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Original Research (Original Article) 


Abdulrahman Abdullah Alsalim et al, 2019;3(9):776–779.

International Journal of Medicine in Developing Countries

Public perception of plastic surgery in a rapidly growing developing country

Abdulrahman Abdullah Alsalim1,2*, Abdulaziz Khalid Alotaibi1,2, Faisal Abdullah Alhabradi1,2, Salah Aldekhayel1,2,3

Correspondence to: Abdulrahman Abdullah Alsalim

*College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Email: alsalim021 [at] ksau hs.edu.sa

Full list of author information is available at the end of the article.

Received: 29 April 2019 | Accepted: 26 June 2019


ABSTRACT

Background:

The role of plastic surgery as a specialty may not be clearly understood by the public, making it difficult to distinguish from other medical specialties. The objective of the current study was to explore the public perception of plastic surgery in a rapidly growing developing country.


Methodology:

A cross-sectional study was conducted in Saudi Arabia through an online survey, which was developed and distributed to the Saudi public through social media over the period of two months (October–November 2017). Participants were asked to match 12 medical and surgical procedures to the most qualified specialist to perform the procedure.


Results:

A total of 4842 participants responded to the survey. Females comprised 75% of the respondents. The age distribution was as follows: age <21 years (20%), 21–24 years (36%), 25–40 years (40%), 41–54 years (3%), and age >55 years (1%). The majority had a college degree (57%). The proportion of respondents who ranked plastic surgeons as the most qualified in performing the following procedures: rhinoplasty (39%), mandible fracture (5%), blepharoplasty (78%), cleft lip surgery (61%), thumb replantation (29%), hand/finger fracture (6%), rhytidectomy (83%), breast reconstruction (89%), breast augmentation (97%), open leg wound (24%), open wound on the face (54%), and botulinum toxin injections (61%). Plastic surgeons ranked the highest in the following 7 of the 12 domains: blepharoplasty, cleft lip and palate surgery, rhytidectomy, breast reconstruction, breast augmentation, treatment of open wound of the face, and botulinum toxin injections.


Conclusion:

Large gaps in public education about the roles of plastic surgeons exist which may warrant more effective societal interventions.


Keywords:

Public perception, plastic surgery, rapidly growing developing country, Saudi Arabia.


Introduction

Plastic surgery is a broad field with several evolving sub-specializations in areas, such as cosmetic surgery, burn surgery, craniofacial surgery, hand surgery, microsurgery, reconstructive surgery, pediatric plastic surgery, and peripheral nerve surgery [1]. The history of plastic surgery goes as far as 600 years B.C when ancient Indians suffering from congenital anomalies traveled for long distances to visit Sushruta, who is known as the first plastic surgeon, to perform reconstructive surgeries [2]. Despite its profound history and significance, the general public may not appreciate the holistic role of plastic surgery in modern health care. It has been shown that large misconceptions exist between cosmetic surgery and plastic surgery [3]. People tend to believe cosmetic surgeons have less training and cosmetic procedures are easier to perform [4]. Plastic surgery training is 5 to 8 years of a formal residency training program which covers all the general principles of the field, and those doing various fellowships may spend a longer period [1]. Cosmetic surgery is a 1-year subspecialty fellowship which covers a relatively narrow aspect of the plastic surgery field [5]. It is believed that the public has a weak understanding of plastic surgery in several countries [6,7]. Unfortunately, the rapid evolution of social media channels and the heavy focus on cosmetic surgery as a representation of the plastic surgery field has led to reinforce such misconceptions. The current study investigates the public perception of plastic surgery in a rapidly developing country with a predominantly young population. This survey will evaluate the national needs for active societal involvement in public education.


