Abstract
Background:
Social media is a powerful tool for plastic surgeons to connect with patients and to post both educational content and advertisements for their practices. TikTok is a platform that has gained popularity in the last 5 years, particularly for plastic surgeons. Although several studies have assessed engagement with plastic surgery content on other platforms, no studies have analyzed engagement on TikTok and compared engagement levels to those of Instagram.
Methods:
This study identified and evaluated the posts of the top 10 most popular plastic surgeons on TikTok and Instagram using the search term “#plasticsurgery.” The number of likes, views, and comments, and the surgical procedure covered in their 25 most recent posts was noted at 2 separate time points. Posts were categorized into the following categories: before-and-after, celebrity, private life, comedy, advertisement, or education. Engagement was calculated by totaling the number of views, likes, and comments.
Results:
A total of 1000 posts across both TikTok and Instagram were analyzed, 293 of which discussed specific procedures. TikTok had significantly higher total average engagement (438,261 per post) than Instagram (275,565 per post) (P = 0.03). Celebrity (P = 0.007) and abdominoplasty (P = 0.002) content received more engagement on Instagram than on TikTok.
Conclusions:
These data suggest that TikTok may have surpassed Instagram in user engagement with plastic surgery posts. However, Instagram may have higher engagement for posts in specific content categories. Plastic surgeons may use these data to maximize engagement by identifying the best platform for posts of different content.
Takeaways
Question: Is there a difference in engagement levels on posts by plastic surgeons on varying procedures and topics on TikTok when compared with Instagram?
Findings: A total of 500 posts on each platform were classified by category and surgical procedure covered. Engagement was calculated by totaling the number of likes, views, and comments. TikTok had a higher overall total average engagement per post compared with Instagram. Abdominoplasty content received more engagement on Instagram than on TikTok.
Meaning: Varying post categories receive more engagement than others on each platform; therefore, surgeons may use these data to identify the best platform for posts of different content.
INTRODUCTION
Social media usage is highly prominent in health care, with up to 88% of physicians and nurses using it routinely.1 This is true for plastic surgeons as well, as over half reported having some form of an active professional social media account.2 In fact, social media integration into medical practice may be inevitable, as it is an effective resource for marketing and patient education.3,4 TikTok and Instagram are social media platforms with an extensive reach, having more than 3.5 million active monthly users collectively.5 Both platforms allow users to post short videos, enabling surgeons to post educational content, showcase their work, and connect with their audience. Given that aesthetic content receives more than 30 billion views on these platforms, surgeons who effectively target content using audience engagement metrics may experience large-scale sweeping practice benefits.6
In 2017, Sorice et al7 found that Facebook, YouTube, and Instagram, respectively, had the greatest patient use among plastic surgery patients. However, with the advent of TikTok in September 2016, an increasing number of individuals have been shown to use the platform each year. According to the Pew Research Center,8 in September 2023, 62% of US adults 18–29 years, 39% of US adults 30–49 years, and 24% of US adults 50–64 years use TikTok. Instagram, which was released 6 years earlier than Tiktok, has a similar age distribution: 78% of US adults 18–29 years, 59% of US adults 30–49 years, and 35% of US adults 50–64 years use Instagram.8 Beauty is one of the top 5 post categories on TikTok, and plastic surgery providers and patients have increasingly contributed to the post content.9 The high prevalence of usage on both TikTok and Instagram among users 30–55 years, who account for 61% of cosmetic surgery procedures, make it imperative to understand the current plastic surgery trends on TikTok in comparison to already established social media platforms.10
Although several studies have assessed user engagement with plastic surgery content (ie, viewing, liking, and commenting on posts) on older platforms such as Instagram, no studies have analyzed engagement across different content categories on TikTok and compared engagement levels with those on Instagram. Additionally, no studies have compared engagement with content regarding specific plastic surgery procedures between TikTok and Instagram. This study aimed to evaluate engagement levels on posts by plastic surgeons on TikTok and Instagram and compare engagement across platforms.
