance to avoid harm to patients, surgeons and the field of plastic surgery
Social Media: A Necessary Evil?	Beneficence: It is not always easy to see how a patient benefits from a surgeon posting their images online. Non-maleficence: Generally, patients are at a higher risk of being harmed than surgeons from social media, as it is impossible to know if a post might go viral and reveal their identity. Surgeons need to be transparent and obvious if they are being paid and sponsored for a post. There is also a concern that the doctor-patient relationship is being distorted. Removing engagement metrics, such as followers or likes could reduce deceit from surgeons using these metrics. Residents should not post surgical results as their own, as ultimately the patient’s responsibility lies with the attending surgeon. There need to be clear distinctions between social media and a surgeon’s own website.
The Marriage of Plastic Surgery and Social Media: A Relationship to Last a Lifetime	Plastic Surgeons should aim to handle negative reviews in a constructive manner, which can help demonstrate knowledge, compassion and attention to patient issues. Consulting with professional societies and an attorney to ensure posts are of a high ethical and legal standard is highly encouraged
Tips and Pearls on Social Media for the Plastic Surgeon	Patient safety: Patient information needs to be deidentified and social media should not be allowed to affect care (anaesthetic lengthening to take photographs). Truthfulness: There needs to be transparency in all shared information and permission should be obtained with the new social media specific consent form once it is released Professionalism: Aim to keep personal and professional accounts separate and avoid inappropriate/unprofessional content. Thoughtfulness: Surgeons need to remember that as ambassadors on these platforms for their specialty, they ought to consider how viewers may react to certain content (gore, body parts). Duty: Plastic Surgeons should always dissociate from individuals not upholding professional standards as well as report violations to the relevant professional bodies.
Conceptualizing Professionalism in social media: A Framework for Evaluation	There are four points to determine the professionalism of a social media post: Context: Ensure a post does not trivialise patient experience. Intent: Educating the public or promotion of one’s practice both have professional intentions, but anything related to self-promotion should be kept on a separate personal account. Content: Dialogue should include professional language. Any form of sensationalism or indifference to surgical specimens are to be avoided. The pose of a physician should be similar to when taking a professional picture. Presentation: No emojis or filters should be used, as these can trivialise the trust of a patient towards their physician and are unprofessional. Hashtags need to be in the style of a journal figure legend and use professional language.
In Constant Search of ‘‘Like’’: How Technology and Social Media Influence the Perception of our Body	The increased use of SoMe during the pandemic led to individuals becoming hyperaware of facial imperfections which had previously gone unnoticed..These can be caused by a number of technical factors, and Plastic Surgeons should raise awareness of how they cause these distortions.