It used to be that if you wanted to watch a surgery, you had to sit in a gallery behind a glass panel. And even then, you usually had to be a medical student. The surgeon performed on the other side, but there was no interaction between the doctor and spectators.
Now, anybody can watch a surgery, and they’re watching from the comfort of a mobile device.
“So thank you all for tuning in. I'm Dr. Rich. Rich Castellano. Double board-certified facial plastic and reconstructive surgeon. We're doing a facelift procedure under local anesthesia …”
Dr. Castellano, a plastic surgeon working out of his offices in a retirement community about two hours north of Tampa began a recent facelift operation by introducing himself to his live audience.
Castellano is alone in the room with his patient and assistant in The Villages, but people all over the world are watching. He streams many of his surgeries live on Facebook, and on the mobile app Periscope.
His patient today is Andrea Whitehead. She’s 76. And just before he gets started, he reassures her:
“You're going to do great, we're going to take great care of you.”
Castellano has been broadcasting surgeries live for just over a year now, and has posted more than 400 videos. He started with wearable tech, like Google Glass, but found it too limiting, so he moved on to streaming straight from his smartphone.
"Everybody wants the freshest information; it doesn't get much fresher than live,” Castellano said.
While Whitehead lies on the operating bed -- numbed, but awake -- Castellano sets up his equipment. He attaches three smart phones to a tripod, and signs into his Facebook and Periscope accounts. On the two walls opposite him, a projector displays the feeds live, so he can see comments and questions from viewers.
“So we monitor oxygen, we monitor heart rate and monitor blood pressure, but most importantly, we monitor Andrea and ask her how's she's doing,” Castellano says to his audience.
His assistant reads a comment from Periscope.
“Someone asked, 'Why is there chin swelling?’”
“There's chin swelling there because of the tumescent solution I'm putting in,” Castellano replied as he continued to inject Whitehead with the solution. “This is a numbing medicine."
Castellano asks the audience who they are and where they’re from. They say they’re doctors, medical students, people considering facelifts. Some are just fascinated by what they think is gross and macabre.
There were a lot of “WTFs” scrolling across the comments section.
Another patient who agreed to have his surgery live-streamed is Gerard DePace. The 56-year-old Spring Hill resident had a brow lift just two weeks ago. He said he was fascinated by the concept of live-streaming surgery.
When Castellano and his assistant read the comments out loud, DePace said that kept him entertained on the operating table.
"I kind of liked it, I couldn't help but laugh,” DePace said. “I was trying not to laugh because I didn't want to move. Some of the comments people were saying -- there were like 1,500 people watching -- he would say out a few of the comments people were saying to him. One person said, 'Well, he looks like John Travolta and I'm like, 'I don't know whether that's a good thing' and some person said, 'Well, is he single?' and that was nice. Kind of made me feel good."
DePace went back and watched the video and said that helped him remember his aftercare instructions.
"I love it now because I have a record of it to go back , plus he's talking about what I should do afterwards, what he's doing and you can't remember all that as you're lying there," DePace said. "So I have a record to go back and reference of what was done and what I needed to do when I got back home.”
Castellano said you have to reach people where they are, and where they are right now is on social media.
"In the days of old you went to the doctor, you did what they say, but people have choices now,” Castellano said. “If you're not an effective communicator, if you don't know how to thrive in retail medicine, you'll have upset patients, you'll lose business, patients give you negative reviews online. So like it or not, that's where we are."
When he says “retail medicine,” Castellano is talking about the ability of patients to shop around for a doctor. He has to market himself, especially since plastic surgery is elective and not medically necessary. That means it’s typically not covered by insurance.
Other plastic surgeons are operating live on social media, too. In Miami, there’s a doctor who uses Snapchat to stream tummy tucks, and breast and butt lifts.
Castellano thinks Facebook Live and Periscope are just the beginning. The social media-savvy doctor said it won't be long before the next tool in a surgeon's repertoire arrives: virtual reality.