Over the past few years social media adoption has taken off in aesthetics with doctors, nurses, and practices hoping to attract audiences and engage with their patient base. Instagram, in particular, has attracted a lot of attention, thanks to its image-friendly format and rapidly growing user base. It is also easy to learn; most of your friends are likely there, and younger staff members are happy to share the ins and outs.

One of the biggest drivers to Instagram adoption in our industry is the perception that you can get famous and acquire lots of new patients by dramatically increasing your fan count. This is reality for New York plastic surgeon Dr. Lara Devgan. She has amassed a large audience of 108,000 followers with photos and videos that regularly generate dozens of comments and thousands of likes.

But there's another reality to the aesthetic industry's presence on Instagram: some of your peers are employing unethical tactics to artificially enhance their presence on the platform. The desire for Insta-fame has distorted Instagram's original intention of generating personal connections and encouraged others—including highly regarded doctors and clinicians—to secretly buy, rather than build, their fandom.

“The level of faking it in aesthetics is quite astounding at times,” says Mark Sandritter, who joined RealSelf after five years managing social media accounts at Vox Media. “It seems that some practices are focused on making social media a popularity contest, rather than achieving true success by doing things that actually attract new patients.”

While there's nothing illegal about the deception associated with buying fans (for now), it is likely a big waste of money and a threat to one's reputation. And when buying up fake followers, it generates a big disconnect from what constitutes performance in social media.

Buying Followers on Instagram

Search “buy Instagram followers” on Google and you'll see dozens of websites offering to boost your following by thousands. The Apple App Store has nearly 100 listings that promise to boost your Instagram fan base. With Follower Source for Instagram, for example, you can even buy followers with credits earned by following other accounts.

Businesses like these often charge less than $100 for 10,000 followers, and the prices go down when you buy in bulk. It's possible to add a million fake followers in one click for just a couple thousand dollars.

As you could expect, most of these “followers” aren't really following you; actually, they are not even human beings. They're software-generated fake accounts, aka “social bots,” that are sold in bulk to artificially inflate buyers' social profiles. The problem is so pervasive that a 2015 study determined that 30 percent of Instagram accounts were inactive, meaning they only ever posted once at the most, and eight percent behaved like spambots.1 With a current monthly user base of 800 million, that suggests there are nearly 65 million fake accounts just on Instagram!

Suddenly those large followings don't seem nearly as impressive.

Paid Influencer Programs

Most brands on Instagram have developed their audiences with the help of Instagram influencers, who get paid to post. There's no universal definition of an influencer, but an individual is often considered one by simply having a large following. A six-figure following, regardless of how engaged it is, is enough to achieve influencer status in the eyes of many. And while an influencer with a million followers can get paid thousands of dollars for a single post, there's no guarantee that it's money well-spent.

The mark of a true influencer isn't how many people they reach, but how many people they can engage. A high follower count doesn't mean anything unless the person can cause those followers to take action. A person with 100,000 followers, but only one percent engagement, is significantly less influential than a person with 25,000 followers and 10 percent engagement. The ability to get people to like, comment, and click is the real value an influencer brings.

Fake Followers Can Damage your Reputation

The fact that fake followers don't actually generate new business is the least of it; they can actually impair your reach on Instagram feeds, damage your online reputation, and have a negative impact on your practice as a whole.

All social networks like Instagram and Facebook utilize algorithms to disseminate content. When you post something, it's initially only displayed in the feeds of a small portion of your followers. If those followers interact, aka engage, with the post—commenting on it, sharing it with others, etc.—the algorithm assumes the content is worthwhile and shows it to more followers. Conversely, if those initial followers don't engage, your reach gets restricted.

The majority of fake followers generate zero engagement. That means your content could actually be restricted from reaching your real followers because the fake followers overweight non-interaction, skewing the algorithm in the wrong direction.

Fake followers are also at constant risk of being purged. Social media companies work continuously to delete bots and fake accounts, occasionally removing thousands en masse. There's nothing more embarrassing than explaining why you went from having 25,000 followers one day to 2,500 the next.

Consider, for example, the purge Instagram implemented in 2014, which deleted millions of fake accounts, causing some users to lose one-half or more of their followings.

The BBC summed up some of the impact:

“Rapper Ma$e, who lost more than a million followers, deleted his account after he was accused of paying for more followers, while video blogger Jamie Curry tweeted: ‘I lost 30k followers on instagram omg.'”

Rest assured, the major social networks have only gotten more sophisticated in their detection efforts since then, and businesses that buy fake followers are putting a big red flag on their accounts.

3 Ways to Detect “Faking It” on Instagram

How can you tell if someone is faking it with an artificially enhanced follower count? There are several ways, and you don't have to wait for hosting platforms to take action:

1) Check their engagement: One telltale sign of an account with fake followers is a low engagement rate. An account with 50,000 legitimate followers will likely average between 750 and 4,500 engagements per post. If it instead averages 250 engagements, it's almost a guarantee the follower base is full of fakes. (Bonus tip: Read the comments and see if they make sense; spammy, nonsensical comments are another sign of a fake following.)

