FACIAL PLASTIC SURGERY IN THE DIGITAL AGE:
PHYSICIAN WEB SITES IN FACIAL PLASTIC SURGERY
Stephen J. Wall, MD, PhD, and Daniel G. Becker, MD

Patients considering facial plastic surgery commonly seek detailed information about plastic surgery procedures and often eval­ uate several practitioners in an effort to identify a physician in whom they are confi­dent and comfortable. Factors that influence this decision include the physician's experi­ence and personal style. Location and fees are also important practical concerns. The patient may know individuals who have un­dergone the same or similar procedures as that being contemplated; in this situation, these patients serve as a valuable source of information for the plastic surgery candidate. The prospective patient may not know such individuals, however, or may be hesitant to discuss with others the decision to pursue an aesthetic procedure. For these patients, options for identifying a prospective surgeon include consultation with his or her primary physician, advice from professional referral services, or review of published advertise­ ments.

Over the last few years, a new source of readily accessible information has become available. Increasingly sophisticated patients now recognize the Internet as an additional forum for accessing information about health care. Indeed, millions of individuals visit health care sites seeking information. Ex­amples of web sites receiving over 700,000 visits include drkoop.com, www.nih.com, thriveonline.com, and betterhealth.com. 2 Pa­ tients are also seeking specific information online about plastic surgical procedures and plastic surgeons. A survey of Internet sites, reviewed in this article, illustrates the wide­spread efforts in patient education and prac­tice advertising.

THE INTERNET

The Internet is an exhaustive source of infor­ mation on topics in facial plastic surgery. A typical search engine lists all web sites related to the search word, often in descending order of most frequently visited sites. For example, a search on Microsoft Network's search engine on August 22,1999, was undertaken for "plas­ tic surgery" and "facial plastic surgery." Also, searches were undertaken for "facelift" and "rhinoplasty" (Box I). Plastic surgery identi­ fied 39,469 web sites, facial plastic surgery re­ sulted in 5718 web sites, facelift resulted in 12,031 web sites, and rhinoplasty identified 2923 web sites.

for Searchword on
Microsoft Network Search,
August 22, 1999
Searchword: facial plastic surgery

1. Facial Plastic Surgery (facial-plastic- surgery. org)

2. ASPRS/PSEF Plastic Surgery Informa­ tion Service (plasticsurgery.org)

3. American Board of Facial Plastic and Reconstructive Surgery home page (abfprs.org)

4. Facial Plastic Surgery at OHSU (ohsu. edu/som-FPS/index.html)

5. Facial Plastic Surgery at Fountain of Youth (fountainofyouth.com)

Searchword: plastic surgery

1. 4Cosmetic Surgery (4cosmeticsurgery. com)

2. ASPRS/PSEF Plastic Surgery Informa­ tion Service (plasticsurgery.org)

3. Aesthetic Plastic Surgery (link.springer. de/link/service/joumals/00266/index.html)

4. American Society of Opthalmic Plastic and Reconstructive Surgery (asoprs.

5. Facial Plastic Surgery (facial-p/astic- surgery.org)

Searchword: facelift

1 . Facelift-Plastic and Reconstructive Sur­ gery performed by Dr. Harold D. Clavin (annika.com/clavin_facelift_excbtop. html)

2. Facelift (cosmetnet.com/loverme/facelift. html)

3. not a surgical web site

4. not a surgical web site

5. Facelift (acss.com/locator/backup/wolf _facelift.html)

Searchword: rhinoplasty

1 . Rhinoplasty-Plastic and Reconstructive Surgery performed by Dr. Harold D. Clavi n (plasticsurgeons. org/drclavin/excb/ rhinoplasty/1 a. html)

2. Rhinoplasty-Plastic and Reconstructive Surgery performed by Dr. Harold D. Clavin (annika.com/clavin_^rhinoplasty __ excbtop.html)

3. Rhinoplasty (www11geocities.com/Hot Springs/5 1 42/rino.html)

4. same as 3

5. Rhinoplasty Center on the Web (rhinoplasty.org)

6. Rhinoplasty DocShop (rhinoplastydoc shop.com)

The top 10 most popular web sites for facial plastic surgery included Academy web sites (e.g., American Academy of Facial Plastic and Reconstructive Surgery web site, www.facial- plastic-surgery.org; and the American Society of Plastic and Reconstructive Surgery web site, ivww.plasticsurgery.org). These web sites may provide linkages to the web sites of member surgeons in a patient's geographic region. The top 10 most popular web sites also included specific practice web sites. Also, entrepreneur­ ial web sites exist that list a surgeon's practice for a fee; the individual visiting this web site is linked to the subscribing physician's infor­mation. The popularity of these web sites is directly related to community awareness, which typically is secondary to a variety of marketing efforts. Once a web site is among the most popular, however, this tends to be self-sustaining because it is more easily acces­ sible by the Internet user. The quality, useful­ ness, and reliability of a web site also is impor­ tant in helping it maintain popularity.

