To Bot or Not? Challenging the Top Social Media Influencers in #PlasticSurgery

Background: The influence of social media on plastic surgery continues to be explored. Prospective patients may seek out surgeons with greater number of followers. Recently, companies selling Twitter bots have been exposed. The authors sought to examine the number of fake users, practice types, and the content of tweets broadcasted by top influencers in plastic surgery. Methods: Top 100 influencers were identified. The influencers were categorized into academic versus private practice and sorted according to their board-certification status. Among each board-certification status, the top five influencers of each category (American Board of Plastic Surgery, American Academy of Facial Plastic and Reconstructive Surgery, international plastic surgeon, other physician, nonphysician) were determined, and their 300 most recent tweets were analyzed for educational, promotional, or personal content. Fake bots among respective followers were identified by TwitterAudit. Results: Private practice surgeons represented 68 percent of the top tweeters. Academicians were only 8 percent. American board-certified surgeons represented 55 percent of the top tweeters. Compared with American board-certified surgeons, nonphysicians had a higher number of fake bots. Among the 7500 tweets that were analyzed, nonphysicians were more likely to have promotional and less likely to have educational posts when comparing to board-certified American or international plastic surgeons. Conclusions: Plastic surgeons are quick to adapt to the dynamic and evolving nature of social media. However, academic surgeons are poorly represented among the top influencers. Although top influencers are board-certified plastic surgeons, they continue to occupy only a fraction of the total discourse on plastic-surgery.