Assessment of YouTube as an Informative Resource on Facial Plastic Surgery Procedures

Abstract

This study investigates the video quality and creator qualification of YouTube videos about facial plastic surgery procedures.

YouTube is a major modality for patient education. During the last decade, videos documenting facial plastic surgery procedures, patient experiences, and medical commentary have garnered hundreds of millions of views. The growing prevalence of YouTube as a primary source of medical information has prompted investigators to evaluate video quality and creator qualification.^1,2 To date, the quality of facial plastic surgery content on YouTube has not been evaluated.

Methods

Using the YouTube search feature, and filtering by relevance and rating, 3 of us (B.W., A.N., and I.A.) searched for and evaluated the top 240 resulting videos using the following terms: blepharoplasty, eyelid surgery, dermal fillers, facial fillers, otoplasty, ear surgery, rhytidectomy, face-lift, lip augmentation, lip fillers, rhinoplasty, and nose job. Data were collected from the first 10 results for each term and filter pairing. After watching each video, we determined the US board status of each physician by using the American Board of Medical Specialties database, then classified videos as being created by a health care professional, patient, or third party. We evaluated each video using the DISCERN criterion for assessing consumer health information.³ A score of 1 indicates a low overall video quality, whereas a 5 indicates a high-quality source of information for patients.³ To eliminate potential bias, 70 of the 240 videos were evaluated by 2 of us (B.W. and A.N.), and score correlation was calculated. A random selection of videos was also evaluated by the senior author (B.P.) to ensure rating quality. We calculated the mean DISCERN score and compared these scores for videos including US board-certified physicians and videos without. A second comparison was made between videos with US board-certified physicians in plastic surgery, ophthalmology, and otolaryngology and those without any medical professional (Table 1). We conducted a 2-sample t test to determine statistical significance for each scenario. The study is exempt from institutional review board approval because it involves research of existing data, documents, records, or pathologic specimens that were publicly available or the participants were deidentified.

Table 1. DISCERN Score Comparison.

Commentator	DISCERN Scorea	No. of Videos
US board-certified physician	2.54b	72
US board-certified physician in plastic surgery, ophthalmology, or otolaryngology	2.63b	57
US board-certified physician in other specialty	2.20	15
Medical professional without US board certificationc	2.35b	74
No medical professional	1.85b	94

^aScores range from 1 (low overall quality) to 5 (high-quality source of information).

^bStatistically significant difference compared with the video scores of no medical professional (P < .001).

^cIncludes registered nurses, physician assistants, and non–US board-certified physicians.

Results

We included 158 464 041 combined views, with a mean of 660 267 views per video. The mean age of the videos was 4 years (range, 9 days to 11 years) and the mean length was 10.18 minutes (range, 0.50-51.18 minutes). The term nose job received the most views, totaling 56 251 991 views with a mean of 2 812 600 views per video. The mean DISCERN rating was 2.21 overall, and blepharoplasty had the highest mean rating of 2.75. The DISCERN rating for bias was 2.78 (Table 2). The correlation coefficient for videos scored by both reviewers was 0.74. Ninety-four videos did not include a medical professional. Seventy-two videos included US-board certified physicians and had a mean DISCERN score of 2.54. Fifty-seven of those physicians were board certified in ophthalmology, otolaryngology, or plastic surgery; their videos had a mean DISCERN score of 2.63. The difference between the mean DISCERN score of videos including a US board-certified physician and those without a medical professional was 0.69 (P < .001). We found no statistically significant difference (0.43; P = .08) between videos that included US board-certified plastic surgeons, ophthalmologists, or otolaryngologists and those that included US board-certified physicians from other specialties (Table 1).

Table 2. Compiled Data From Top 240 YouTube Videos by Search Term.

Search Term	Mean DISCERN Scorea	Mean Length, min	No. of Views		US Board-Certified Commentator, %	DISCERN Rating for Biasb	Mean Video Age, y
			Total	Mean
Blepharoplasty	2.75	12.21	4 648 494	232 424.70	30	2.85	4.77
Eyelid surgery	2.45	10.52	15 855 206	792 760.30	35	2.65	4.29
Dermal fillers	2.00	7.86	1 512 466	75 623.30	30	1.55	9.94
Facial fillers	2.35	8.75	2 757 169	137 858.45	75	1.95	3.08
Otoplasty	2.25	10.98	1 731 782	86 589.10	20	3.60	4.14
Ear surgery	1.55	7.75	4 462 150	223 107.50	15	3.75	4.44
Rhytidectomy	2.05	7.82	838 373	41 918.65	25	3.00	4.51
Face-lift	2.40	10.32	9 177 632	458 881.60	50	2.20	3.74
Lip augmentation	1.90	7.99	4 849 440	242 472.00	20	3.10	2.78
Lip fillers	2.05	10.40	34 996 141	1 749 807.05	20	3.25	2.34
Rhinoplasty	2.70	13.16	21 383 197	1 069 159.85	45	3.25	2.79
Nose job	2.10	14.44	56 251 991	2 812 599.55	35	2.20	1.63
All	2.21	10.18	158 464 041	660 266.84	33	2.78	4.00

^aScores range from 1 (low overall quality) to 5 (high-quality source of information).

^bScores range from 1 to 5, with higher scores indicating less bias.

Discussion

Although a popular resource for facial plastics information, YouTube videos can present biased information, be unbalanced when evaluating risks vs benefits, and be unclear about the qualifications of the practitioner. Most videos did not include qualified medical professionals to verify accuracy. The videos with the highest DISCERN scores and most patient utility are often from specialty-related, board-certified physicians. Patients and physicians who use YouTube for educational purposes should be aware of the possible biases within the videos and be prepared to verify this information with an unbiased source. Further evaluation of the quality of plastic surgery YouTube videos is necessary to create criteria that would result in high-quality and highly viewed videos.