Social media allows aesthetic practitioners and their patients to interact in unprecedented and evolving ways. It serves to establish a more personal relationship between practitioners and their existing patients, as well as potential new patients.However, to many clinic managers and practitioners, social media represents a sea of confusion that is hard to navigate. Understandably, tweeting, pinning, posting and blogging can be daunting to the busy aesthetic practitioner. From Facebook to Flickr, Twitter to Tumblr, rapidly expanding platforms are emerging for practitioners to distribute educational and relationship-building material to existing and potential patients. Consumers are increasingly savvy about their wants, needs and options, and they demonstrate a growing desire to search for aesthetic procedures and providers online – long before making a phone call or setting foot in a clinic.Aside from nurturing a more personal relationship, social media sites can also work to facilitate health information and services. Through the dissemination of education materials, I have witnessed social media aiding patient education and collaboration, as well as helping with recruitment.With the staggering number of people and businesses active on social media channels, it is also getting harder for aesthetic practices to stand out in the digital world. It takes ingenuity and a creative mindset to build a community and keep them engaged. A campaign with the right tone and relevance can create affordable, meaningful engagement with audiences, when compared with the cost of traditional advertising. We are able to compare this more effectively by looking at paid for social media advertising. For one company, using Facebook tools to target online ads cut new customer acquisition costs by 39%.² As such, social media marketing plays an important role in marketing for an aesthetic practice. There are not many other ways to reach thousands of potential patients all over the world without spending a fortuneon advertising and PR. However, that being said, although most social media marketing may not seem expensive at first glance since participation is free, it does requires commitment and, as a practitioner, your time is your most valuable resource.

SOCIAL MEDIA PLATFORMS

The way your clinic communicates to patients and the goals you set for your practice will help you to increase patient awareness of the services and treatments on offer, as well as promote your lead generation activities to attract new patients online.Social media represents an ideal opportunity to promote your clinic and expertise, especially as it has become a preferred method of sharing information among healthcare consumers.^{4, 5}However, as this evolving marketing tactic is constantly changing, it can be overwhelming. The best approach is to break down social media into platforms that are mandatory and those that are optional, based on the clinic’s primary and secondary target audiences, goals, budget, and manpower. To do this, we must first understand how these free platforms operate, and be clear on their primary function.With more than one billion monthly active users, 945 million mobile users, and 757 million daily users,⁶ Facebook remains the biggest social platform, but there are other platforms growing in importance to aesthetic clinics, including LinkedIn, Pinterest, Instagram, Google+, and YouTube. As a minimum, it is a worthwhile investment in your time to reserve your name and clinic listing on all major social media networks, even if you are not planning to be active on all of them at the current time.

Below are four steps that I have found to be effective when utilising social media to connect with your patients.

Step 1: Choose your Platform	Create profiles on all platforms as well as creating your own clinic blog
Step 2: Connect	Start connecting with colleagues, partners, professional organisations and vendors. Encourage them to share your content with their networks to grow your online presence, which in turn, will help to increase your search engine ranking (SEO).3 This, in simple terms, means how high your clinic website will appear organically in online search results - the higher your ranking, the more visible you are.
Step 3: Content	Be constant in your posting – be this once every day, once or twice a week. The frequency will depend on the resources and time available, and this should be established in your social media marketing plan. Make sure to keep your network engaged. Link your social media accounts so posts will be shared on individual feeds. You can do this by using an online tool such as Hootsuite, Pagemodo or Social Oomph, which allows you to manage all your online platforms in one place – by scheduling posts and sharing content across all
Step 4: Engage	If someone replies or posts on any of your pages, ensure that you respond in a timely manner. From my experience, this means replying within 24 hours, or preferably less. Reply with links to articles containing relevant information / videos that correspond with the user’s query (or helpful links to your clinic pages), or invite them to follow or connect with your network. Share engaging posts, visually appealing graphics and video content that is of interest to your target audience.