Subjects and Methods

A cross-sectional study was conducted using a convenient sample of the Saudi public who participated in an online survey. A questionnaire was adopted from a previously published study and translated into the Arabic language by a certified translator [3]. Using Google forms, the survey was distributed to participants utilizing local popular social media channels: WhatsApp© (WhatsApp Inc., Mountain View, CA), Twitter© (Twitter, Inc., San Francisco, CA), and Snapchat© (Snap Inc., Los Angeles, CA). Social media influencers were invited to distribute the survey through social media. Only Saudi adults above the age of 18 years who were willing to participate in the study were included. Participants were asked to match 12 medical and surgical procedures to 7 medical specialists believed to be the most qualified to perform the procedure. One specialist was allowed per procedure. These procedures were rhinoplasty, fractured mandible, blepharoplasty, cleft lip and palate surgery, thumb replantation, treatment of a hand/finger fracture, rhytidectomy, breast reconstruction, breast augmentation, treatment of an open leg wound, treatment of skin cancer of the face, and botulinum toxin injections. The given specialties included dermatology, otolaryngology, general surgery, ophthalmology, oral and maxillofacial surgery, orthopedic surgery, and plastic surgery. Two open-ended questions were asked at the end of the questionnaire; “How would you describe a plastic surgeon?” and “What are the three most common procedures a plastic surgeon performs?” Statistical analysis was performed using IBM SPSS® software (IBM Corp., Armonk, NY) version 23.0.


Results

A total of 6,841 individuals accessed the survey link; of those, 4,842 individuals responded to the survey over a period of 2 months (October–November 2017). Twenty-three responses were rejected due to incomplete information. Demographic variables are summarized in Table 1. The majority (75%) of respondents were females. The majority of the participants were younger than 40 years of age (96%). Regarding the educational background, most respondents have a college degree (57%), whereas 5% has either a Master degree or PhD. When asked about the main source of information to choose a plastic surgeon, family or friend represented the main source of information (40%) followed by social media (28%), medical center (18%), and lastly doctor’s website (7%). When matching procedures to different specialties, plastic surgery was the highest ranked specialty in 7 of the 12 procedures (Table 2). These included breast augmentation (97%), breast reconstruction (89%), rhytidectomy (83%), blepharoplasty (78%), cleft lip surgery (61%), Botulinum toxin injections (61%), and facial wounds (54%). In rhinoplasty, most participants believed ENT surgeons were the most qualified (57%) followed by plastic surgeons (39%). In mandible fractures, oral and maxillofacial surgeons were ranked the highest (82%). Orthopedics was ranked as the most experts in thumb replantation (42%) followed by plastic surgeons (29%) and general surgeons (27%). Similarly, the highest ranked specialty in the management of hand fractures was orthopedic surgeons (89%). Just of over half of the samples (51%), chose general surgeons for the management of leg wounds.

Answers to the open-ended questions were grouped similarly and most participants believed “a plastic surgeon is a surgeon who is specialized in beauty.” Yet, some believed bariatric surgery and teeth whitening fall under the scope of plastic surgery.


Discussion

The study aims to examine the public’s misconception about plastic surgery as a specialty where some believe it is a cosmetic luxury rather than a medical necessity. Perhaps the persistent focus of the local media on cosmetic surgery as a representation of plastic surgery is one of the main factors. Others may include the exponential spread of multiple aesthetic clinics and medical spas in recent years in addition to the lack of effective official societal involvement in public education. The current study demonstrates that public perception of plastic surgery is mostly limited to aesthetic procedures. Furthermore, non-plastic surgery procedures (such as weight loss surgery and dental cosmetics) were mistakenly perceived as part of the realm of plastic surgery. The lack of clear differentiation between cosmetic medicine and plastic surgery has been seen in other cultures. The former represents a wide specialty being practiced by different medical and surgical specialties. The American Academy of Aesthetic Medicine defines aesthetic medicine as it “comprises all the medical procedures that are aimed at improving the physical appearance and satisfaction of the patient, using non-invasive to minimally invasive cosmetic procedures. The Aesthetic Medicine specialty is not confined to dermatologists and plastic surgeons as doctors of all specialties seek to offer services to address their patient’s aesthetic needs and desires.” [8]. Several aesthetic board certifications are being offered to physicians and allied health professionals; however, none of them is recognized by the American Board of Medical Specialties. These boards offer training courses and examinations to candidates that do not equal the rigorous training and certification offered by programs accredited by the Accreditation Council for Graduate Medical Education [9].

Table 1. Demographic characteristics of respondents.