METHODS
Video Selection
The most popular plastic surgeons who posted content on both TikTok and Instagram were populated using the search term “#plasticsurgery,” the most prominent hashtag in plastic surgery content.11 The 10 plastic surgeons with the highest follower counts across both platforms were identified, and the surgeons’ 25 most recent video posts were evaluated at 2 separate time points (February 2024, January 2025). Although users on Instagram can post content in both picture and video format, only videos (ie, Instagram Reels) were included in the study design to generate the most even comparison to TikTok, as users can only post video content on TikTok. New accounts for both TikTok and Instagram were created using new email addresses to limit bias from the research team’s existing algorithms and search history on each account.
Post Categorization and Statistical Analyses
Posts were categorized independently by 2 authors into the following categories: before-and-after, celebrity, private life, comedy, advertisement, or education. The basis for each category is summarized in Table 1. Before-and-after content was defined as any content explaining surgical changes in a patient from before to after any plastic surgery procedure. Posts categorized as before-and-after required images of the patient before and after the operation. Celebrity content consisted of videos discussing plastic surgery procedures performed on celebrities. Private life posts contained content describing surgeons’ own personal lives. Comedy posts were posts centered around a joke or intended only to entertain without adhering to any other category description. Advertisement posts were content that aimed to inform the viewer about a particular product or service. Educational posts were any posts that contained information about a plastic surgery procedure, surgical technique, or pathology. Posts were placed into the categories that fit best based on the definitions stated in Table 1. Posts could be categorized into all applicable categories, and any ambiguities were discussed by both reviewers for final categorization. Additionally, the surgical procedure discussed in the post, if any, was noted. Average engagement per topic was determined by totaling the number of likes, views, and comments per post. We used t tests or Mann-Whitney tests to determine differences across post categories and social media platforms for normally and nonnormally distributed data, respectively. For significant differences, the effect size (Cohen d) was calculated. Statistics were conducted using Stata version 18.5 (StataCorp).
Table 1.
Description of Post Categories
| Category | Category Description |
|---|---|
| Before-and-after | Comparisons of preoperative and postoperative case photographs |
| Celebrity | Discussions about celebrities who have undergone a plastic surgery procedure |
| Private life | Personal life (ie, family and vacation) |
| Comedy | Posts intended to make the viewer laugh |
| Advertisement | Practice advertisements and services |
| Education | Explanation of plastic surgery procedures, surgical technique, or pathologies |
RESULTS
A total of 1000 posts across both TikTok and Instagram were analyzed. As shown in Table 2, TikTok posts were most commonly categorized as comedy (38%), followed by education (32%), before-and-after (12%), advertisement (7.4%), celebrity (5.9%), and private life (5.3%). Comedy and education were the most engaged topics, and before-and-after posts were the least engaged. Instagram posts were most commonly education (28%), followed by comedy (27%), before-and-after (26%), advertisement (11%), private life (4.9%), and celebrity (2.2%). Celebrity and comedy posts were the most engaged topics, and before-and-after posts were the least engaged. TikTok had a significantly higher total average engagement (438,261 per post) compared with Instagram (275,565 per post) (P = 0.03; d = −0.123). Celebrity content received more engagement on Instagram than on TikTok (P = 0.007; d = 0.907).
Table 2.
Average Engagement of Various Content on TikTok Versus Instagram
| Post Content | TikTok | P | |||
|---|---|---|---|---|---|
| No. Posts, n (%) | Average Engagement | No. Posts, n (%) | Average Engagement | ||
| Before-and-after | 60 (12) | 94,918 | 132 (26) | 85,530 | 0.43 |
| Celebrity | 30 (5.9) | 235,684 | 11 (2.2) | 998,392 | 0.007 |
| Private life | 27 (5.3) | 139,738 | 25 (4.9) | 304,622 | 0.21 |
| Comedy | 192 (38) | 656,372 | 137 (27) | 575,215 | 0.34 |
| Advertisement | 38 (7.4) | 196,247 | 55 (11) | 86,587 | 0.09 |
| Education | 164 (32) | 448,490 | 142 (28) | 206,337 | 0.07 |
| All posts | 500 | 438,261 | 500 | 275,565 | 0.03 |
Overall, posts by plastic surgeons had significantly higher engagement on TikTok compared to Instagram (P = 0.007). However, “celebrity” posts by plastic surgeons had significantly higher engagement on Instagram compared to TikTok (P = 0.007).
