In fairness, other plastic surgeons enjoy great success on TikTok and tell me that they find the app to be more supportive of their content than Meta. “The culture of every social media app is wildly different,” explains Kelly Killeen, MD, a board-certified Beverly Hills plastic surgeon, who’s garnered sizable followings on both TikTok and Instagram. “I do certainly get moderated on TikTok, but I don’t get many account violations. When I do get actual violations, it’s always on a before-and-after post [that they categorize as] ‘disordered eating’ or ‘sexual/nudity content.’ I appeal and always win.” On TikTok, this happens only “once in a blue moon,” she says. “I have over 100 before-and-after posts up.” On Instagram, however, “every single video I post gets flagged and needs appeal.”
Dr. Killeen will sometimes notice reduced views on certain TikToks, which, she posits, “indicates I’ve triggered the AI. This happens most frequently when I use female anatomy terms.” In her experience, lower views usually result from the app limiting her posts to viewers who are 18+, which makes them ineligible for widespread exposure on TikTok’s For You page. (According to TikTok, users can still find this kind of restricted content through search tools or by following an account. It also notes that modest views may be due to a lack of community engagement rather than a post being unfit for the For You feed.)
Ideally, social media platforms would have “a credential verification system with altered moderation for medical professionals,” says Dr. Killeen. “When I discuss breasts and nipples, and show [surgical] photos, it’s a different animal than [someone] discussing Bianca Censori’s Grammy dress with full-frontal gratuitous nudity.”
Each platform publishes community guidelines and has its own strategies for enforcing them. On its site, Meta claims to make “careful allowances” for adult nudity—for certain medical and educational content or in the context of breastfeeding, for instance. When asked how their nudity policy applies to plastic surgery, Meta explained, “We don’t allow adult nudity on Facebook or Instagram, which includes female nipples. While we do make some exceptions for this, including breastfeeding and in a post-mastectomy context, this does not apply to these [cosmetic surgery] procedures.”
All Meta policies are outlined in its Transparency Centre and “designed to help keep our community safe, and that includes reducing the pressure that some people can feel as a result of social media,” the company tells Allure. Meta’s Regulated Goods policy includes a clause on cosmetic procedures (as well as weight loss products). It explains that Instagram and Facebook will restrict the visibility of any post (so that it is shown only to those 18 and older) that “admits to or depicts using a cosmetic procedure or surgery, highlighting its positive or negative impact, or side effects; shows coordination or promotion (by which we mean speaks positively, encourages the use of, or provides instructions to use or perform) of a cosmetic procedure or surgery; and/or depicts the before and after transformation of skin conditions after the usage of a cosmetic product, procedure, or surgery in a manner that may make people feel bad about their appearance or imply negative self-perception.” Even when certain plastic surgery-related content is allowed, it may not be eligible for recommendation, says Meta, which means it won’t have a very wide reach. Instagram aims to “avoid making recommendations that could be low-quality, objectionable, sensitive, … [or] inappropriate for younger viewers,” including anything it deems “sexually explicit or suggestive.”
In January, Meta announced a loosening of the regulations that it says have been “limiting legitimate political debate and censoring too much trivial content.” (There was no mention of medical—or aesthetic medical—content in the statement entitled “More Speech and Fewer Mistakes.” While some of the surgeons I spoke with are wondering if the changes will affect them, they say they haven’t benefited so far.)
