An Analysis of Male Plastic Surgery Content on TikTok

Abstract

Background

TikTok is a powerful and popular source of patient education. However, the lack of content regulation raises concerns about the spread of medical misinformation.

Objectives

We aimed to analyze the source, content, quality, and reliability of TikTok posts focusing on surgical and nonsurgical cosmetic treatments for men.

Methods

A search was conducted on TikTok with 16 popular hashtags related to male cosmetic procedures. The top 25 male-focused videos from each hashtag were chosen for analysis. Videos were categorized by content creator, video type, and descriptive metrics. Educational videos were evaluated for quality with the validated modified DISCERN (mDISCERN) score and the Patient Education Materials Assessment Tool (PEMAT) scale. Statistical analysis was performed with univariate and linear regression models.

Results

The included 399 videos totaled 389 million views, 16.4 million likes, 174,594 comments, and 586,743 shares. Most videos were uploaded by plastic and reconstructive surgeons (38.3%). A significant number (38%) of videos by physicians were posted by international physicians, with videos by United States physicians receiving fewer views, comments, and shares than videos posted by international physicians. Patient experience was the most common video category (48.9%). Educational videos had low overall quality, with physician-created videos demonstrating higher DISCERN and PEMAT scores but lower engagement compared to nonphysician videos.

Conclusions

The quality of TikTok videos on male cosmetic surgery was generally low, emphasizing the importance of accurate information dissemination by physicians on social media. The strong presence of international physicians highlights the potential implications of social media on medical tourism.

Since its inception in the 2000s, social media has radically transformed how individuals communicate, share experiences, and connect globally.¹ Almost 60% of the world population over 18 years old utilizes a social media platform monthly, a figure that climbs to nearly 89% in the United States, underscoring its prevalence.^2,3 A recent entrant to the market, TikTok (ByteDance, Culver City, CA), has established itself as the fastest-growing social media platform, becoming the most downloaded entertainment application worldwide in 2022, with over 672 million downloads and over 6 billion lifetime downloads. The platform has more than a billion monthly users and over 138 million active users in the United States.^4,5

Social media's impact has permeated every aspect of modern life, including healthcare, where it is utilized by physicians to share information, by patients to share their journeys, and for innumerable other purposes.⁶ TikTok has been instrumental in allowing patients to share their experiences with followers or letting physicians promote their businesses and educate their clients.⁷ However, like other social media platforms, TikTok's unregulated nature allows for rapid spreading of unverified information, often resulting in the dissemination of possibly inaccurate medical information. This lack of regulation could negatively impact patient decision-making and ultimately patient outcomes.^7-9 Previous studies in which TikTok was evaluated as a medical information resource have demonstrated poor overall quality and the need for more accurate healthcare information.^10,11

Aesthetic-based specialties such as plastic surgery, dermatology, and oculoplastic surgery have embraced social media to create content to promote their practices, visually educate their patients, and facilitate discourse.^12,13 However, an unexpected consequence of social media use is its detrimental impact on the self-image and perception of beauty of its users, which leads to an increased desire for cosmetic plastic surgery procedures.^12,14,15 A study by Chen et al showed that social media use was positively associated with consideration of cosmetic surgery in both males and females, especially those who utilize photographic filters, which are widespread on TikTok.^14-17 Another study by Abbas et al also points to television and social network site use in promoting acceptance of surgical and nonsurgical routes to appearance enhancement.¹⁸ Additionally, in a 2021 report by the American Society for Dermatologic Surgery, social media proved to be a stronger influencer than friends for both cosmetic procedures and skin care purchases, with many digital campaigns promoting procedures or surgeries by physicians.¹⁹