A total of 293 posts discussed specific plastic surgery procedures across TikTok and Instagram. As shown in Table 3, TikTok posts were most commonly about abdominoplasty (26%), nonsurgical skin rejuvenation (14%), and gluteal fat grafting (14%). Gluteal fat grafting and nonsurgical skin rejuvenation were the most engaged topics, whereas abdominoplasty was the least engaged topic. Instagram posts were most commonly about abdominoplasty (27%) and breast augmentation (16%). Injectables and gluteal fat grafting were the most engaged topics, whereas blepharoplasty was the least engaged topic. TikTok content on plastic surgery procedures had a higher total average engagement (251,395 per post) when compared with Instagram (153,840 per post). However, the difference is not significant. Abdominoplasty content received significantly more engagement on Instagram when compared with TikTok (P = 0.002; d = 0.678).
Table 3.
Average Engagement of Plastic Surgery Procedures on TikTok Versus Instagram
| Surgical Procedure | TikTok | P | |||
|---|---|---|---|---|---|
| No. Posts, n (%) | Average Engagement | No. Posts, n (%) | Average Engagement | ||
| Abdominoplasty | 40 (26) | 18,312 | 38 (27) | 102,428 | 0.002 |
| Breast augmentation | 18 (12) | 256,095 | 23 (16) | 92,207 | 0.12 |
| Nonsurgical skin rejuvenation | 21 (14) | 345,897 | 18 (13) | 118,830 | 0.06 |
| Gluteal fat grafting | 22 (14) | 778,764 | 18 (13) | 331,390 | 0.15 |
| Injectables | 14 (9) | 179,395 | 14 (10) | 399,469 | 0.21 |
| Rhinoplasty | 12 (8) | 101,037 | 8 (6) | 107,138 | 0.46 |
| Blepharoplasty | 13 (8) | 32,026 | 9 (6) | 85,498 | 0.12 |
| Total | 153 | 251,395 | 140 | 153,840 | 0.10 |
Posts covering abdominoplasty by plastic surgeons had significantly higher engagement on Instagram than TikTok (P = 0.002).
DISCUSSION
Social media platforms, such as TikTok and Instagram, have become an increasingly popular tool for plastic surgeons to advertise and educate patients about their practices. Content on TikTok and Instagram is highly versatile with different categories that cater to different target audiences. Our study aimed to assess engagement levels on posts of different content categories by plastic surgeons on TikTok and compare engagement levels between TikTok and Instagram. Results showed that celebrity-related content (P = 0.007) and abdominoplasty-related content (P = 0.002) were significantly more engaging on Instagram than on TikTok. The overall content was more engaging (P = 0.03) and educational content was trending toward greater engagement on TikTok compared with Instagram, though the difference was not statistically significant (P = 0.07).
Previous studies showed that most content posted on social media platforms is aesthetic content, with Lin et al12 finding that 94.4% of plastic surgery posts on Instagram were aesthetic procedures. Studies have also shown that educational videos and personal experiences tend to attract more engagement, highlighting the platform’s potential as a resource for prospective patients seeking information and reassurance about plastic surgery procedures.13 Our research supported these findings, as 37.8% of the content reviewed on both platforms was on aesthetic procedures, 1.7% was on reconstructive procedures, and the remaining 60.5% consisted of other plastic surgery content. In addition, educational posts were the second most frequently posted content form and proved to be more engaging than other content categories, especially on TikTok compared with Instagram. Comedic content was the most frequently posted content and received high engagement on both platforms as well, acquiring more engagement than educational posts on Instagram. Although it is possible that the increased percentage of comedic content on TikTok yielded higher engagement, this is unlikely, as comedic content had the second highest overall engagement for both platforms, despite the higher frequency of comedy posts on TikTok. These results also align with previous studies demonstrating entertainment as the most popular and preferred content category on the platforms, receiving more than 500 billion views.6,14
The differences in content engagement across platforms may be attributed to several key factors. TikTok’s short-form video format has a higher engagement rate than Instagram Reels.15 TikTok’s “For You” page, driven by an artificial intelligence–powered proprietary algorithmic recommendation system, is designed to expose users to diverse content, often including niche or lesser-known creators. This enables plastic surgeons with an active TikTok presence to reach a vast audience and gather more views regardless of how large their following base is. Conversely, Instagram’s reliance on user behaviors and interactions to curate a customized Reels feed places greater emphasis on building a dedicated following, which may partially explain the relatively lower engagement for plastic surgery content outside of popular celebrity-based posts.16 For example, 9 of the top 10 accounts that self-identified “beauty influencers” follow are beauty brands.17 This potentially explains celebrity-based content being the highest engaged category on Instagram and significantly higher than TikTok. Thus, underlying algorithmic differences between the 2 platforms may play a significant role in determining content visibility and subsequent engagement. TikTok also allows for videos up to 10 minutes, whereas Instagram Reels are limited to 90 seconds. This capacity for longer form content may facilitate more entertainment or educational content on TikTok, possibly contributing to the platform’s higher overall engagement. It is important to note that Instagram does allow the traditional feed posting of videos up to 60 minutes in length, though it does not serve as a direct comparison to TikTok like Instagram Reels. This dynamic may explain the notably higher average engagement observed for plastic surgery posts on the TikTok platform relative to Instagram. However, it is also important to consider that these short, engaging clips can sometimes lead to the oversimplification of complex medical procedures, potentially misinforming viewers.
