Crowdfunding has exploded in recent years and shows no signs of abating. Each day, individuals and companies use popular platforms such as GoFundMe, Kickstarter, and Indiegogo to launch fund-raising campaigns for anything you can think of, from lemonade stands and tech startups to breast augmentation and the ancillary costs of pro-bono reconstructive surgery.

While many plastic surgery crowdfunding campaigns provide much-needed funds to individuals and charitable causes with nowhere else to turn, others feed endeavors that many view as objectionable or utterly salacious. Crowdfunding platforms such as MyFreeImplants.com and GetCosmetic.com, which participants use to raise funds for cosmetic surgery, bring up ethical and moral questions.

“It is implicitly understood that the purpose of crowdfunding is to benefit a social purpose or assist an entrepreneurial effort that would otherwise struggle with initial funding. Cosmetic surgery covers neither of those,” says David Polgar, a tech ethicist and cofounder of the Digital Citizenship Summit, which will be held in West Hartford, Conn, in October.

What Is Crowdfunding?

Forbes defines crowdfunding as “the practice of funding a project or venture by raising many small amounts of money from a large number of people, typically via the Internet.”

In a typical case, the fund-raiser raises up to 40% of the funds from first- to third-tier connections, including family, friends, co-workers, and others associated with the fund-raiser. Once the project has gained momentum, other individuals who are unaffiliated with the owner may begin to contribute, sometimes in droves.

Crowdfunding traces its roots to 1997 when an intrepid rock band funded a reunion tour by soliciting donations online from fans. The first dedicated crowdfunding platform, Artistshare, was founded in 2000, after which other crowdsharing platforms gradually began to proliferate. By 2011, crowdfunding revenue had reached $1.5 billion.

Governments worldwide have been forced to pay attention. In April 2012, President Obama signed the Jumpstart Our Business Startups (JOBS) Act, also known as “the crowdfunding bill,” to legalize equity crowdfunding. After much haggling, the US Securities and Exchange Commission finally removed all hurdles to equity crowdfunding in March of this year.

The Good, the Bad and the Pretty

With the explosion of this new form of fund-raising, it was somewhat inevitable that there would be controversy. Crowdfunding purists and ethicists believe this form of funding should follow a certain code—ideally providing some type of social good.

There are examples of crowdfunding everyone can agree upon. For example, it’s probably safe to assume that no one will criticize the group of gamers who raised thousands of dollars to fund the brain surgery of fellow gamer Daniel Somerville, who, lacking medical insurance, had no way to pay for his surgery.

And then there is 7-year-old Quinn Callender, whose friend, Brayden Grozdanich, has cerebral palsy and needed surgery to help him walk. Unsatisfied with the funds raised at his lemonade stand, Callender enlisted the help of his parents to launch a crowdfunding campaign that ultimately brought in more than $60,000.

In the plastic surgery arena, there are inspiring examples of successful crowdfunding. MobileCause teamed up with Face Forward, a foundation devoted to providing “physical and emotional reconstruction” to women and children who are victims of domestic violence or any other “cruel act of crime.” The app will allow women to launch crowdfunding campaigns from their smartphones to fund additional costs of reconstructive surgery, which is provided at no charge by the plastic surgeon who founded Face Forward Foundation. Through their collaboration, MobileCause and Face Forward hope to bring awareness to the issue of domestic violence while helping survivors start their new lives. Any funds that go unused roll over to help other patients on the waiting list.

Crowdfunding is also being used to raise funds for plastic surgery technologies. For example, in January Apira Science Inc launched an Indiegogo crowdfunding campaign for its iDerma Facial Beautification System at the International Consumer Electronics Show in Las Vegas. The campaign aimed to improve the user experience when iDerma reaches the broader market. It raised more than $66,000 in just 1 month.

He Said, She Said

The plastic surgery arena has also played host to some of the more controversial uses of crowdfunding. Platforms such as MyFreeImplants.com (MFI) and GetCosmetic.com allow people to seek funding from strangers for elective, cosmetic surgery.

To date, MFI has helped approximately 1,500 women fund their breast enhancement procedures, according to the platform’s founder, Jay Moore. MFI currently has about 3,500 active fund-raisers and 5,000 donors. The service continues to grow and is currently in the process of expanding into other procedures.

How does it work? After creating an account, women converse with benefactors online to solicit donations to be used to achieve their cosmetic surgery goals. Contributors make direct donations in exchange for messages, photos, and videos from participating women. The funds are deposited in an escrow account called “The Boob Bank.” Once the target amount has been raised, women choose from the site’s network of participating surgeons.

