Effect of Social Media on Decision to Undergo Rhinoplasty

Background: Rhinoplasty is surgery for changing the shape of the nose and it may be motivated by the need to change the appearance of the nose, improve breathing, or both. Rhinoplasty can change the bone, cartilage, skin of the nose, or all three. When planning rhinoplasty, the surgeon will consider other facial features, the skin on the nose, and patient expectations. Aim: To assess the influence of social media on patients who underwent rhinoplasty, and determine if it was the main influence for their decision. Methods: A retrospective record-based descriptive approach was used to review the medical records of all patients who underwent rhinoplasty in Aseer Central Hospital (ACH) between 2015 and 2020. Data were obtained through pre-structured questionnaires and included patients’ bio-clinical data, indications, and effects of different social media platforms. Results: Hundred patients who underwent rhinoplasty, had complete medical files, and responded to phone calls were included. All the cases were aged above 18 years and 56% were men. Snapchat was the most used social media platform (57%), followed by WhatsApp (19%). Social media influenced more than 2/3 of the patients to undergo rhinoplasty. Approximately 58% of those influenced were males compared to 52.8% of those who were not. Instagram had the highest influence on male decisions to undergo rhinoplasty; its influence was significantly higher among females. Conclusions: The study revealed that social media platforms were used extensively, and they influenced patients’ decisions to undergo rhinoplasty mainly through the provision of news about famous people.


Global Journal of Otolaryngology
How to cite this article: Waleed A, Abdelaziz Q, Daefullah A a. Effect of Social Media on Decision to Undergo Rhinoplasty. Glob J Oto, 2020; 22(4): 556094. DOI: 10.19080/GJO.2020. 22.556094. and determined if it was the main influence on their decision to undergo this surgery.

Methods
A retrospective record-based descriptive approach was used to review medical records of all patients who underwent rhinoplasty in Aseer Central Hospital (ACH) between 2015 and 2020. Aseer Central Hospital is the main tertiary hospital in Abha city, the capital of the Aseer region in Southern Saudi Arabia. All Rhinoplasty cases are included (multible surgeon); however, records with missing data were excluded. Data were collected by the researchers using a pre-structured questionnaire, to minimize errors. Data included the patient's bio-clinical data and indications for rhinoplasty. Subsequently, patients were contacted by phone (postoperatively) to explore the effect of different social media on their decisions on rhinoplasty.

Data Analysis
The data collected were revised, coded, and fed into IBM SPSS version 22. The graphs were constructed with Microsoft Excel. All statistical analyses were performed using two-tailed tests and an alpha error of 0.05. P values less than or equal to 0.05 were considered statistically significant. Frequencies and percentages were used to describe the distributions of the collected variables, including patients' demographic data, and social media use and effects. Cross-tabulation was used to demonstrate the relationships between the frequency of use of social media and the effects on rhinoplasty decision-making, and gender and the effect of social media on their decisions using the chi-square test.

Results
A hundred patients who underwent rhinoplasty, had complete medical files, and responded to phone calls were included. All the patients were older than 18 years and 56 % were men. Snapchat was the most used social media platform (57%), followed by WhatsApp (19%). Forty-seven patients rarely found new articles on rhinoplasty on social media, while 18% searched for it weekly. A total of 21% of the patients received information on rhinoplasty from Snapchat followed by Instagram (18%), and 74% of the cases believed in advertisements that presented rhinoplasty as a safe surgical procedure on social media, while 30% were influenced by a famous person who had undergone rhinoplasty. Generally, social media influenced 64% of patients to perform Rhinoplasty.
Approximately 58% of those who were affected were males compared to 52.8% of those who were not affected; the difference was not statistically significant (P=.626). Snapchat was the most commonly used platform among those who were influenced (60.9%), followed by WhatsApp, compared to 50% of others who were not affected (P=.476). Snapchat was also the social media platform that presented most rhinoplasty data (20.3%) compared to 13.9% (P=.803). Approximately 78% of those who were influenced by social media believed in advertisements that presented rhinoplasty as a safe surgical procedure compared to 66.7% of those who were not (P=.210). Additionally, 40.6% of those influenced by social media were motivated by famous people compared to 11.1% of others; the difference was statistically significant (P=.002) ( Table 1).    Table 3: Distribution of post-rhinoplasty perceived change by patient gender and social media use.

