Major findings and limitations of all studies

Primary studyQuestionMain resultsLimitations
Body image and acceptance of surgery
Wallner et al. [18]How does social media impact the perception of the female buttocks?Satisfaction with one’s own perception of their buttocks was mainly affected by factors such as sex life, country of origin, weight, and social media use.
Frequency of TikTok and Instagram use was associated with decreased happiness with one’s own buttocks and increased desire for cosmetic surgery.
Participants in Germany and USA were more likely to consider surgery than those in Nigeria or Japan, despite having similar perceptions of their own buttocks.
Favored waist-to-hip ratio was similar in Nigeria, Germany, and the USA, but favored a smaller buttock in Japan.		Web-based surveys may have reached a younger audience.
Representative image for the waist-to-hip ratio was not racially diverse, which could have affected self-esteem in persons of color.
de Vries et al. [24]Does time spent on social media lead to cosmetic surgery acceptance? Is its effect gender specific?Social network use relates to cosmetic surgery desire through appearance investment.
Girls reported more frequent use of social networking sites and had higher appearance investment and greater desire for cosmetic surgery.
Desire for cosmetic surgery was not moderated by gender.		Results are only applicable to the Netherlands as the social media site analyzed is only available there.
Almajnoni et al. [30]What is the attitude towards cosmetic surgery in the western regions of Saudi Arabia? (Makkah and Medina regions)Plastic surgery was accepted by 52.4% of survey participants. Factors that increased acceptance of cosmetic surgery included female gender, age > 30, and being divorced or a widow/widower.
Most common procedure that participants have had was laser hair removal.
More consideration was given to laser hair removal, rhinoplasty, and liposuction when asked about future procedures.		Small number of male respondents.
Sindi et al. [31]What is the attitude towards cosmetic surgery in the western regions of Saudi Arabia? (Makkah, Medina, Jeddah, and Altaif regions)When asked to rate themselves on attractiveness, the average rating was 5.3 out of a 7-point scale.
Women were more likely to consider facial Botox and liposuction, while men considered rhinoplasty and liposuction.
82% of participants reported 2 or more hours daily of social media use.
Media exposure was a significant predictor for surgery consideration in both men and women, with self-attractiveness for women, and history of cosmetic surgery for men as another factor.		Only generalizable to this region of Saudi Arabia
Hermans et al. [36]How does passive and active usage of social media affect young adults’ perception of cosmetic procedures?Survey participants had a low overall interest in cosmetic surgery, but perceived that it was more common than it actually is.
Increased frequency of using visual social media had an increased effect on cosmetic procedural intention. This was not the case for non-visual forms of social media.
Increased surgery intention was seen in participants who followed influencers who were open about prior cosmetic procedures. However, surgery acceptance was not increased. Following influencers who have not had cosmetic surgery correlated with a decreased intention for surgery.
Increased filter use on Instagram was positively correlated to surgery intention and acceptance.		Provides evidence of correlation but cannot infer causation.
Sayegh et al. [32]What is the attitude towards cosmetic surgery in the Jazan region of Saudi Arabia?Surgical procedures were accepted by 62.1% of participants.
Non-surgical cosmetic procedures were accepted by 63.7% of participants.
Higher acceptance scores for cosmetic surgery were seen in engaged and widowed participants. Divorced participants had a higher acceptance of non-surgical cosmetic procedures.
Lower acceptance of surgery was seen in participants with higher incomes and higher levels of parental education.
Increased age was associated with higher surgery acceptance.		Small sample size
Chen et al. [27]Does the use of social media photo-editing applications lead to increased cosmetic surgery acceptance?Social media had a positive association with cosmetic surgery consideration, with Tinder and SnapChat having the highest acceptance scores.
Increased consideration for surgery was seen in Instagram users, but acceptance was not increased.
Cosmetic surgery acceptance increased as the number of social media sites used increased.		Recruitment via social media may have skewed the sample to a younger population.
Alhusaini et al. [40]How do socio-demographic characteristics and SnapChat use affect the decision to undergo cosmetic surgery and the overall acceptance of cosmetic surgery?Overall acceptance was low among the participants.
The most popular option for future surgery was rhinoplasty.
Increased acceptance of surgery was seen in participants who were older, female, or who had had cosmetic surgery.
The tendency to undergo cosmetic surgery increases with increased SnapChat use, following influencers, and viewing advertisements and publications on social media.
Social media influencers were the most dominant factor in influencing the decision to undergo cosmetic surgery.		Provides evidence of correlation but cannot infer causation.
Ateq et al. [46]Does social media use lead to body dysmorphia and acceptance of cosmetic surgery?Body dysmorphic disorder (BDD) was found in 24.4% of participants.
Patients with BDD were found to spend significantly more time on social media such as Instagram and SnapChat. 29% of participants with BDD spent 4–7 h per day on social media compared to 19% who spent 1 h or less per day.
