surgery (4/50, 8%), plastic surgery (3/50, 6%), dentistry (2/50, 4%), and family medicine (1/50, 2%). The majority of posts were generated in the United Kingdom (22/50, 44%), followed by the United States (21/50, 42%), Australia (4/50, 8%), Canada (1/50, 2%), the Czech Republic (1/50, 2%), and the Philippines (1/50, 2%). Post content consisted mainly of before and after pictures (44/50, 88%) and addressed the following topics: acne scarring, keloids, photodamage, port wine stain, telangiectasias, brown spots, veins, rhinophyma, rhytids, xanthelasma, café au lait macule, nevus of Ota, and various periodontal applications. Laser-induced complications and laser safety considerations were addressed in a minority of posts, only 14% and 6%, respectively. Figure 1 features the laser surgery details provided in the Instagram posts.
DISCUSSION
This study suggests that skin laser surgery, in general, may be adequately portrayed on social media, however, laser safety specifically is not. Even though adverse events are uncommon, some are inevitable when performing laser and light-based procedures. The most commonly litigated minimally invasive cosmetic procedure in the US is laser hair removal. In the 2014 publication by Jalian and colleagues, it was determined that nonphysicians were the providers in almost half (42.9%) of litigation cases.2 Given variable, and in our opinion inadequate, regulations across state lines surrounding laser operator credentials, aesthetic procedures are increasingly being performed by nonphysician providers. In a recent publication by Rossi and colleagues in 2019, it was suggested that when it comes to minimally invasive cosmetic procedures, nonphysicians may have a higher rate of adverse events.3 Furthermore, it was found that adverse events are more likely to occur in settings outside of a physician's office, usually in a MedSpa.3
Adverse events from laser surgery range from minimal and reversible to severe and irreversible. Minimal events include transient pigment alteration, bruising, pain, and swelling. However, the severe end of the spectrum includes ocular injury affecting vision and irreversible scarring. A comprehensive understanding of ocular anatomy and principles of laser safety are essential for practitioners who offer cosmetic laser treatments in their practice. Most eye injuries associated with laser surgery are related to either improper laser technique or lack of appropriate eye protection.4 Recently, efforts have been proposed to help mitigate these errors, by incorporating procedural checklists.5 However, based on Instagram content, social media awareness of such risks from laser surgery and efforts to allay them may be lacking.
In our search, most of the content was posted by physicians in a doctor's office setting, and a wide variety of laser surgery topics were addressed. However, laser safety considerations and laserinduced complications were only discussed in a minority of posts, 14% and 6%, respectively. This could be cause of concern, as patients may inaccurately presume that laser procedures are without risk and capable of being performed by any provider regardless of credentials. Given the increasing technical connectedness of our patient population, as well as the increase in younger patients seeking laser and light-based procedures, many patients are resorting to social media for information.
Finally, in addition to public education, social media can serve as a helpful marketing tool. Instagram remains the 6th most popular social media network in the world with more than 60 percent of Americans admitting to using it daily.1 We encourage dermatologists to continue to highlight their expertise in minimally invasive cosmetic procedures, in particular, laser surgery to spread patient awareness and education. Instagram has proved to be a useful and relatively accurate portrayal of laser surgery and we as a specialty should continue to add to this body of work under the hashtag "#lasersurgery". This can be accomplished by briefly defining the procedure, including knowledge of procedure risk and safety measures when necessary, and featuring before and after photographs.
Adverse events from laser surgery range from minimal and reversible to severe and irreversible. Minimal events include transient pigment alteration, bruising, pain, and swelling. However, the severe end of the spectrum includes ocular injury affecting vision and irreversible scarring. A comprehensive understanding of ocular anatomy and principles of laser safety are essential for practitioners who offer cosmetic laser treatments in their practice. Most eye injuries associated with laser surgery are related to either improper laser technique or lack of appropriate eye protection.4 Recently, efforts have been proposed to help mitigate these errors, by incorporating procedural checklists.5 However, based on Instagram content, social media awareness of such risks from laser surgery and efforts to allay them may be lacking.
In our search, most of the content was posted by physicians in a doctor's office setting, and a wide variety of laser surgery topics were addressed. However, laser safety considerations and laserinduced complications were only discussed in a minority of posts, 14% and 6%, respectively. This could be cause of concern, as patients may inaccurately presume that laser procedures are without risk and capable of being performed by any provider regardless of credentials. Given the increasing technical connectedness of our patient population, as well as the increase in younger patients seeking laser and light-based procedures, many patients are resorting to social media for information.
Finally, in addition to public education, social media can serve as a helpful marketing tool. Instagram remains the 6th most popular social media network in the world with more than 60 percent of Americans admitting to using it daily.1 We encourage dermatologists to continue to highlight their expertise in minimally invasive cosmetic procedures, in particular, laser surgery to spread patient awareness and education. Instagram has proved to be a useful and relatively accurate portrayal of laser surgery and we as a specialty should continue to add to this body of work under the hashtag "#lasersurgery". This can be accomplished by briefly defining the procedure, including knowledge of procedure risk and safety measures when necessary, and featuring before and after photographs.
DISCLOSURES
The authors have no relevant conflicts of interest to declare.
REFERENCES
1. O'Brien KF, Newsom EC, Park JH, Lawrence N. Increasing a dermatologist's footprint on Instagram: an analysis of top influencers performing nonsurgical cosmetic procedures. Dermatol Surg. 2021;47(8):1093-1097. doi:10.1097/ DSS.0000000000003088. PMID: 33988555.
2. Jalian HR, Jalian CA, Avram MM. Increased risk of litigation associated with laser surgery by nonphysician operators. JAMA Dermatol. 2014;150(4):407- 411.
3. Rossi AM, Wilson B, Hibler BP, Drake LA. Nonphysician practice of cosmetic dermatology: a patient and physician perspective of outcomes and adverse events. Dermatol Surg. 2019;45(4):588-597.
4. Flegel L, Kherani F, Richer V. Review of eye injuries associated with dermatologic laser treatment. Dermatol Surg. 2022;48(5):545-550. doi:10.1097/DSS.0000000000003427. PMID: 35333214.
5. Labadie JG, Hamilton HK, Dover JS. Laser safety checklists: an update on how we do it. Dermatol Surg. 2022;48(8):882-883.
2. Jalian HR, Jalian CA, Avram MM. Increased risk of litigation associated with laser surgery by nonphysician operators. JAMA Dermatol. 2014;150(4):407- 411.
3. Rossi AM, Wilson B, Hibler BP, Drake LA. Nonphysician practice of cosmetic dermatology: a patient and physician perspective of outcomes and adverse events. Dermatol Surg. 2019;45(4):588-597.
4. Flegel L, Kherani F, Richer V. Review of eye injuries associated with dermatologic laser treatment. Dermatol Surg. 2022;48(5):545-550. doi:10.1097/DSS.0000000000003427. PMID: 35333214.
5. Labadie JG, Hamilton HK, Dover JS. Laser safety checklists: an update on how we do it. Dermatol Surg. 2022;48(8):882-883.
AUTHOR CORRESPONDENCE
Jessica G. Labadie MD jessica.labadiemd@ gmail.com