Patients Data
Perceived Change in Self-Confidence

Discussion
Rhinoplasty is a common procedure performed by, Plastic and ENT physicians and indicated for patients who have external nasal deformity and cosmetic issues [14]. Rhinoplasty, also known as a "nose job," is an available alternative for people who are unhappy with the size or shape of their nose [15]. In addition to the wellknown cosmetic benefits of the procedure, it has evolved and has versatile applications, such as improvement of nasal function after a traumatic injury or illness or breathing problems that affect sleep and the ability to exercise [16].
Recently, several people have sought a cosmetic plastic surgery procedure. The rapidly emerging minimally invasive procedures, such as Botox and filler injections, play a significant role in this trend; they have become popular among cosmetic patients [17,18]. Several factors may influence the decision to undergo plastic surgery, and social media use is a major [19]. Patients interested in esthetic plastic surgery procedures look for relevant information on social media and rely on those that are easily accessible [20]. Social media platforms provide networking options that help users to explore millions of photographs and share links and videos on their computers and mobile devices. It has grown out of obscurity to count more than 955 million active monthly users [21]. Rhinoplasty may be motivated by social media advertisements. Its goal is to revise the nose to a patient's desired appearance and functionality. The current study assessed the role of social media in decision-making on rhinoplasty among patients who underwent rhinoplasty in Aseer Central Hospital. The study revealed that more than 2/3 of the patients who underwent rhinoplasty were influenced by information and advertisements on social media platforms. The most commonly used social media platform was Snapchat, which was used by more than half of the patients, followed by WhatsApp. Approximately 1/3 of the patients used social media platforms to explore rhinoplasty data monthly. More than 3% of them believed in the social media advertisements that presented rhinoplasty as a safe surgical procedure, but less than 1/3 were influenced by famous people who underwent rhinoplasty for cosmetic purposes.
The study also revealed that the types of social media platforms used, the extents of dependence on social media information on rhinoplasty, and the beliefs in the advertisements for the surgery insignificantly differed across patients who were influenced by social media to undergo cosmetic rhinoplasty and others who did not. This provides insights into the role of social media in decision making among males and females in our region. Social media platforms may significantly influence people to undergo rhinoplasty, but there may be other significant motivations such as nasal deformity affecting general appearance. News about famous people undergoing rhinoplasty had a significant effect on decisions among those who used social media as the source of news; the role of social media in the decision to undergo rhinoplasty was not directly through the information provided, but indirectly through the updates on news about famous people.
The most significant finding was that the influence of social media on decisions to undergo rhinoplasty was higher among males than females, which was inconsistent with the established logic, as females are naturally more concerned with cosmetic surgeries and influenced by advertisements [22][23][24]. A descriptive survey was conducted by Andrew et al. (2013) on the use of social media and questionnaires were distributed to members of the American Society of Plastic Surgeons. The prevalent patterns of social media influence were elucidated [25]. The survey Global Journal of Otolaryngology demonstrated that nearly half of the participants were regular social media users. Participants' belief that the social media incorporation into medical practice is inevitable was the most recorded motivation for use (56.7%); others believed that social media was an effective marketing tool (52.1%), and it provided a forum for patient education (49%). Surgeons with primary esthetic surgery practices recorded high use of social media. More than 2/3 of the respondents stated that social media did not affect their practice, whereas 1.5% reported a negative impact.
Another study was conducted by Arab K et al. [26] in 2019 to assess the influence of social media on the decision to undergo cosmetic procedures. The researchers concluded that out of 816 respondents, 48.5% reported being influenced by social media to undergo cosmetic procedures. Nearly half of them followed plastic surgeons on social media. Locally, a study was conducted in 2019 by Aldosari et al. [27] to assess the effect of social media on facial plastic surgery enrolments in Saudi Arabia. More than 60% of the participants reported that a surgeon's self-advertisement had a positive impact on the trendiness of plastic surgeries; 53.4% agreed that cosmetic television programs had an effect on the trend of plastic surgeries, and approximately 65% of the participants decided that social media influenced the trend of cosmetic procedures.
Cosmetic surgery demand has been increasing within the last few years, and plastic surgeons have used several methods for advertising, away from traditional methods. One of the new methods is the use of social media platforms, which are available to and used by millions of people all over the world.

Conclusion
The study confirmed a high usage of social media platforms, which influenced some patient decisions to undergo rhinoplasty, especially in males. The effect of social media platforms on case decisions was indirect, through the provision of news about famous people and their patronage of cosmetic rhinoplasty, which was a more significant motivation than advertisements and information provided through the media on the safety of rhinoplasty.