The secret world of dolls

They call themselves dolls. These are cosmetic surgery patients who document their desires and results on Instagram, but only, most say, for other patients or prospective clients. They use names and hashtags that connect the work to their provider. So, for example, KathySmithDoll would be a woman who underwent surgery with a Dr. Kathy Smith.

In an era of patient empowerment, these pages—they’re called “Sx pages,” with “Sx” mimicking the prescriptive “Rx”—form a just-out-of-sight Instagram community. They serve as a cosmetic surgery shopping guide, a best-practices education system, and can also sound the alarm about bad experiences with practitioners. Some presurgery doll pages are more like inspiration pages or mood boards, collecting images of desired shapes.

That way, “other girls doing research can find someone with a similar build to theirs and follow their journey for a glimpse at what they might look like if they got similar procedures,” said Tai Hall, a massage therapist in Maryland. On her Instagram page, she showcases before-and-after body-contouring results; in her Facebook group, she teaches postoperative self-massage and how people can best take care of themselves while healing.

These Instagram pages, she said, “are really big deals.”

The Sx Instagram pages are private and anonymous, to some extent, and follow strict rules to stay that way, particularly since many feature nudity. (As a social media practice, Sx pages are fairly similar to teenagers’ private “finsta” friends-only accounts. They are, similarly, unverified and what they report is unverifiable.) Many of the bios on these pages indicate they won’t allow access to men.

Each Instagram page bio often unveils elaborate details, including height and weight. The patient—the doll—will list surgery dates and tag her surgeon, recovery house, any post-op care specialists or private nurses, and her post-op massage therapist.

Recovery houses, surgery providers and massage therapists also use the hashtags to promote their services. Some of these are flooded with ads or spam. Some are used by practitioners for education about surgery.

According to the American Society of Plastic Surgeons, more than 1.8 million cosmetic surgeries were performed in the United States in 2018. Breast augmentation and liposuction accounted for about a third of those.

And the number of “cosmetic minimally invasive procedures”—Botox, laser hair removal, soft tissue fillers and more—has grown rapidly in the United States. There were fewer than 5 million procedures in 2000. In 2018, there were nearly 16 million. (Almost half of those procedures are Botox treatments.)

Cosmetic procedures are also becoming more popular among people of color. The American Society for Aesthetic Plastic Surgery reports that cosmetic augmentation, like liposuctions and buttocks lifts, increased 56 percent among African-Americans from 2005 to 2013, and is still rising.

As the number of savvy customers grows, doll pages provide a useful glimpse into the less glamorous side of before and after—the details that people like to overlook, like bruising, drainage and the often painfully long process of healing after significant surgeries.

Patients become online advertisements for their surgeons. Surgeons develop a reputation on social media for being the best at certain procedures, for delivering a desired look, or for working with certain ethnic groups and body types.

“They’ll cry and upload videos of pain and success and their struggles, or whatever they’re going through, and their surgery sisters help uplift them,” Hall said.

And there is a lot to talk about, from surgeons to procedures to recovery houses to advice on how to travel with the least hassle from airport security or airline staff when patients are clad in fajas—a kind of post-op girdle—or other foam paddings.

Sx pages can be an effective patient empowerment tool if done honestly and fairly, said Dr. Alan Matarasso, a plastic surgeon in New York and the president of the American Society of Plastic Surgeons.

“It makes sense because this is a small group of people,” he said. “Not a lot of doctors do Brazilian butt lifts, but patients need to realize that they are not rating a restaurant.”

Matarasso encourages prospective patients who rely on Sx pages to research and prepare in other ways as well.

“The standards have to be even greater than if you had a sick gallbladder, because you don’t have to do this,” he said. “This is not like vetting a hotel room. You have to be careful.”

Matarasso recommends that prospective patients ask to see the surgeon’s best results and worst results, or a random case—say, the 37th case they did that year. He suggests that prospective clients visit the American Board of Plastic Surgery websites to do research and that patients query the licensing state and find out what, if any, violations a surgeon may have had. Patients can ask board-certified surgeons their specialty and whether they are certified in it.

Hall, the massage therapist, warned that patients may see women who heal faster or achieve different results than they might. As is often the case on Instagram, people tend to post fewer of their struggles and more of their highlight reels.

Sx pages might be even more valuable for patients who plan to travel internationally for their surgery. Many people in the United States do this to save money. Doll pages serve to warn prospective patients about problems that surgeons and hospitals don’t disclose.

After surgery, especially if extensive travel is needed, patients may recuperate at recovery houses for a few days. Procedures like fat transfer to the buttocks leave patients unable to move around or sit; doctors may install drains to help remove fluid after surgery.

In a recovery house, a caretaker can tend to their incisions, help with bathing, food, pain medications and even perform regular post-op massages.

In May, the mother of an Instagram model named Yatnaa Rivera died during a procedure in the Dominican Republic. Rivera took to Instagram to ask for help and to warn others. The doctor who performed the operation, Hector Cabral, had been fined for operating in the United States without a license. He is linked to several deaths and is still practicing. (Cabral did not respond to inquiries via social media; his office answered calls but said he was on vacation.)

Instagram accounts tagged into his doll hashtag (#CabralDoll) to spread the message.

Every day women are bombarded with images of beauty. With filters and editing apps, and the army of social media influencers who receive money or free cosmetic services in exchange for their Instagram posts, it’s often hard to know what’s real. Authentic depictions of what cosmetic surgery entails can be a reality check on what is attainable with cosmetic surgery.

In May, the American College of Surgeons released voluntary ethical guidelines for social media by surgeons. Many of them address patient privacy, but they also advise practitioners to provide trustworthy medical advice and to be cautious around these “powerful educational tools.” Even so, now a real-time, crowdsourced system allows patients to cut through the surgeons’ marketing and advertising efforts.

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