Editorial https://doi.org/10.1093/asj/sjac182 www.aestheticsurgeryjournal.com Dr Rosenfeld is a clinical professor, Department of Plastic Surgery, University of California San Francisco, San Francisco, CA, USA and is a clinical editor for Aesthetic Surgery Journal and a Second Thoughts on First Thoughts editor for ASJ Open Forum. Corresponding Author: Dr Lorne King Rosenfeld, 1750 El Camino Real, Suite 405, Burlingame, CA 94010, USA. E-mail: drr@drrosenfeld.com Private Practice and Social Media: Two Roads Diverge Lorne King Rosenfeld, MD Editorial Decision date: June 28, 2022; online publish-ahead-of-print July 5, 2022. “With our artistic eforts constantly on exhibition about the wards, not only the patients judged our results, but we too, if only out of the corners of our eyes, jealously compared our work with that of our colleagues.” Sir Harold Gilles, 1922. 1 Robert Frost begins one of his memorable poems with a timeless philosophical dilemma: “Two roads diverged in a yellow wood and sorry I could not travel both.” 2 The state of contemporary aesthetic surgery is facing its own Frostian crossroad. There are now 2 competing strategies for building a private practice. The frst is the old-fashioned modus operandi where a surgeon hangs up a proverbial shingle, treats their frst patients with the greatest of care, and enjoys the referral of their next patient. This cycle is akin to a paraphrasing of a memorable ad tagline by the in- vestment company Smith Barney: “Patients don’t just walk into the ofce and say sign me up for surgery. It takes hard work. So how do new surgeons attract their next patient? By gaining the respect—the old-fashioned way: they earn it—1 patient at a time.” 3 But today, we are witnessing a disruption of this age- old patient cycle by a marketing tool the likes of which we have not confronted in our over 2500 years of surgical his- tory: social media. Admittedly, physicians have been “mar- keting” themselves since the beginning of time: even the aforementioned goal of just taking better care of a patient is not only ethically admirable but an efcacious form of marketing. Yet there is a vast philosophical divide between this time-worn stratagem and the contemporary curating of oneself and one’s surgical results on social media. How so? Instead of taking one’s time—traditionally, a very long time—to nurture a practice, we now have a perfect storm of circumstances that represents an irresistible siren to the newly minted plastic surgeon: the devaluation of re- constructive insurance work, the burgeoning of aesthetic surgical candidates, and the invention of the omnipresent new marketing medium called “social media.” The storm’s aftermath is the ability of a surgeon to fool mother nature and preternaturally accelerate one’s prac- tice development. Now, not unreasonably, there is and will always be a gnawing sense of urgency to procure one’s next patient and duly perform a surgery to ultimately pay the bills. But with the winds of this social media engine at one’s back, the young surgeon might be compelled to embrace this more seductive path. But buyer beware be- cause it could embody a Faustian choice. That is, to be “successful,” ethics may be tailored: cutting some corners of of professionalism and the sacred physician-patient re- lationship and/or stretching some of the truth about out- comes, both good and bad. 4-6 And therein lurks the dilemma. As I have already ad- mitted, all practices, and particularly aesthetic surgery endeavors, should legitimately be free to promote their services. But it cannot be denied that these kinds of eforts, @ © The Author(s) 2022. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Aesthetic Surgery Journal 2022, 1–3 Downloaded from https://academic.oup.com/asj/advance-article/doi/10.1093/asj/sjac182/6628814 by guest on 26 July 2022