Figure 1: Four steps to engagement

Facebook

Facebook is the number one global social media network. It is a virtual meeting ground where friends, family, and colleagues come to read what you choose to share.Aesthetic clinics and practitioners have embraced Facebook, although it has historically been fraught with potential privacy issues and challenges – of who can see what content, and how to manage negative or inappropriate posts, and protect your business page from spammers – that have forced Facebook to tighten up their policies.⁸ Introduced in January 2015, Facebook’s Privacy Basics feature provides a step-by-step tutorial to help users understand what happens when they share a Facebook status, image or video. It tells users how to specify whom they want to share particular content with, and how to manage content they may be tagged in by friends. It is also very easy to monitor a page on Facebook and to block, report, or hide any negative posts or inappropriate content.Business pages are where the information about your clinic needs to be posted, and I would recommend, from working within the industry, that this is updated daily. Posts could include information about your clinic, products and treatments offered, special training, patient seminars; content that engages your audience. Facebook is the ideal outlet to keep up with your loyal patients and attract new ones, through targeted ads and boosted posts. Of all the social channels in use today, Facebook offers a highly sophisticated paid-for advertising service that is widely considered the gold standard. The platform allows business owners to create targeted ads for different audiences, set a daily or campaign budget and measure the results across devices in a relative cost effective way when compared to traditional print or broadcast advertising.⁹

 Twitter

The advantages Twitter offers include brevity (140 characters) and immediacy (users can communicate with each other in real-time). This can be beneficial for dissemination of medical information and time-sensitive news. As on Facebook, however, practitioners and those who represent aesthetic clinics must exercise restraint if tempted to engage an irate patient in this public forum. Once something is tweeted and retweeted by another user, it is forever in the public domain and cannot be retracted.Every tweet can either hurt or help your clinic image. Make sure you therefore put alot of thought into what you tweet. It is advisable to steer clear of controversy, political views, religion and negative comments. If you have interesting content, Twitter is a great tool for quickly spreading the word. Retweeting and sharing other users’ content is quite simple, and if a user with a lot of followers retweets you, your content has the potential to be seen by a lot of additional users. As with all social platforms, with Twitter it is important not to simply share your own links or media hits. To attract followers, it is essential to also share interesting, relevant content from other Twitter users to keep your followers engaged and interested.

Even if the internet provides ample information, it cannot replace the face-to-face consultation, which always should remain a detailed process, covering both risks and limitations of alternative procedures

To ethically build a meaningful base of followers on Twitter, your Twitter strategy should focus on three broad categories: Content, Engagement and Rewards.10 Good content in this respect is content that is easily shareable. It should be compelling and quality information that is of interest to your followers; engagement can be nurtured with your audience by asking questions, engaging in debate and dialogue, and even asking for retweets. Rewards can also be offered by way of social-media-only deals (last-minute appointments, package treatments or a gift with purchase of products) or by posting behind-the-scene images of the clinic that are exclusive to your social media audiences.

Instagram

Launched in 2010, this photo-sharing site allows individuals, organisations and businesses to post their own photos and repost photos they consider engaging or potentially of interest to their followers. As on Twitter, hashtags function as subjects for each post and provide a link to related posts that use the same hashtag. While individual clinics, aesthetic products and patient advocacy groups are well-represented among these users, this platform skews a very young audience and is favoured by celebrities.Instagram, like Pinterest (discussed next), is a visual social media platform that is based entirely on photo and video posts. The network, which Facebook owns, has more than 300 million active users,¹¹ many of whom post about food, art, travel, fashion and pop culture. Instagram, unlike many other platforms, is almost entirely mobile. There is a web version, but you cannot take photos or create new posts, and other functions are limited.Getting started on Instagram is challenging because it requires something to take photos of, other than before-and-after photos of your patients. For aesthetic practitioners, this could include photos of your clinic, community events, your clinic or brand represented at exhibitions, your team at award ceremonies, a staff birthday, or any other snapshots that lend themselves to creating attractive images. Instagram users are elitists when it comes to photos; only the best and most attractive images will get liked and shared so keep that top of mind when selecting what to post. Instagram is only getting bigger, more important, and influential.¹² However, this is a platform where more artistic niches excel, so it may not be the best t for every clinic. If you want to succeed with Instagram, it is important to choose someone to manage your content who has a good eye for detail and has at least basic photography skills so that the photos and videos posted are high quality.