Younger age, being single, lower socioeconomic status, and being female were associated with BDD.
Individuals with BDD had a higher acceptance of plastic surgery.		Gender bias due to nearly 70% female participation.
Responses were self-reported, therefore diagnoses of BDD may be inaccurate.
Walker et al. [34]Does looking at images of people with cosmetic enhancements increase the desire for cosmetic surgery?Participants who viewed images of cosmetically enhanced females had an increased desire for surgery, compared to controls who were shown travel images.
Social media use predicted the desire for surgery when controlled for body dissatisfaction. Social media use was more predictive than body dissatisfaction for desire for surgery.
Body dissatisfaction in the control group did not predict a desire for surgery.		Survey-based study can only imply correlation but not causation.
Sonmez et al. [41]What is the relationship between frequency of social media use, appearance-related social media pressure, BMI, and body appreciation in patients undergoing cosmetic procedures?Pressures from social media negatively affected body appreciation.
Appearance-related social media pressures and BMI had a negative effect on body image.
Patients with invasive surgeries were more likely to read comments about surgeons utilizing before-and-after photos, search for information about a procedure, and look at the webpage for the surgeon.		Sample consisted of only females and was limited to one city in Turkey.
Gesto et al. [42]How do image-based Instagram activities related to either self, friends, or celebrities affect acceptance of cosmetic surgery and body dissatisfaction?Most image-based activities were related to friends, followed by celebrities, and then images of oneself.
Viewing or interacting with images of oneself or celebrities were directly and indirectly related to acceptance of cosmetic surgery, while activities related to friends was not.
Using Instagram for viewing and interacting with images was associated with more appearance comparison, higher body dissatisfaction, and increased acceptance of surgery.
The indirect effect of viewing or interacting with self- and celebrity-images on acceptance of cosmetic surgery was significant.		The study cannot make causal inferences, only correlations.
Alkhathami et al. [43]What effect does social media have on the acceptance of cosmetic surgery in Saudi women?36.6% of those surveyed felt that social media increased the pressure they felt to undergo cosmetic surgery.
29.6% take selfies to post on social media and 27.7% utilize applications to apply filters and thereby improve their appearance before posting.
There was not a significant correlation between time spent on social media and cosmetic surgery acceptance.		Female-only population.
Surveys on social media are skewed toward the younger population.
Seekis and Barker [44]Using the tripartite influence model, what is the association between women’s engagement with beauty content and cosmetic surgery consideration?There was a positive correlation between social media use, dysmorphic appearance concerns, and consideration of cosmetic surgery.The study included women only.
Nerini et al. [45]Does knowing that a photo has been altered have an effect on body dissatisfaction and acceptance of surgery?Enhanced images were effective in increasing perceived attractiveness.
Groups who were shown images without a disclaimer had a more internalized thin ideal and a higher acceptance of surgery for social reasons.		Small sample size.
Cannot generalize to the population.
Men were not included in this study.
More variation in the images is needed.
Social media engagement
Ben-Naftali et al. [19]What does the discussion of breast implant-associated anaplastic large cell lymphoma look like on social media?The majority of posts dealing with the disease were educational in nature.
Breast augmentation was represented in a largely positive light on YouTube. While posts on Instagram and Facebook were evenly split between positive and negative attitudes.
YouTube is used mostly by physicians and least by patients, while Facebook has the most non-professional authors.
Posts on Instagram had the highest return on investment in terms of engagement.		Analysis of attitudes towards implants in the context of a rare condition.
Mullens et al. [20]What are the qualitative and quantitative differences between engagement on Instagram vs. Twitter using the hashtag #plasticsurgery?The most common author types utilizing the hashtag were surgeons or clinics. Plastic surgeons were more commonly found on Instagram compared to Twitter.
Nearly half of all Twitter posts contained no visual media.
Instagram posts were more likely to be promotional in nature or contain images and videos whereas Twitter posts were more educational in nature.		Only a small portion of the large amount of content was analyzed.
Potential for inconsistency among reviewers.
Unable to assess engagement from saving or sharing of posts by users.
Çınar et al. [22]How do parents of children with cleft lip/palate engage with one another on Facebook groups?The most common posts were requests for information (55.4% of posts).
Additional common posts were those seeking support, showing appreciation to the other group members or clinicians, giving advice, providing support or information, and making announcements.		Limited to Facebook given the lack of a “group community” function with other social networking sites.
Nayyar et al. [26]What are the social media preferences of patients seeking plastic surgery?
Breast augmentation, facial rejuvenation, and combined breast and abdominal procedures were studied.		Patients found Facebook, followed by YouTube to be the most preferred social media source.
The type of social media platform was the most important in deciding where to obtain information.
Patients preferred videos and content delivered by the plastic surgeon.