Compared with other informational modal­ ities, such as print advertisements, radio, and television, an abundance of information per­ taining to aesthetic surgery options is available on the Internet. An everexpanding number of people are turning to the Internet as a resource for answers to specific questions. A recent re­ port stated that 64.2 million Americans rou­ tinely used the Internet for data retrieval. 1 The sources or sites are organized along an infor­ mation algorithm called the World Wide Web, which uses specific addresses denoted as uni­ versal resource links. Each address serves as a site, which can be accessed by the user to retrieve audio and visual information contrib­uted by an electronic author. Additional mod­ ifiers can be appended to the universal re­source link to define more accurately the database with respect to content and location.

Focusing a search inquiry markedly reduces the number of web sites identified for the de­ sired category. The usefulness of searchword modifiers is demonstrated with a simple exam­ ple: a Microsoft Network search identified 39,469 web sites devoted to "plastic surgery," 5718 web pages devoted to "facial plastic sur­ gery," and 437 sites devoted to "Philadelphia facial plastic surgery." Unless the searcher has used qualifier descriptors to narrow the search, there is a high likelihood that the searcher may find other information or abandon a search before encountering a particular physician's site, unless it happens to be in the top 10 to 20 web sites, or unless some other form of advertising (e.g., print advertising) has di­rected the potential patient to the surgeon's web site.

For the surgeon with a web site, the key is for the potential patient population to know about the web site and access it. For this reason, many surgeons include their web site informa­ tion in print advertisements. Indeed, print ad­ vertisements increasingly direct the reader to a surgeon's web site for more information.

City magazines are a commonly selected re­ gional advertising modality because of their target audience. Demographic analyses have demonstrated that the targeted household is typically more affluent and well-educated than corresponding households for purchasers of daily newspapers. In a survey of readership for 14 city publications, average household in­come was $115,730, and 84.6% of readers had attended college. In addition, with 69% of identified readers being women, and 59% be­ tween the ages of 25 and 54, each advertise­ ment reaches more of the population that typi­ cally pursues aesthetic surgery (Metrocorp Marketing, New York, NY).

Readership includes the primary individual (subscriber or newsstand purchaser) and sec­ondary readers (those who see the magazine in offices, waiting rooms, and so forth). A sur­ vey of 15 large city publications revealed an average circulation of 72,000 per month. Fur­ thermore, magazines often remain in a com­mon reading area for many months, so a greater number of individuals are exposed to the advertisement. In particular, the increas­ingly prevalent "Best of. . . ." issues (that list top restaurants, stores, activities, and so forth in a given metropolitan area) are often saved for a year because they serve as a reference for popular recommendations. Marketing firms estimate that on average, an additional three to four individuals read each monthly maga­ zine, in addition to the primary subscriber. The average total estimated readership for the 15 sample publications discussed previously ap­ proximates 227,000.

It is important to note that running a monthly advertisement in a large metropolitan area entails a considerable expense. A typical one-half page color advertisement costs $5131 (range, $2530 to $9940) to list for a single month, exclusive of costs incurred in designing the advertisement. Full-page advertisements cost an average of $7778 per month (range, $3330 to $14,320) (Metrocorp Marketing, New York, NY). Of course, if publication increases the number of patient referrals, then the expen­ diture is offset by fees generated from consul­ tation with new patients.

The authors undertook an effort to assess prevalence of web sites by performing a non- scientific review of advertisements by aesthetic surgeons in city magazines. Based on availabil­ ity the May, June, or July 1999 issue of 16 se­ lected city magazines were examined for ad­ vertisements related to facial aesthetic surgery, body surgery, or other intervention related to aesthetic image improvement. The presence of a web site listing was recorded.

One hundred and sixteen advertisements for aesthetic surgeons were identified in city mag­ azines from these 16 metropolitan areas (Table 1). The number of advertisements per issue ranged from 0 to 24. Ninety-five percent of all advertisements were for individual physi­cians. Seven advertisements were identified for multiphysician practices, with the number of listed providers ranging from 4 to 26. Evalu­ ation of the size of the advertisements revealed that 21% occupied between 0% and 24% of the page, 43% occupied between 25% and 49% of the page, and 37% occupied 50% to 100% of the page. Of the advertisements identified, 50% (58 of 116) listed web site addresses.