Pinterest

If your business is product-based, i.e. skincare, cosmetics, home care devices, etc. Pinterest can be helpful to promote sales and encourage usage. This platform consists of digital bulletin boards where users can save and display content they like in the form of pins. Users create and organise their boards by category, so, for example, as a personal user, one might have a board dedicated to food where they pin recipes, another board dedicated to photography they find interesting and so on. Although some research suggests that posting to this platform multiple times per day is beneficial, this is dependant on the industry.¹³ For aesthetics, this can be a fairly low- maintenance platform in terms of ‘pinning’ – as we are often not dealing in the realms of big brands. I would suggest considering it as complementary to your main social media channels and consider posting a few times a week, or as and when you have good content to share that suits your online message. Pinterest is very visually oriented; every post has to be an image or video. However, keeping your boards organised and search-friendly by adding hashtags can be time-consuming, so you will need to factor this in.

LinkedIn

With new social networks sprouting up constantly, LinkedIn is a platform that often gets underutilised or put on the back burner. But it can be extremely powerful if you take the time to uncover all of the platform’s hidden features. The social network is primarily centred on business-to-business relationships. It enables users to connect and share content with other professionals, including colleagues, potential employers, business partners, and new employees. It can also be an excellent marketing tool. The design of Company Pages has changed a lot over the years. Make sure yours is set up correctly and optimised for the newest layout, featuring a compelling and high-quality banner image. The best ways to be active on LinkedIn are to join groups that are relevant to your clinic, aesthetic medicine, as well as personal and professional interests, and to comment on discussions.

YouTube

YouTube, which is owned by Google, has upwards of 1 billion users14 and is a unique source of information distribution and communication. The influence of YouTube on personal health decision-making is generally well established,¹⁵ with footage catering to all aspects of health and wellbeing, be these treatment videos, patient experiences or informative advertisements. The visual nature of this video-sharing site has proven a natural fit for dermatologists, plastic surgeons and other aesthetic physicians. It’s well known that online sites draw more traffic with images than text, and the brief video format is ideal for illustrating aesthetic products and procedures or helping patients get acquainted with your practice. A 2014 study revealed more than 100 dermatology-related videos on the site, generating nearly 50,000,000 views.¹⁵ Popular topics included skin cancer/ tanning awareness and educational/demonstration videos relating to skin conditions.

Google +

Google + is Google’s own attempt to go social. Having your practice on Google+ is more about SEO value than reaching patients or engagement, as Google+ isn’t really a social media platform in the traditional sense.It is more often used as a tool for boosting search engine ranking and visibility, as the information you publish on here may be used by Google when online users search for your clinic. To get started, create a page for your clinic. Optimising your Google+ page and profile, by providing as much detail about your clinic as possible, is essential for using this platform to your advantage.¹⁶ Google+ is composed of ‘Circles’, similar to networks, so that you can share various types of information to specific circles. For example, you may have circles divided into friends, family, colleagues, staff, distributors and suppliers, etc. You can invite users to join your circles, although they can add you without you adding them back. Google + also has features to help you broadcast your updates to targeted audiences. Similar to Twitter, Google + keeps track of what’s trending and hashtags can be used to make your posts searchable.Google+ is constantly evolving and offers value as a platform to enhance a clinic’s search results and post optimised content. For these purposes, it is important to have a presence in this powerful network.

The following statistics are taken from a survey of 1,597 participants: Facebook: 66% of men and 77% of women surveyed use Facebook. 87% of participants aged 18-29 and 73% aged 30-49 use Facebook. Twitter: 24% of men and 21% women surveyed use Twitter. 37% of participants aged 18-29and 25% aged 30-49 use Twitter. Instagram: 22% of men and 29% of women surveyed use Instagram. 53% of participants aged 18-29 and 25% aged 30-49 use Instagram. Pinterest: 13% of men and 42% of women surveyed use Pinterest. 34% of participants aged 18-29 and 28% aged 30-49 use Pinterest. LinkedIn: 28% of men and 27% of women surveyed use LinkedIn. 23% of participants aged 18-29 and 31% aged 30-49 use LinkedIn. * Source: Pew Research Centre’s Internet Project September Combined Omnibus Survey, September 11-14 & September 18-21, 2014. N=1,597 internet users 18+