No difference in preferences between current patients of the institution and crowd-sourced participants from Amazon MTurk.		MTurk may have allowed one participant to fill out multiple surveys.
Kinney et al. [29]How does social media influence patient empowerment?
Used Cyber Info-Decisional Empowerment Scale (CIDES) to analyze the impact of social media.		Facebook was associated with higher empowerment for patients to ask questions during consultation, gave them awareness of options, and empowered them to make the decision to undergo consultation.
Social media preference was also stratified by type of procedure. Patients desiring a cosmetic procedure preferred Instagram, followed by Facebook and YouTube. Patients looking for reconstructive surgery preferred YouTube, followed by Facebook, Instagram, and Twitter (X).		The survey offered financial compensation, which may have attracted certain individuals and therefore results may not be generalizable to the USA population.
Sorice et al. [37]How does the plastic surgery patient interface with plastic surgeons online?Facebook had the greatest patient use and engagement. YouTube had the second most users, while Instagram was second most in engagement. The least popular was Twitter (X).
Social media played a minor role compared to the practitioner’s own website in influencing patients to make an appointment.
Patients prefer plastic surgeons to post before-and-after photos, contests to win procedures and practice information. Dissemination of research held the least interest by patients.		The sample size was small and restricted to a single practice.
Patient demographics (race, income, education, and occupation) were not identified.
Alhujayri et al. [39]How has COVID-19 affected the perception of cosmetic surgery in Saudi Arabia?The majority of patients would undergo a cosmetic procedure to correct a scar or birth defect (75.8%).
Factors that motivated participants to consider or undergo plastic surgery during the pandemic were having more down time to recover and the perception that clinics would be less busy.
The most significant factor affecting the decision not to undergo a procedure was fear of COVID-19 (49.7%), and financial instability (44.6%).		Cross-sectional study, which does not show the timing effect of the pandemic on the overall population’s perception of plastic surgery.
Perceptions and outcomes
Egan et al. [21]How are patients discussing their experiences and outcomes from migraine surgery on social media?84% of posts were regarding nerve radiofrequency ablation, and 12% regarding nerve stimulators. A systematic analysis was noted by the authors to report similar proportions.
When analyzed for successfulness of surgery positive outcomes were found in 81% of nerve surgery, 47% of nerve stimulators, and 49% of nerve ablation procedures. These results were comparable to those found in the literature.
The most common complications reported were numbness, itching, and need for further surgery.
15% of posts were related to surgical advice, including which type of procedure and surgeon recommendations.
7% of posts reference complications.		Possibility of selection bias as a Facebook group specifically for migraines was used.
Zargaran et al. [28]To gain insights into the experiences of patients with an adverse effect of cosmetic Botox injections.Of the 511 respondents, 79% reported adverse effects, which is higher than the reported national average, suggesting underreporting.
The most common adverse effects include anxiety.
Other findings include that 69% of respondents had long-lasting effects and 92% felt that they were not properly informed about how to report adverse effects.		Possibility of recall bias.
Dengre et al. [25]How does viewing before-and-after photos of cleft lip repair alter the expectations of parents?50% of parents felt that the photos influenced their expectations however it did not affect parent satisfaction with the results.
Parents who viewed photos via Facebook or Instagram had higher expectations than those who viewed them via Google Images.
Parents felt that seeing images on social media made them feel less alone and gave the photos a “real life story,” while viewing the photos out of context on Google had a more negative experience.		Single center study.
Bater et al. [33]To evaluate peoples’ perception of persons with hair transplants via web-based images.Observers had a positive perception of age, attractiveness, successfulness, and approachability when looking at images of hair transplant recipients vs those who had not.Small sample size.
Non-blinded images may have primed participants to have a more positive response to hair transplant.
Putting social media to work
Tirrell et al. [23]How racially diverse are Instagram posts by plastic surgery professionals?Posts were 88.14% white, 81.5% female, and 99.7% cis-gender.
Racial and ethnic patients were under-represented in posts, despite a reported increase in plastic surgery among Black, Hispanic, Asian, and Native American patients.
Less than 12% of images represented people of color.
In terms of gender representation, more female or female-to-male images were shown than male or male-to-female images.
Reconstructive procedures were more likely to be diverse than cosmetic procedures.		Skin tone was observed and reported.
Focused primarily on academic-based plastic surgery accounts.
Timberlake et al. [38]Can social media be used as a crowd-sourcing method for scientific research?Recruitment to the study was 86% by social media and 14% by clinic visits.
Parents were able to easily understand the accompanying directions for obtaining a buccal swab and 10% of participants were found to have a novel mutation involved in craniosynostosis.
99.5% of participants noted that they would participate in another social media-based study because they did not need to travel and there was low monetary cost for them to participate.		Single center.
Facebook group may induce selection bias for willing participants.