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Misleading Surgery Videos are Popular with Patients

Many patients don’t realize online plastic surgery videos don’t tell the whole story, which could increase the likelihood they’ll seek out surgery.

Videos documenting medical events—from knee replacement to bariatric to facial plastic surgery procedures—have risen in popularity over the past ten years. The hundreds of millions of views plastic surgery videos receive reflect larger trends in the field, which has seen a 200% increase in procedures since 2000 and a total of 17.5 million surgeries and minimally invasive cosmetic procedures in 2017 alone. Whether these videos should be used as a reliable source of information for patients was recently assessed by a team of five researchers from Rutgers University, who found that videos on YouTube are often largely misleading. They shared details of their methodology and findings in a research letter in The Journal of the American Medical Association Facial Plastic Surgery.

Using YouTube’s search function and filtering by relevance and rating, the team searched for twelve common search terms representing both surgical procedural names as well as more commonly used terms, including blepharoplasty, dermal fillers, ear surgery, eyelid surgery, face-lift, facial fillers, lip augmentation, lip fillers, nose job, otoplasty, rhinoplasty, and rhytidectomy. 

From a pool of 240 videos that surfaced in that search, they collected data from the first ten results for each term and filter pairing. Researchers then watched each video and classified it by whether they were created by a healthcare professional, patient, or third party, and when a physician was featured, whether that physician was US board-certified by cross-referencing with the database of the American Board of Medical Specialties.

The team then evaluated the video quality using the DISCERN criteria for assessing consumer health information in media which consists of 15 key questions plus an overall quality rating that ultimately reflects the source’s reliability, the information about treatment choices, and the overall quality of information. A total score of 1 indicates a low-quality source of information, and 5 indicates a high-quality one. To avoid potential biases, 70 of the 240 videos were evaluated by two of the researchers, and additionally, the senior author evaluated videos selected randomly. They also conducted a 2-sample t-test to determine the statistical significance of each scenario.

Researchers found that 30% of the videos featured a US board-certified physician, 30% featured a medical professional, including registered nurses, physician assistant, or non-US board-certified physician, and 40 % featured no medical professional. The highest DISCERN rating was for the term blepharoplasty, with a rating of 2.75, while the mean DISCERN rating across all search terms studied was 2.21. The correlation coefficient for videos that were scored by two reviewers was 0.74. 

The videos reflected a total of over 158 million combined views with a mean of 660 thousand views per video. In addition, the mean age of the videos ranged from nine days to 11 years, with a mean age of four years, and the length ranged from 0.50 - 51.18 minutes, with a mean length of 10.18 minutes. 

Although YouTube videos are easy to access and popular with patients, the information presented in the videos may not give the whole story, and it’s increasingly important to remind patients of that fact whenever possible. “Patients and physicians who use YouTube for educational purposes should be aware that these videos can present biased information, be unbalanced when evaluating risks versus benefits, and be unclear about the qualifications of the practitioner,” said lead author Boris Paskhover, MD, assistant professor at Rutgers New Jersey Medical School. “YouTube is for marketing. Most people who post these videos are trying to sell you something.”

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