Demographic variables N = 4,819
Age groups (years)
<21 971 (20.15%)
21–24 1,737 (36.04%)
25–40 1,925 (39.95%)
41–54 167 (3.47%)
>55 19 (0.39%)
Gender
Male 1,227 (25.46%)
Female 3,592 (74.54%)
Educational level
Did not finish high school 160 (3.32%)
High school 1,332 (27.64%)
Some college 267 (5.54%)
College degree 2,753 (57.13%)
Master 222 (4.61%)
PhD 85 (1.76%)
The main source of information when choosing your plastic surgeon
Social media 1,351 (28.03%)
Recommendation by family or friend 1,945 (40.36%)
Doctor’s website 332 (6.89%)
Medical center 849 (17.62%)
Others 342 (7.10%)

Table 2. Choice of the specialist in clinical procedures.

N = 4,819 General surgery ENT surgery Plastic surgery Orthopedic surgery Oral Maxillofacial surgery Dermatology Ophthalmology
Rhinoplasty 21 (0.44%) 2,763 (57.34%) 1,888 (39.18%) 91 (1.89%) 42 (0.87%) 7 (0.15%) 7 (0.15%)
Fractured Mandible 18 (0.37%) 75 (1.56%) 255 (5.29%) 513 (10.65%) 3,953 (82.03%) 3 (0.06%) 2 (0.04%)
Blepharoplasty 36 (0.75%) 15 (0.31%) 3,740 (77.61%) 3 (0.06%) 23 (0.48%) 529 (10.98%) 473 (9.82%)
Cleft Lip 188 (3.90%) 341 (7.08%) 2,929 (60.78%) 6 (0.12%) 1,240 (25.73%) 113 (2.34%) 2 (0.04%)
Thumb Replantation 1,289 (26.75%) 8 (0.17%) 1,375 (28.53%) 2,053 (42.60%) 3 (0.06%) 88 (1.83%) 3 (0.06%)
Hand/Finger Fracture 220 (4.57%) 4 (0.08%) 300 (6.23%) 4,287 (88.96%) 5 (0.10%) 1 (0.02%) 2 (0.04%)
Rhytidectomy 22 (0.46%) 10 (0.21%) 4,009 (83.19%) 9 (0.19%) 55 (1.14%) 712 (14.77%) 2 (0.04%)
Breast Reconstruction 409 (8.49%) 2 (0.04%) 4,283 (88.88%) 11 (0.23%) 1 (0.02%) 111 (2.30%) 2 (0.04%)
Breast Augmentation 86 (1.78%) 2 (0.04%) 4,654 (96.58%) 5 (0.10%) 71 (1.47%) 1 (0.02%) 86 (1.78%)
Open Leg wound 2,451 (50.86%) 9 (0.19%) 1,156 (23.99%) 704 (14.61%) 1 (0.02%) 491 (10.19%) 7 (0.15%)
Face wound 902 (18.72%) 21 (0.44%) 2,596 (53.87%) 26 (0.54%) 178 (3.69%) 1,094 (22.70%) 2 (0.04%)
Botulinum toxin injections 24 (0.50%) 10 (0.21%) 2,938 (60.97%) 5 (0.10%) 16 (0.33%) 1,823 (37.83%) 3 (0.06%)

Most of the sample described plastic surgeons as surgeons specialized in beauty. Less than 7% of the participants considered plastic surgeons as experts in the management of mandible and hand fractures. Microsurgery was not considered a major part of plastic surgery and less than a third of the participants considered thumb replantation under the domain of plastic surgery. We took a similar approach to a study done in New York, in which a survey was distributed in the major districts of the city, using a different population [3]. Our results represent a growing population in a fast developing country. Yet, the results seem to parallel those from developed countries. In New York City, plastic surgeons were ranked as experts in the same procedures as in the current study with the addition of rhinoplasty, which was predominated by plastic surgeons as opposed to ENT [3]. Various social media applications have changed the methods of knowledge dissemination amongst the public in the last decade. In a study evaluating the effect of social media, patients were interested in following their plastic surgeons’ social media accounts and interacting with “before” and “after” pictures [9]. Such interactions facilitated influencing patient knowledge about the surgery performed. Facebook©, YouTube©, Snapchat©, and Twitter© are the most popular applications used as an influencing tool due to their major impact on public perception [10]. However, in the current study, less than a third of participants considered social media as the primary source of information to choose their physicians. It seems that “word of mouth” recommendation remains the most popular method in choosing physicians. Limitations of the current study include the cross-sectional design and mode of dissemination through social media. This could have missed a proportion of the population who do not use these means frequently. However, the fact that the majority of the participants are younger than 40 years corresponds to the demographic profile of Saudi Arabia with 74.5% of the population being less than 40-year old [11]. Availability of free higher education for Saudis either locally in Saudi Arabia or abroad can also explain why the majority of participants have a college degree or higher [11]. Furthermore, the gender distribution is skewed towards female probably due to their higher interest in plastic surgery.