A significant concern across all social media platforms is the potential dissemination of false or misleading information. On TikTok, the dissemination of videos quickly with broad magnitude makes it challenging to regulate content accuracy. Furthermore, non–board certified individuals sharing content about plastic surgery can contribute to spreading misinformation, compromising the safety of patients.13 Similarly, Instagram faces issues with promotional content that tends to emphasize aesthetic appeal over factual accuracy. This could potentially mislead users about their procedures and the associated risks and realities of it.13 For plastic surgeons, controlling the narrative on social media platforms while maintaining professionalism is crucial to outweigh misinformation from less qualified content creators.18 Additionally, the use of quality assessment tools to evaluate content may assist in maintaining high standards for information posted on these platforms.
There are significant limitations of this study that must be considered. Although this study provides relevant insights into engagement levels of plastic surgery content on TikTok and Instagram, the analysis solely relies on platform-specific metrics derived mainly from likes, views, and comments, which may not capture the full context of user engagement or the broader impact of the content. Additionally, we did not account for video length, saves, and reposts, which could be potential confounders influencing engagement levels and should be considered for future studies. Moreover, although “#plasticsurgery” is one of the most prominent hashtags used, as 1 study noted, it had the highest number of associated posts (523,361 of 1,789,270 posts queried), statistical analysis in this study may be limited, as not all plastic surgery content may be captured by this hashtag.11 Therefore, future studies should include a larger cohort of plastic and cosmetic surgeons to ensure more generalizable results. It would also be valuable to analyze whether plastic surgeons from different countries create content in varying ways and whether platform preferences differ based on regional factors. It is important to note that engagement levels may vary due to external factors such as emerging trends, algorithm changes, and user behavior shifts on these rapidly evolving platforms—factors that are not necessarily controlled or captured in this cross-sectional assessment.
CONCLUSIONS
The findings of this study highlight the distinct content and engagement patterns between TikTok and Instagram for plastic surgery-related posts. TikTok showed higher overall engagement, with celebrity content showing statistically significant differences. Additionally, educational content was trending toward significance on TikTok compared with Instagram, suggesting TikTok may be more effective for plastic surgeons to reach and educate their target audience. Abdominoplasty content received significantly more engagement on Instagram than on TikTok. Plastic surgeons can optimize their social media content and strategies to maximize reach, engagement, and patient acquisition by following these platform-specific engagement trends. Ongoing research in this area will be essential to ensure surgeons can effectively leverage the power of social media to connect with prospective patients, provide valuable information, and maintain the highest standards of ethical and transparent practices within the field of plastic surgery.
DISCLOSURE
The authors have no financial interest to declare in relation to the content of this article.
Footnotes
Published online 5 June 2025.
Disclosure statements are at the end of this article, following the correspondence information.