2) Check their followers: A quick scan of an account's followers can also be revealing. Bot accounts often lack profile photos or uploads, tend to be private, and typically follow many accounts while having low followings themselves. Fake following services may also have their own Instagram accounts, and many will follow accounts that purchase their services. If you notice an account that sells followers among someone's followers, they're probably a client.

3) Use a tool: Online tools like Social Audit Pro will scan accounts' followers and estimate how many are legitimate based on account activity. They're not 100-percent accurate, but they provide useful insights about the validity of Instagram followings.

Faking It Happens on other Social Media Channels

Instagram isn't the only platform that suffers from artificially enhanced followings. On Twitter, for example, you can use TwitterAudit to search any account for fake followers.

Nearly every account will have some fake followers, but hopefully your follower ratio looks more like this:

And less like this aesthetic “influencer”:

Audit websites, however, aren't an exact science, but rather, an estimation of fake users based on follower activity. A better approach is to use the same criterion the major social networks do: Engagement.

According to a study by Markerly, engagement on social media averages two to eight percent, depending on the size of the account.2 An account with 10,000 followers, for example, should generate at least 200 engagements on every post. If you see an account with a huge following getting only a handful of likes and comments, it's another big red flag.

Consider the actual accounts of three doctors with very engaged Instagram followings. One has a small following, the other two much larger ones; all boast healthy engagement rates:

Compare that to these three accounts that almost assuredly purchased a significant portion of their followers:

If a following seems too good to be true, it probably is. A simple check will show who's making it and who's faking it .

Fight Fakers with Expert Insights that Connect with Real People

Artificially enhanced follower counts are only part of the problem. Patient safety is another concern, as the most prolific tweeters and Instagrammers aren't always the most qualified. On Instagram, an analysis of the 21 most-used plastic-surgery hashtags revealed that just 17.8 percent of the top related posts were from surgeons eligible for ASAPS membership vs. 26.4 percent from non-eligible physicians, including OB/GYNs, family practitioners, and an ER doctor.3

And that doesn't include the 5.5 percent of posts that were published by dentists, spas with no associated physician, and even a hair salon. Clearly, nobody is well-served when the neighborhood hairstylist weighs in on aesthetic procedures.

Fake followers and unvetted insights are both big problems on the major social networks, but ethical practitioners can counter both with a single tactic: Contributing content that's timely, relevant, and above all, helpful to potential patients, who are more likely to like it, comment on it, and share it with others. That engagement is the true measure of success on social media, which is why having 1,000 engaged followers is more powerful than having 100,000 fake ones.

Here's how to attract them:

1) It all starts with great content: Given the proliferating volume of online information, posting a lot of generic content just won't “click” with today's aesthetic consumers. Give them real insights that help them make more informed decisions, and they're more likely to return the favor by responding to it. Bonus tip: Share photos and videos regularly as both have been shown to generate high engagement.

2) Amplify your efforts: During their preliminary research, most patients research procedures rather than providers. Savvy practices improve their odds of getting found by incorporating hashtags (e.g., #breastlift, #tummytuck), participating in Twitter chats, and using other strategies that extend their reach beyond their existing audience.

3) Measure your results: Behind your posts lies a goldmine of data on who's seeing your content, how they respond to it, and how far it spreads. Between the major platforms' internal analytics and a host of third-party tools, you can determine what generates engagement, what doesn't, and how to shape subsequent content for maximum effect.

4) Be careful when you outsource: When hiring an agency or consultant to grow your account, there are important considerations. First, do they have subject matter expertise? The lack of domain knowledge in aesthetics could create headaches for you if they make inappropriate statements, connect with unsavory people, or like the wrong content. Getting Instagram to work requires a thoughtful strategy, creative execution, and aptitude for data-driven experimentation. Bonus tip: When screening firms, give them a simple math problem and see how they handle it. A wrong answer means you should keep looking.

Also ask them how they plan to manage your account. Building social followings takes work, and many firms outsource to cheap overseas workforces. You get what you paid for it. Recently we uncovered that an SEO firm was posting the exact same content to all of their aesthetic clients' Twitter accounts. Don't settle for anything less than original content. Lastly, get references from businesses like yours. Find out whether the agency is responsive, ethical, and fun to work with.

Keeping it Real

Like many things we desire in life, there's a temptation to look for shortcuts, and Instagram is no different. Becoming the next Lara Devgan takes a lot of determination, investment, and willingness to be open, listening, and sharing of great information.

So if you found this interesting and relevant, please follow me on Instagram!

1. https://www.huffingtonpost.com/2015/07/02/instagram-spambot_n_7708550.html

2. http://markerly.com/blog/instagram-marketing-does-influencer-size-matter/

3. Aesthetic Surgery Journal, https:doi.org/10.1093/asj/sjx120

Tom Seery is the founder and CEO of RealSelf, an online resource for medical aesthetics. RealSelf reaches a vast, global consumer audience. 65 million people visit each year to obtain important information about aesthetic procedures and to find the right doctor or practice. 8,000 physicians get in front of the RealSelf audience by providing answers to questions and by sharing photos and videos. You can connect with Tom on Twitter @seery.