Figure 2: Summary of top five social platform demographics⁷*

PRIVACY AND LEGAL CONSIDERATIONS

Despite the potential benefits of social media, practitioners should also be aware of potential pitfalls when using these powerful platforms. Privacy compliance is important, and practitioners must keep all patient details anonymous. It is also important to be sensitive to the different backgrounds of those who follow social media accounts because messages have the potential to be misunderstood if not worded carefully. Furthermore, patients should be informed that private information regarding their care cannot be discussed online. Practitioners should also be cognisant of any rules and regulations their organisation may have regarding social media use. Following these simple recommendations can allow clinics to reap the myriad of benefits that social media can offer.A practitioner’s personal actions as well as his or her’s clinic’s actions on any online forum do carry a risk of negatively affecting their reputation and there may even be legal consequences in certain circumstances. It is therefore important to stay abreast of general professional guidelines for social media that are constantly under evaluation.¹⁹ For example, to protect your licensure and reputation, it is imperative to check with the professional associations or organisation you maintain membership in periodically, as well as your malpractice insurance carrier. This is an evolving area in medicine and the law is unable to keep up with the speed at which the exchange of information online and in public forums is increasing.Keep in mind that the individual practitioner is responsible for his own behaviour. Therefore, any staff member who may be posting on social media in your name, or external consultant, PR or marketing agency engaged to manage your online platforms, should be well versed in the guidelines that apply to your clinic and specialty.²⁰For example, the clinic staff and practitioners should preserve the appropriate boundaries of the doctor-patient relationship when interacting with patients online and ensure that patient privacy and confidentiality are strictly maintained. Posting about specific cases or revealing any patient data or identifying comments that could be misconstrued as a breach should be discouraged. It is also vital that medical professionals refrain from offering medical advice or suggesting any action or remedy that would require a consultation with a practitioner first. If you are unclear on the best guidelines to follow while navigating these unchartered waters, it is best to consult with your solicitor.Online interaction with patients about their medical treatment and care in your clinic, such as email exchanges, are widely accepted. However, these conversations should never occur on a social networking platform or open forum. Practitioners should be discouraged from interacting with current or past patients on social networking sites such as Facebook or Twitter. For example, it is frowned upon to reach out to ‘friend’ a patient. Let the patient do the engaging; such as liking your professional business page. Practitioners must use caution to keep their business accounts (which users may ‘like’ and follow without any breaches of the practitioner-patient relationship) and personal accounts separate and distinct to avoid confusion. If a patient tries to friend the practitioner on his personal Facebook profile, common practice is to not accept the friend request but rather to direct the patient to your business page for the clinic. It is vital to adhere to the same principles of professionalism online as the practitioner and clinic staff would do offline.

For posting on each of these social media sites, I would recommend deploying the following formats, in terms of the type of content posted:17 Facebook – paragraph, link, video or photo, hashtag(s) Blog – short paragraph of 500 words approx., image Youtube – original video, a line or two of text Twitter – 140 characters (like a text), hashtag(s) Instagram – photo, a line or two of text, hashtag(s) Pinterest – image, boards, hashtag(s) Linkedin – paragraph, link Google+ – a line or two of text, image, video, hashtag(s)

Figure 3: Social platforms - format types

These are intended as basic guidelines for clinics that are manageable, although there is no definitive rule. In general, if you are tracking engagement, you will be able to see if you are posting too frequently and irritating your fan base so they are not reading your content or unliking your page. The number of times you post as well as the actual timing of your posts can spell success or failure. Certain times are better than others, based on your target audience. The only way to really know what the optimum times of day are is to follow the analytics.18 The majority of these social platforms will have in-built analytic tools (to varying degrees of detail) which will provide information on clicks, views and feedback regarding your posts. Facebook - Daily Twitter - 2 to 3 times per day Google+ - Daily Youtube, Pinterest, Instagram - Weekly Linkedin - Weekly

Figure 4: Posting guidelines¹⁷

CONCLUSION

Use of the internet in general, and social media more specifically, are seen as playing a growing role in aesthetic medicine as primary sources of information sought out by consumers about treatments and practitioners. Ultimately this trend has resulted in more informed patients, but there is also a danger of fostering unrealistic expectations. Information posted online by individual sources is not subject to rigorous standards or policing so, in effect, information is stated with impunity. Even if the internet provides ample information, it cannot replace the face-to-face consultation, which always should remain a detailed process, covering both risks and limitations of alternative procedures.