A study published August 30, 2017 in the Aesthetic Surgery Journal about how people use hashtags on Instagram for terms like #plasticsurgery, #facelift and #boobjob has unleashed a flurry of articles in the consumer press about the cosmetic surgery turf war.

In articles published in the Chicago Tribune  and Wall Street Journal the coverage goes from describing the study to physicians’ comments about botched cosmetic surgery by inadequately trained providers and patients being misled into thinking qualified plastic surgeons are behind the social media posts.

“Social media is becoming a battleground in the fight over who is qualified to do plastic surgery,” journalist Bonnie Miller Ruben writes in the Wall Street Journal.

In essence, study authors queried 21 Instagram hashtags they described as “plastic surgery-related.” Some described cosmetic surgery procedures in medical or laymen’s terms, including #rhinoplasty, #tummytuck, #liposuction, #breastaugmentation and #bodycontouring. Other terms included #cosmeticsurgery, #aestheticsurgery and #cosmeticsurgeon.

The authors report plastic surgeons eligible for membership with the American Society of Aesthetic Plastic Surgery (ASAPS) were underrepresented among those posting plastic surgery-related Instagram content. Foreign surgeons were the most likely to have posted on the hashtags in the study, followed by non-American Society for Aesthetic Plastic Surgery (ASAPS) eligible physicians, such as otolaryngologists, dermatologists, general surgeons and others. ASAPS-eligible board certified plastic surgeons made nearly 18% of the top plastic surgery related posts on Instagram, coming in third after foreign surgeons and non-ASAPS eligible doctors.

In their discussion, the authors write the increasing number of physicians who are not board certified in plastic and reconstructive surgery but perform cosmetic procedures comes at a cost to public safety. And they suggest plastic surgeons should join, together, to educate the public and stay relevant in an ethical and professional manner.

ASAPS President Clyde H. Ishii, M.D., says the study’s take-home message for physicians and surgeons is that medicine— cosmetic surgery, in particular — is unregulated.

“With cosmetic surgery there is money to be made outside of the constraints of insurance reimbursement so the field is attracting many non-plastic surgeons and even lay people,” Dr. Ishii tells The Aesthetic Channel. “It truly is like the Wild West out there with no end in sight. Also, there are no regulations on how people market themselves unless one belongs to organizations like the… ASAPS or the American Society of Plastic Surgeons (ASPS). These two organizations have strict codes of ethic for members.”

Non-plastic surgeon doctors should limit their practice according to their scope of training, according to Dr. Ishii, who practices in Honolulu, Hawaii.

“For example, emergency medicine doctors are trained in emergency medicine and not in cosmetic surgery. Some of them may take an abbreviated course in cosmetic surgery but this training pales in comparison to plastic surgeons who have years of surgical training even prior to entering into a rigorous plastic surgery training program,” Dr. Ishii says.

Facial plastic surgeons can promote and do facelifts and rhinoplasty because it is within their scope of training. Dermatologists, according to Dr. Ishii, should not be doing liposuction or breast augmentation because it is outside their scope of training.

“If they want to do these procedures then they should go and get proper plastic surgery training,” Dr. Ishii says. “Minimally-invasive and noninvasive procedures can be performed by various specialties provided that they are properly trained in these techniques. This training must be part of their core training and not just a weekend course.”

And he agrees with the authors that plastic surgeons must be more active on social media, especially with regard to educating the public in how to select a properly trained cosmetic surgeon, according to Dr. Ishii, who was not an author on the paper.