Over the past 2 decades, there has been a steady rise in men seeking cosmetic procedures, likely driven by numerous factors, including increased male social media use.^20-22 Based on a report from the American Society of Plastic Surgeons, male cosmetic procedures now account for over 13% of total cosmetic procedures, with certain surgical procedures performed over 4 times more than they were in 2000.²¹ Total cosmetic procedures for men increased by 29% between 2000 and 2018.²¹ The report also details the most common cosmetic procedures for men to be facial injectables and skin treatments (the top 3 being laser hair removal, microdermabrasion, and chemical peels), while the most common surgical procedures are rhinoplasties, blepharoplasties, liposuction, breast reduction (for gynecomastia), and hair transplantation.²¹ Despite these trends, males still receive less recognition by cosmetic surgeons and limited attention in their online marketing efforts compared to female patients.²³ With this lack of attention, men who are more vulnerable may turn to social media for information about plastic surgery.²⁴ This, in turn, may lead to diminished self-esteem and improved attitudes toward cosmetic surgery, even if they are consuming unregulated and possibly low-quality information.^18,24,25

Therefore, it is crucial to investigate TikTok content for male plastic surgery as a field that has grown significantly in recent times but continues to be overlooked by medical professionals. Ensuring accurate information and reducing dangerous behaviors when seeking surgery is vital to mitigating adverse outcomes, improving patients’ health, and enhancing the perception of plastic surgery as a specialty. In this study we aimed to analyze the source and content of all TikTok posts regarding male cosmetic surgery treatments, as well as to evaluate the quality and reliability of educational videos present on the platform.

METHODS

In May 2023, we systematically searched the TikTok platform employing a combination of medical terminology and everyday language related to male cosmetic plastic surgery. Our selection of search terms was based on the known popularity of certain procedures among individuals identifying as male. The aim was to choose videos specifically targeting users who identified as “male” or “men.” Searches were conducted, and the results were reviewed by 2 independent evaluators (E.R. and D.C.) to ensure that the videos centered on treatments for this demographic and an appropriate number of videos was included. In cases of disagreement regarding inclusion, the senior author (J.A.R.) served as final arbiter. Each of the 16 identified trending hashtags underwent individual searches. These included #Hairrestoration, #Chinaugmentation, #Limblengthening, #Maleplasticsurgery, #Calfimplant, #Abdominaletching, #Hairtransplantsurgery, #Malefiller, #Malerhinoplasty, #Abetching, #Chinimplant, #Malelipfiller, #Gynecomastia, #Malejawline, #Maleaesthetics, and #Penileimplant. Any videos not in English, lacking spoken or written content, or that were duplicates were discarded. TikTok's internal listing algorithm guided the selection of the top 25 male-focused videos from each hashtag search to form the final study sample. Descriptive attributes of each video, such as cumulative views, likes, comments, and shares, were documented.

Aggregate metrics were applied to compute the engagement rate, which represented the level of audience interaction elicited by each post, for every video.²⁶ The creators’ credentials were determined by inspecting their TikTok profiles or official websites. Posters were categorized as allopathic or osteopathic physicians (ie, those with MD or DO degrees); nonphysician healthcare providers (nonphysician HCPs, eg, nurse practitioners, registered nurses, or nurse injectors, physician assistants); non-healthcare providers with professional licenses (non-HCPs, eg, patient navigators); patients; or others (eg, the general public). In the case of physician creators, their areas of specialization and geographic practice locations were noted. Videos were further segmented into categories such as patient experience (eg, before-and-after comparisons); education (eg, procedure descriptions or posttreatment care); live procedure/surgery; advertisement/product promotion; self-marketing; humor; career (eg, job prospects in the realm of male cosmetic plastic surgery); and others (eg, debates around men undergoing plastic surgery).

The content quality, reliability, understandability, and actionability of each video that was identified as “education” were scrutinized by 2 independent evaluators (E.R. and D.C.) with the validated modified 5-point DISCERN (mDISCERN) and the Patient Education Materials Assessment Tool (PEMAT).^27,28 In instances of significant disagreement, the senior author (J.A.R.) served as final arbiter. Mean scores were computed for each video. In the case of any discrepancy, the J.A.R. acted as tiebreaker.