REFERENCES
- 1.Surani Z, Hirani R, Elias A, et al. Social media usage among health care providers. BMC Res Notes. 2017;10:654. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Economides JM, Fan KL, Pittman TA. An analysis of plastic surgeons’ social media use and perceptions. Aesthet Surg J. 2019;39:794–802. [DOI] [PubMed] [Google Scholar]
- 3.Vardanian AJ, Kusnezov N, Im DD, et al. Social media use and impact on plastic surgery practice. Plast Reconstr Surg. 2013;131:1184–1193. [DOI] [PubMed] [Google Scholar]
- 4.Rivera JC, Juan HY, Long AS, et al. Presence of cosmetic and aesthetic surgery on TikTok. Plast Reconstr Surg Glob Open. 2022;10:e4519. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Statista. Most popular social networks worldwide as of April 2024, by number of monthly active users. Statista. Available at https://www.statista.com/statistics/272014/global-social-networks-ranked-by-number-of-users/. Accessed July 2024. [Google Scholar]
- 6.Statista. Most popular content categories on TikTok worldwide as of July 2020, by number of hashtag views. Statista. Available at https://www.statista.com/statistics/1130988/most-popular-categories-tiktok-worldwide-hashtag-views/. Accessed July 2024. [Google Scholar]
- 7.Sorice SC, Li AY, Gilstrap J, et al. Social media and the plastic surgery patient. Plast Reconstr Surg. 2017;140:1047–1056. [DOI] [PubMed] [Google Scholar]
- 8.Pew Research Center. Social media fact sheet. Pew Research Center. Updated September 13, 2024, November 13, 2024. Available at https://www.pewresearch.org/internet/fact-sheet/social-media/?tabItem=5b319c90-7363-4881-8e6f-f98925683a2f. Accessed July 2024. [Google Scholar]
- 9.Influencer Marketing Hub. 44 Vital TikTok stats to inform your marketing strategy. Influencer Marketing Hub. 2024. Available at https://influencermarketinghub.com/tiktok-stats/. Accessed July 2024. [Google Scholar]
- 10.American Society of Plastic Surgeons. American Society of Plastic Surgeons breaks down 2022 plastic surgery trends among different demographics. American Society of Plastic Surgeons. 2023. Available at https://www.plasticsurgery.org/news/press-releases/american-society-of-plastic-surgeons-breaks-down-2022-plastic-surgery-trends-among-different-demographics#:~:text=Across%20age%20groups%2C%20Generation%20X,70%20accounted%20for%203%20percent. Accessed September 2024. [Google Scholar]
- 11.Dorfman RG, Vaca EE, Mahmood E, et al. Plastic surgery-related hashtag utilization on Instagram: implications for education and marketing. Aesthet Surg J. 2018;38:332–338. [DOI] [PubMed] [Google Scholar]
- 12.Lin E, Schroeder BE, Tran MM, et al. What are board-certified plastic surgeons posting on Instagram? Aesthetic Plast Surg. 2024;48:4051–4058. [DOI] [PubMed] [Google Scholar]
- 13.Zargaran A, Sousi S, Zargaran D, et al. TikTok in plastic surgery: a systematic review of its uses. Aesthet Surg J Open Forum. 2023;5:ojad081. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Statista. Preferred types of content on Instagram according to users worldwide as of April 2023. Statista. Available at https://www.statista.com/statistics/1310997/instagram-most-liked-type-of-content-worldwide/. Accessed July 2024. [Google Scholar]
- 15.Varga S. TikTok vs. Reels vs. shorts (a study by Socialinsider). 2024. Available at https://www.socialinsider.io/blog/tiktok-vs-reels-vs-shorts/. Accessed July 2024. [Google Scholar]
- 16.Keyser M. TikTok vs. Instagram Reels: which platform is winning the race? 2024. Available at https://fourthwall.com/blog/tiktok-vs-instagram-reels-which-platform-is-winning-the-race. Accessed July 2024. [Google Scholar]
- 17.Instagram. Beauty on Instagram. Instagram. 2018. Available at https://business.instagram.com/blog/beauty-on-instagram. Accessed July 2024. [Google Scholar]
- 18.Thawanyarat K, Hinson C, Gomez DA, et al. Content and engagement among plastic surgeons on Instagram. Aesthet Surg J Open Forum. 2023;5:ojac096. [DOI] [PMC free article] [PubMed] [Google Scholar]