Differences in regional competition for a given service are often reflected in the number of practitioners who include their listings in these magazines. For example, Baltimore maga­ zine had advertisements from five oculoplastic offices. The content of the advertisements also differed considerably and is certainly influ­enced by space constraints. Many physicians included photographs of themselves, whereas others included portraits of models or stylized images of a face or body. At a minimum, cre­ dentials and board certifications were listed, as well as contact information.

Table 1. MAGAZINE ADVERTISEMENTS*

'City magazines from May, June, or July 1999 were obtained from 16 selected metropolitan areas. The selected issues were re­ viewed for cosmetic surgery advertisements placed by physicians. Advertisements for cosmetic procedures performed by nonphysi- cians were excluded. The total number of advertisements per issue and the total number of advertisements with a web site address per issue are listed.

DISCUSSION

Ideally, the goal of the physician who creates a web site should be to educate the public with respect to the options available for managing facial plastic surgical concerns and to indicate the training and experience that qualifies him or her to treat the problem. Magazine adver­ tisements and other marketing modalities may enhance patient access to the surgeon's web site.

A web site allows the surgeon to create a directory of information that can be accessed by an interested web browser. The clinician can tailor the information displayed to focus on the inquiry of the potential patient. For ex­ ample, a surgeon might include separate infor­ mation pages for otoplasty, blepharoplasty, and rhytidectomy. Once the initial investment in time is made to create the web site, the electronic author can update the content of the web pages in a relatively short time and as frequently as is necessary. In this manner, the practitioner ensures that the pertinent infor­mation (surgical and office staff, facilities, equipment, and directions) is current and com­ plete. The web page can be as detailed or as brief as desired without proportional increase in expense.

A significant advantage of the Internet is its greater capacity for on-line multimedia educa­ tion. The patient who requires more detailed information on a diagnosis or intervention can rapidly access that data from a well-developed web site. In addition to text, photographic im­ ages can be accessed that depict before and after states for procedures of interest. The goal of these pictures should not be to dazzle, but instead to provide the potential patient with guidance regarding reasonable expectations of surgical outcome.

Web sites may be interactive, that is, they can link someone to e-mail or provide a tele­phone number to make an appointment. The degree of interactivity that one desires varies. At this time, providing a patient with specific advice about his or her problem over the In­ ternet raises significant medicolegal questions.

SUMMARY

In deciding whether to create a personal web site, the physician must consider how this new technology meshes with his or her practice. Although each surgeon relies to a significant extent on a network of satisfied patients and physician colleagues as a source for case refer­ rals, he or she may also elect to pursue a proac­ tive approach to educating the prospective pa­ tient and enlarging his or her patient base. Once prohibited by the medical community, advertisements represent an increasingly exer­cised option for solo specialty practices, group practices, and university-based health sys­tems. One must understand that a significant amount of information exchange is taking place on the Internet, and if the surgeon wishes to relate any information to this audience about plastic surgical procedures in general or the surgeon's particular services in specific, then a web site may be appropriate.

For the surgeon contemplating creation of an Internet web site, additional issues must be considered. There are many complexities to creating a web page and making it as accessible as possible, and whereas some surgeons create their own, most web sites are done profes­ sionally.

What is the optimal mechanism for ensuring that a practice is familiar to the population from which patients are drawn? The long-term success of a practice requires the satisfaction of its patients; the endorsement of a patient remains the best form of advertising. Never­theless, effort is required to reach out beyond this population to inform others of their op­tions. The aesthetic surgeon may decide that it is necessary to use multiple modalities to establish or maintain regional recognition. In most cases, a print advertisement represents a consistently successful method for reaching out to the intended audience. Over the last decade, however, it has become apparent that the creation of a complementary web site is also a cost-effective means to increase practice identification. When used together, these two mechanisms are optimal for educating the pa­ tient and establishing a strong practice pres­ence in the community.

References

1. Reaching out through print, optics, and cyberspace. AAO-HNS Bulletin 18:29-32, 1999
2. Turner S, Ellwanger S: Spring 1999 Cyberstats. Media- Mark Research, wtow.mediamark.com

Ask Dr. Becker a question or arrange an appointment for a nose surgery consultation by calling 856-589-NOSE (6673) or emailing us at info@therhinoplastycenter.com.

NOTE: CLICK HERE for information regarding privacy of your medical information. Additionally, all website users must agree to the terms and conditions of this site. Please CLICK HERE to review terms of use.