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Fake butts, fake followers: an Instagram-famous plastic surgeon talks medical ethics

Dr. Ashkan Ghavami is a board-certified plastic surgeon who has performed procedures on celebrities like Iggy Azalea, Amber Rose, Blac Chyna, and Tori Spelling. He is also one of the most followed plastic surgeons on Instagram, where he shares videos that are variously graphic, educational, and sexy with his 347,000 followers. In September, Ghavami published a paper in the journal Plastic and Reconstructive Surgery discussing the ethics of using social media to document procedures and their outcomes.

I called him up to chat about butts, fake followers, and the changing attitudes about social media in the medical profession. Our conversation has been edited for length and clarity.

What was it like for plastic surgeons when you got on Instagram in 2012? What were your colleagues’ reactions?

I started off by just posting some personal stuff, like most people do. Then I started putting some before-and-afters and bringing my business into it. Nobody else was on Instagram, as far as I remember, not even [now-Instagram-famous surgeon] Dr. Miami. I just knew that it was gonna be an original medium. What we do is all visual. It’s not like we’re fixing blood pressure; with plastic surgery, it’s in front of your eyes and it either looks good or it doesn’t. There’s nothing better than a visual marketing tool like that.

But at that time, nobody even knew enough about it to form an opinion. Some of the higher-ups — you know, the gray-haired, older surgeons — they were kind of jokingly criticizing it. Within a year or two, they were asking me, “How do you do it?” I have surgeons that are close to retirement that are just starting their Instagram pages now.

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What kind of official guidelines exist regarding the use of social media and surgery?

You cannot post anything that a patient has not given you permission for. That’s number one; that goes without saying. You have to be careful about things like a patient chart in the background, because someone can take a screenshot and zoom in on a name. But then, as number two, the focus should always be on patient care, safety, and education — and that’s where the gray zone starts. The point is of having an Instagram page is to educate people, but when it comes to medicine and surgery, we have to work hard to keep their interest. Some of my most educational posts have the least views because the cover photo isn’t some girl’s butt.

So now if I have an important message — if I went to a meeting, or if I was doing an academy talk — I’ll insert a picture of a butt that I worked on as the cover photo. Then at least people will click to see what it is.

So it’s really about finding the right balance between entertainment, education, and advertising?

Yeah. I sometimes use the example of an airline safety video. There’s nothing more serious than death from an airplane crash, but to get the passengers’ attention, the airlines have to use entertainment, dancing videos, rap, cartoons, etc. We have to be entertaining to get our message across, but some doctors can really take this out of whack. Like that one surgeon who wore sunglasses and took a good five to 10 minutes to choreograph a video with someone asleep under anesthesia. She wasn’t even a plastic surgeon; she was just a dermatologist. Those kinds of things are going happen.

What other kinds of unethical behaviors have you seen from surgeons on social media?

There are a lot of ethical problems when it comes to portraying honest descriptions of work. Some surgeons are photoshopping their before-and-afters, or using Facetune, or showing the same patients over and over. It’s horrendous what’s going on. I try to give a complete and accurate picture by showing a lot of pre-op and post-op videos. After three months, six months, one year, how does it look? I guess, in a way, it’s considered promotion or advertising, but really it’s just about people seeing the consistency and quality of my work.

Are you finding that, over time, more patients actually want to be featured on your account?

Yes, it’s very interesting. Iggy Azalea was one of the first big celebs I had that was actually open about surgery. She admitted on Ellen and in Vogue that she had her nose and breasts done, and then she invited me over to her house for Thanksgiving and sang to me on social media. I didn’t even ask her to do it. She just wished me a happy birthday and said, “Thank for my new nose and breasts!” Sometimes now people will just tag me in their photos because they’re so happy and proud [of their surgical outcomes]. It’s like how people tag Gucci because they’re loving how their shoes look.

But with most celebs, there’s still a stigma around plastic surgery.

There’s still a stigma, especially with people in the entertainment industry. They want to keep people guessing. I actually trademarked that: “Keep Them Guessing.” If I was a celebrity, I’d wanna keep ’em guessing too. It keeps you more relevant if people are like, “Wait, is her butt real? Is it fake? What’s going on?” Once they know 100 percent for sure, the discussion is over; there’s nothing else for them to talk about. So it’s good to keep a mystery. But obviously, if you have a huge nose, and then all of a sudden it’s this cute nose, you can’t keep ’em guessing too much with that.

Social media celebs are a little more open to posting about their surgeries, but I kind of consider myself to be the bastard child of Instagram. There are so many celebrities I’ve worked on and not a single one follows me. They’re not hitting the like or follow button because they don’t want their friends and family to see that they’re liking plastic surgery content. Right now, I have close to 360,000 followers, but I’d bet it’s closer to a million if you count the people that regularly go to my page but don’t follow.

I don’t blame them for not wanting to admit they know me. That’s why I started a separate non-surgical page, where I’m letting people know I do lip fillers, Botox, and facials. With that side of my practice, [mainstream] celebs are a little more open to posting about their procedures.

Is there anything else you think people should know about plastic surgeons and Instagram?

They just need to be careful, because anybody can try to have a cool, sexy Instagram page. Research the surgeon independent of Instagram. Make sure that they’re board-certified by the proper board, and that they’ve been around for a little while. There are doctors who have been out of residency training for only two years, and they pay to get 200,000 followers so they can look bigger and more experienced than they are. It’s dangerous, and it makes it much for harder for the consumer to figure out who’s legit and who’s faking it.

Medicine is still a sacred thing, but surgeons and doctors are human too. Just because they went to med school and took an oath doesn’t mean they’re a good human being. I see it as a privilege for someone to put their body in my hands to alter. Nothing in art is more sacred than the medium of the human body. I love what I do more than I love money. If that ever changes, I’m gonna retire and do something else.

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