Conclusion

The current study summarizes public perception about plastic surgery as a specialty in a rapidly developing country. Formal societal involvement in public education and knowledge dissemination is of paramount importance to better educate the public and maintain the legacy of the specialty. Surgeons should also be involved in public education through proactive participation in various channels to heighten the perception of the full realm of the specialty rather than focusing on its aesthetic surgery subspecialty.


Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

Ethical approval was sought from King Abdullah International Medical Research Center, Protocol No: RC17-175-R, dated 03 October 2017.


Author details

Abdulrahman Abdullah Alsalim1,2, Abdulaziz Alotaibi1,2, Faisal Alhabradi1,2, Salah Aldekhayel1,2,3

  1. College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
  2. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  3. Division of Plastic Surgery, Department of Surgery, King Abdulaziz Medical City --NGHA, Riyadh, Saudi Arabia

References

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  2. Saraf S, Parihar R. Sushruta: the first Plastic Surgeon in 600 B.C. Internet J Plast Surg. 2006;4(2). https://doi.org/10.5580/1456
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How to Cite this Article
Pubmed Style

Abdulrahman Abdullah Alsalim. Public perception of plastic surgery in a rapidly growing developing country. IJMDC. 2019; 3(9): 776-779. doi:10.24911/IJMDC.51-1555691462


Web Style

Abdulrahman Abdullah Alsalim. Public perception of plastic surgery in a rapidly growing developing country. http://www.ijmdc.com/?mno=44446 [Access: July 09, 2020]. doi:10.24911/IJMDC.51-1555691462


AMA (American Medical Association) Style

Abdulrahman Abdullah Alsalim. Public perception of plastic surgery in a rapidly growing developing country. IJMDC. 2019; 3(9): 776-779. doi:10.24911/IJMDC.51-1555691462



Vancouver/ICMJE Style

Abdulrahman Abdullah Alsalim. Public perception of plastic surgery in a rapidly growing developing country. IJMDC. (2019), [cited July 09, 2020]; 3(9): 776-779. doi:10.24911/IJMDC.51-1555691462



Harvard Style

Abdulrahman Abdullah Alsalim (2019) Public perception of plastic surgery in a rapidly growing developing country. IJMDC, 3 (9), 776-779. doi:10.24911/IJMDC.51-1555691462



Turabian Style

Abdulrahman Abdullah Alsalim. 2019. Public perception of plastic surgery in a rapidly growing developing country. International Journal of Medicine in Developing Countries, 3 (9), 776-779. doi:10.24911/IJMDC.51-1555691462



Chicago Style

Abdulrahman Abdullah Alsalim. "Public perception of plastic surgery in a rapidly growing developing country." International Journal of Medicine in Developing Countries 3 (2019), 776-779. doi:10.24911/IJMDC.51-1555691462



MLA (The Modern Language Association) Style

Abdulrahman Abdullah Alsalim. "Public perception of plastic surgery in a rapidly growing developing country." International Journal of Medicine in Developing Countries 3.9 (2019), 776-779. Print. doi:10.24911/IJMDC.51-1555691462



APA (American Psychological Association) Style

Abdulrahman Abdullah Alsalim (2019) Public perception of plastic surgery in a rapidly growing developing country. International Journal of Medicine in Developing Countries, 3 (9), 776-779. doi:10.24911/IJMDC.51-1555691462