“Some in the media criticize the site but they want to talk about it because it brings viewers, which brings ad dollars to them so they can sell us stuff we don’t need. Then you’ve got feminist groups whose clearly held slogan is, ‘my body my choice,’ but when it comes to fund-raising for a procedure in this fashion, they sing a different tune.” — Jay Moore, founder of MFI

According to Moore, MyFreeImplants.com not only helps women achieve their aesthetic dreams but also provides friendship and a social alternative to shy men who are uncomfortable meeting people in the bar scene.

Others are not so enthusiastic.

The very act of setting up a crowdfunding campaign does not force someone into donating, but it does set up some very uncomfortable social pressure, Polgar says. “Close friends are generally expected to contribute (and contributions are made public). By crowdfunding for a cosmetic surgery, the crowdfunder is putting their social network in an uncomfortable position where they may donate solely out of the motivation to maintain the relationship.”

Others have issues with the way sites such as MyFreeImplants.com tamper with the doctor-patient relationship. “The best outcomes occur when the surgeon understands the motivations and expectations of the patient and they come to a mutual agreement about setting goals that are reasonable and achievable,” says Christian Vercler, MD, a plastic surgeon and assistant professor of surgery at the University of Michigan Health System in Ann Arbor, where he is co-chair of the Ethics Committee.

Vercler—who also chairs the Ethics Committee of the American Society of Maxillofacial Surgeons, is a member of the ethics committee of the American Cleft Palate – Craniofacial Association, and lectures internationally on ethics and plastic surgery—is skeptical that such an agreement can be struck when crowdfunding is involved. “I suppose that this could happen in a situation where the money for the surgery was raised through crowdfunding, but the deck is stacked against [it].”

For example, he says, some websites require the patient to work with a predetermined Website ‘house surgeon.’ ” This limits the patient’s ability to choose their surgeon, or to change surgeons if she or he feels uncomfortable. If the patient is unhappy with the outcome, then what happens? Does the surgeon still have the same responsibility to take care of her? Fundamentally, cosmetic surgery is still surgery, and so the surgeon should be guided by a patient-doctor relationship, not a consumer-merchant relationship.”

The other problem is that a person might be trying to raise money for an operation that they are not an appropriate candidate for, he says. “For example, what if a heavy smoker raised $15,000 for a facelift that a conscientious, reputable plastic surgeon would refuse to do because of the known risk for serious complications among smokers? Does that person have to give the money back? Is there a surgeon affiliated with the website that has promised to operate on anyone who can raise the right amount of money?”

Also, Vercler adds, “it is impossible to ‘fact check’ these sites, so it is ripe for deception and abuse. In the case of breast augmentation, donors could be offered pre- and post-operation photos but photos could come from anywhere. It’s not necessarily the person contributors are led to believe they’re helping. This concern is essentially true for any crowdfunding of the medical variety.”

In his undergraduate course on medical ethics, Vercler uses the example of MyFreeImplants.com and asks students to comment. “They are generally outraged that such a thing exists,” Vercler says.

The practice has also been lambasted by everyone from mainstream publications to major plastic surgery organizations. Slate.com has referred to it as “the creepiest crowdfunding ever,” and 2009 president of the American Society of Plastic Surgeons, John Canady, MD, stated that it “turns a surgical procedure into a contest.”

The British Association of Aesthetic Plastic Surgeons has been equally scathing in its critique. “I thought I could no longer be appalled by the circus-like atmosphere surrounding plastic surgery, but this is really quite shocking,” said the organization’s past president, Adam Searle, in a press release.

Of course, the founders of cosmetic surgery crowdfunding platforms adamantly disagree. “We believe that everyone has full say about what they do with their own body,” says Alex Bradley, co-founder of GetCosmetic.com. “And what goes with that is how they fund the procedure. No one should be limited in how they pay for surgery. If there are people—friends, family, or even strangers—happy to help someone with their cosmetic procedure, then everyone’s a winner.”

Moore, the founder of MFI, agrees. “There are lots of people comfortable using this sort of fund-raising service, and they’re the ones getting the procedure,” he says. “Some in the media criticize the site but they want to talk about it because it brings viewers, which brings ad dollars to them so they can sell us stuff we don’t need. Then you’ve got feminist groups whose clearly held slogan is, ‘my body my choice,’ but when it comes to fund-raising for a procedure in this fashion, they sing a different tune.” Moore says that any safety concerns are unfounded, as MFI strictly forbids the exchange of contact information, and people caught doing so are banned from using the service.

So who is the ultimate arbiter of what is “right” and what is “wrong” in crowdfunding? So far, there is none. Regulators have weighed in on some level, but as with any moral question, there will always be disagreements. Absent any violations of law on the part of platforms such as MyFreeImplants.com, lawmakers will be hard pressed to force consenting adults to conform to a specific code of conduct. n

William Payton is a contributing writer for Plastic Surgery Practice magazine. He can be reached via PSPeditor@allied360.com.

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