Nonparametric analyses with medians and interquartile ranges (IQRs) were implemented for a more nuanced depiction of data distribution due to violations of normality assumptions. To determine significant variations in mDISCERN and PEMAT scores and descriptive video metrics across diverse content creators and categories, the Kruskal-Wallis H test, t test, and analysis of variance (ANOVA) were performed. Significant variations in mDISCERN and PEMAT scores and descriptive video metrics were identified with the Mann-Whitney U test and t test, after stratifying by physician status, comparing physicians with nonphysician healthcare providers, international physicians with domestic physicians, and healthcare workers with laypersons. Simple linear regression models were employed to investigate the correlation between physician status and content reliability scores. Interrater reliability was assessed with Cohen's kappa. All statistical analyses were executed with Stata, version 17.0 (StataCorp, College Station, TX).

RESULTS

Overall Trends

In total, 16 hashtags were included in our analysis. Each hashtag had 25 included videos except for #Malejawline, which only had 24 total videos. The videos together totaled 389,000,000 views, 16,400,000 likes, 174,594 comments, and 586,743 shares. The mean views, likes, comments, and shares per video were 975,132 (SD = 5,332,197), 41,206 (SD = 189,513), 438 (SD = 1715.6), and 1470.5 (SD = 7311.8), respectively (Figure 1). The hashtag with the highest number of total views and likes was #Hairrestoration, while #Limblengthening had the highest number of total comments and shares. The number of videos per hashtag posted by a plastic and reconstructive surgeon (PRS) ranged from 0 (0%) for #Limblengthening and #Penileimplant up to 21 (84%) for #Abetching (Supplemental Table 1, available at www.aestheticsurgeryjournal.com). Two hundred twenty videos were posted by physicians, with 62% posted by US physicians and 38% by international physicians. For videos posted by US physicians, most were posted by physicians from the West (22%) and South (22%), followed by the Northeast (14%) and Midwest (4%) (Figure 2).

Content Creator Trends

The content creator category with the highest number of videos was PRS (153, 38.3%), followed by patient (79, 19.8%), nonphysician HCP (72, 18%), and other MD or DO (67, 16.8%) (Table 1). Videos posted by patients had the highest number of views, while videos posted by non-HCP gathered the highest number of likes, comments, and shares. Engagement was highest for videos posted by non-HCP (7.7%), followed by other (4.6%), and patient-posted videos (3.3%). Among the 6 poster groups, a statistically significant difference was found in median views (P < .0044), likes (P < .001), comments (P < .001), shares (P < .001), and engagement rate (P < .001).

Videos posted by physicians (2.1%) had significantly less engagement than videos posted by nonphysicians (2.1% vs 2.6%, P = .008) (Table 2). Posts by physicians from the United States had significantly lower median views (15,820.5 vs 44,168, P = .007), comments (10 vs 32, P = .033), and shares (14 vs 48, P = .038) than videos posted by international physicians. No significant differences in views, likes, comments, shares, or engagement were found between videos posted by US vs international PRS.

Video Category Trends

The video category with the highest number of videos was patient experience (195, 48.9%), followed by education (90, 22.6%) and live procedure (68, 17%) (Table 3). Patient experience videos had the highest median views (42,368), likes (999), and comments (25). Patient experience and education each had the highest median shares (18.5). Videos in the humor category had the highest engagement (3.8). Statistically significant differences in median views (P = .003), likes (P = .007), and comments (P < .001), shares (P < .001), and engagement rate (P < .001) were observed between the 7 video category groups.

Educational Video Trends

A subanalysis was conducted for videos categorized as educational. The 90 videos within this category totaled 57,200,000 views, 3,577,248 likes, 35,130 comments, and 106,031 shares. The average educational video had 643,257.1 views (SD = 1,904,873.0), 40,193.8 likes (SD = 148,665.8), 394.7 comments (SD = 1212.3), and 1191.4 shares (SD = 6002.0).

