Today’s airbrushing could be tomorrow’s Botox.

Americans are finding inspiration through celebrities and celebrity plastic surgeons online. In fact, half of plastic surgeons say social media is a cheap way of advertising their services, an American Society of Plastic Surgeons survey found, and one renowned Miami-based plastic surgeon, Michael Salzhauer, has accrued hundreds of thousands of followers by detailing his surgeries on Instagram and broadcasting real-time Snapchats of his surgeries. He has over 500,000 followers on Instagram and started his Snapchat account on advice from his teenage daughter.

However, the people advertising cosmetic surgery on Instagram are not always the best-qualified to conduct these procedures, a study published Wednesday in the Aesthetic Surgery Journal found. The survey of more than 1.7 million posts under 21 plastic-surgery related hashtags on Instagram found that only 18% were posted by board-certified plastic surgeons. Others were posted by barbers, salons, dentists, and other non-certified physicians, putting patients who respond to ads at risk, the study said.

“This is a very scary finding,” Robert Dorfman, the first author of the study and a third-year medical student at Northwestern University Feinberg School of Medicine said. “A cosmetic surgeon is not necessarily the same thing as a board certified plastic surgeon, and patients need to be made aware of this.”

The findings come as social media pressures more people to get plastic surgery: Over 40% of surgeons in a recent American Academy of Facial Plastic and Reconstructive Surgery survey said patients said looking better in selfies on Instagram, Snapchat and Facebook FB, -0.89% was an incentive for getting surgery. “People see pictures of themselves fairly routinely on Facebook,” said Fred Fedok, a Foley, Ala.-based plastic surgeon and president of the academy. Constantly seeing yourself from unflattering angles can take its toll on your self-esteem, he said.

Although the overall number of procedures has increased 115% in the U.S. since 2000, the kinds of procedures are shifting, influenced by the people they follow on social media. The majority of facial plastic surgeons (66%) said that nonsurgical procedures such as lip fillers used by social media and reality TV stars like Kylie Jenner and Lisa Rinna were the most common in their practice, according to a 2016 survey from the American Academy of Facial Plastic and Reconstructive Surgery, a professional association representing more than 2,500 surgeons.

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Many patients are opting for these less-invasive procedures, while major surgeries have fallen, the academy’s most recent data show. Of 15.9 million procedures performed in the U.S. in 2015, 6.7 million were Botox, up 1% on the previous year, and 2.4 million were soft tissue fillers, up 6% in 2015 on the previous year. Breast augmentation procedures were down 2% in 2015 on the year at 279,143. Liposuction, which is arguably less dramatic than silicone implants or, indeed, a face lift, was up 5% over the same period, but down 37% from 2000 at 222,051 procedures. The latter can cost anywhere from $3,000 to $15,000, experts say.

The top minimally invasive procedures are Botox, which roughly costs between $350 and $550 per area, fillers, chemical peels and microdermabrasion. Encouraged by young social media stars, more people are starting earlier. “A lot of people are utilizing things like Botox, fillers, peels and laser resurfacing in the early process of aging to try to minimize the effects and tread water as long as they can without undergoing a surgical procedure,” said Debra Johnson, a plastic surgeon with a private practice in Sacramento and president of the American Society of Plastic Surgeons.

Pop culture has long played a big role in the $14 billion plastic surgery industry. Over the past decade, the number of surgical procedures rose as television shows like “Botched,” a reality show about surgeries that have gone horribly wrong, “Extreme Makeover,” “The Swan,” and “Keeping Up with the Kardashians” have shown the realities of plastic surgery to the average consumer, Johnson said. Celebrity influence plays a large role in patients seeking plastic surgery, according to 99% of doctors in the American Academy of Facial Plastic and Reconstructive Surgery’s survey.

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The American Society of Plastic Surgeons introduced new professional guidelines for social media, but recommends doctors use platforms like Twitter to educate and engage as well as network professionally. Many patients use RealSelf, a social platform for sharing experiences about cosmetic surgery, to learn about the harsh realities of going under the knife. “It used to be that if you wanted to go get plastic surgery you’d talk to your friends and your doctor — now the vast majority of patients go online and look at reviews and other social media,” Johnson said.

Fillers and chemical peels are obviously less costly than more serious procedures that require a general anesthetic. Elective cosmetic procedures are generally not covered by insurance, but Johnson said many doctors even offer payment plans for cash-strapped patients. “Our research shows the vast majority of patients are middle class people, mostly women, who just want to maintain a youthful appearance,” Johnson said. “People are working longer into their late 60s and 70s and they want to look youthful, competitive and energetic in the workplace.”