Nearly half of the educational videos were posted by PRS (n = 43, 46.7%) (Table 4). Other MD or DO had the highest mDISCERN score (2.8, SD = 0.9), followed by PRS (2.5, SD = 0.8) and the other content creator category (2, SD = 0.5). The highest PEMAT score was from other MD or DO content creators (0.60, SD = 0.14), followed by PRS (0.54, SD = 0.14) and patients (0.50, SD = 0.22). No significant differences were found in the mDISCERN or PEMAT scores between the 6 content creator groups.

Educational videos were further analyzed by content creator categories. Educational videos posted by physicians (n = 63, 70%) had significantly higher mDISCERN (2.57 vs 1.81, P < .001) and PEMAT (55.80 vs 47.64, P = .017) scores when compared to videos posted by nonphysicians (n = 27, 30%) (Table 5). No significant difference was found in mDISCERN or PEMAT scores between videos posted by US vs international physicians or US vs international PRS posters.

A statistically significant positive association between physician status and mDISCERN and PEMAT scores was found through linear regression after adjusting for video characteristics by engagement rates, with physician status significantly associated with a .085 increase in mDISCERN scores and a .76 increase in PEMAT scores compared to nonphysicians.

DISCUSSION

The demand for cosmetic procedures, particularly in men, has risen rapidly since the 2000s. This increase can be attributed to many factors, and particularly increased social media use. Men may be especially susceptible to the influence of social media due to the limited attention they receive from cosmetic surgeons and their online marketing. Consequently, men who are more vulnerable and have lower levels of body satisfaction may resort to social media for treatment decisions. While previous studies have looked at plastic surgery content on various social media platforms, none have specifically investigated the origin, content, and quality of information specifically targeting males. Therefore, in this study we aimed to address this gap by investigating male-specific plastic surgery content on TikTok, the world's fastest growing social media platform.

The significant number of views, likes, comments, and shares on male plastic surgery–focused videos demonstrates the growing popularity of male-focused treatment. It reflects a shift in societal norms and the increasing desire of men to utilize plastic surgeons to improve their body image. Our study highlighted #Hairrestoration, #Limblengthening, and #CalfImplant as the most viewed hashtags, suggesting that these procedures might be the procedures most coveted by male clientele. Furthermore, the immense popularity of the #Hairrestoration hashtag hints that less invasive procedures, like hair transplants, may be prioritized by men over procedures that require general anesthesia. Parsa et al showed that people perceived men as having increases in likability, social skills, and trustworthiness following treatment, suggesting a possible reason for this increasing trend in societal approval of male cosmetic surgery and male interest in having surgery.²³ As the cultural acceptance of male plastic surgery continues to evolve, we anticipate a continued increase in male procedures performed worldwide.

The ability of social media platforms to serve as places for patients to share their experiences with others without boundaries or regulation likely contributes to their appeal for cosmetic procedure content. It enables potential patients to look to others who underwent their procedure of interest and hear their stories and outcome. Our results emphasize this notion through the popularity of both videos posted by patients and videos in the “patient experience” category. While this can be beneficial for potential surgical candidates, it can also present challenges, because bias or isolated events shared by individuals could improperly influence someone's decision to undergo or forgo a procedure without proper medical advice. These findings underscore how imperative it is for medical information on social media platforms to portray accurate and unbiased content.

The educational videos in our analysis were deficient and weak in quality. None of the poster groups had an average mDISCERN score over 3 (“good quality”), indicating the low value of the videos across all groups. This is consistent with previous findings of inaccurate and misleading plastic surgery content on social media content, likely due to the lack of content regulation on these platforms. It again illustrates the importance of plastic surgeons creating high-quality, evidence-based content for social media to effectively educate their viewers about the benefits, risks, and realistic outcomes of cosmetic procedures.

Somewhat alarmingly, our study findings suggest that videos posted by nonphysicians generate more robust engagement than videos posted by physicians, despite the latter providing better information quality (as shown through higher MDISCERN and PEMAT scores). This discrepancy may arise for 2 reasons: either physician-created educational content fails to reach its target audience and garner as much engagement as videos from nonphysicians, or individuals on social media trust and consume content from laypersons as much or more as they do from medically trained individuals. We speculate that in reality it is a combination of both. Patients must understand the value of listening to credible and trustworthy information on social media. At the same time, plastic surgeons and other physicians must find strategies to enhance content engagement to reach and educate their target audiences effectively.

Our findings also suggest that social media platforms serve as a strong tool for male cosmetic medical tourism marketing, with international physicians playing a significant role (38%) in generating male plastic surgery–related TikTok content. Medical tourism is a rapidly expanding field, catering to over 23 million patients currently and projected to reach 70 million patients by 2027.²⁹ Although medical tourism is not a new phenomenon, coverage in the press and on social media has recently increased public awareness of cosmetic tourism, and patients are increasingly willing to travel to other countries for their procedures.^30,31 Many patients travel from first world countries to developing countries primarily for cosmetic treatments, motivated by lower costs, access to alternative procedures, and the opportunity to circumvent long wait times in their home country.^32,33 While previous studies have noted the significant presence international surgeons on social media, to our knowledge no study has suggested an amplification of international physician presence specifically within male-focused content.³⁴

Also notable in our study, not only was a vast amount of content created by physicians outside the US, but their videos also garnered higher views, comments, and shares than US physician-based content. This suggests that there is strong interest in male medical tourism. These findings are noteworthy for the PRS community considering the vast reach of social media. International physicians can significantly shape the narrative and viewers’ perceptions of male plastic surgery. Furthermore, despite its popularity, there is robust debate as to whether medical tourism is safe, with some reports suggesting a higher risk of complications after plastic surgery performed abroad. Addressing these complications may create a burden on the US health system that may have been avoided by performance of the initial operation under US guidelines.^30,35,36

Future Works

Expanding the investigation to other social media platforms beyond TikTok is crucial to understanding the entire social media landscape of male plastic surgery content. Additionally, future works should further investigate the extent of men seeking plastic surgery internationally, and whether social media content from international medical professionals plays a significant role in a male’s decision about where to have an operation performed. A study explicitly seeking to understand the overall impact of social media on male patient plastic surgery decision-making is critical to better understanding this patient population.

Limitations

Our study was constrained by its observational and cross-sectional design. Given the vast amount of content on TikTok, it is not feasible to capture all male plastic surgery–related posts. The popular procedures and trends in male plastic surgery that prompted our search term hashtags may evolve, thereby limiting the long-term generalizability of this study. Notably, videos relevant to our study may lack our specific search hashtags but still be encountered on users’ “For You” page, populated by TikTok's algorithm, or by following specific content creators. These videos would not necessarily have been included in the results of our hashtag-based search. Furthermore, TikTok's algorithm, which is influenced by a search user's account details (including search user history, time of the search, geographic location, gender, and age), further limits the generalizability of our study. Even users without a registered account have search results influenced by the search time and geographic location. The algorithm also limits the reproducibility of our study, because top hashtag search results are temporary and constantly changing in response to user preferences, video growth, and search patterns. Furthermore, current posting trends and habits of content creators may limit generalizability, because creators may focus on content that is currently profitable. In some cases, creators may even pay to promote content, unnaturally increasing engagement for a video or category. We also acknowledge that our exclusion of non-English language videos limits generalizability to videos in different languages. Finally, despite our efforts toward objective categorization and grading, the scales required a partially subjective evaluation of the content, which may have been skewed by our personal biases. Despite these limitations, this study provides invaluable insight into the current landscape of male plastic surgery content on TikTok.

CONCLUSIONS

Social media platforms like TikTok have been instrumental in promoting male plastic surgery content, signaling a shift in societal norms and a growing desire in men to improve their body image through cosmetic procedures. The growth of male medical tourism and the involvement of international physicians in generating this social media content emphasizes the global influence and reach of these platforms. However, the unregulated nature of social media also presents a challenge, because it allows for the spread of potentially inaccurate medical information, highlighting the importance of accurate and unbiased medical content.

Supplemental Material

This article contains supplemental material located online at www.aestheticsurgeryjournal.com.

Disclosures

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

REFERENCES

Author notes