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For years, rumors of censorship have swirled within the plastic surgery community, with prominent physicians arguing, from conference podiums and social media platforms, that Meta and TikTok are routinely flagging their content, especially when it features before-and-after images (B&As) of their patients. (These types of clinical photographs are considered standard practice in aesthetic medicine, and are often presented at plastic surgery meetings and included in scientific journals.) Since at least 2017, social media users across industries and the political spectrum have accused both companies of so-called “shadow-banning” (and both have publicly denied some of those claims). While there is no single definition of shadow-banning, people generally invoke the term when they see their content consistently underperforming for no discernible reason. The plastic surgeons I’ve spoken to allege that shadow-banning, in their experience, can take different forms, from reducing the visibility of their accounts and restricting their posts (B&As, especially) to dramatically limiting their reach, views, engagement, and profile-boosting privileges. Some of what they describe could be considered active content moderation—being notified that a post broke the rules and now can’t be widely disseminated, for example. Other times shadow-banning may be more mysterious, like a post being hidden from followers. But the general complaint from some plastic surgeons is censorship, plain and simple.
Lending credence to the claims is new research (spearheaded by board-certified plastic surgeon Jerry Chidester, MD, in collaboration with plastic surgeons at Harvard Medical School Teaching Hospital) looking at shadow-banning and plastic surgeons’ social media presence. In 2024, Dr. Chidester surveyed a group of plastic surgeons on Instagram. Of the 107 respondents, 68% reported being shadow-banned by the platform and 85% noticed a decrease in the visibility of their page in the past year. It’s worth noting that plastic surgeons who took the time to respond may be more inclined to have experienced shadow-banning—this is known as self-selection bias. Dr. Chidester acknowledges this limitation and attempted to address it in the survey. “We gauged responses by follower count, and even plastic surgeons in the lower end of follower count were still experiencing shadow-banning,” he explains. “We also had the inclusion criteria of plastic surgeons active on social media, hoping to minimize the selection bias.” In the future, he’d like to see the American Society of Plastic Surgeons broadly survey its members “to better generalize the results on shadow-banning,” he says.
An outspoken critic of this alleged censorship is board-certified Chicago plastic surgeon Otto Placik, MD. An early adopter of social media, Dr. Placik, 62, joined at a time when he says most doctors from his generation deemed it an “undignified” and “desperate” move. While he’s grown popular on Instagram, with over 100,000 followers, he believes the platform has become increasingly restrictive over the years. Almost daily, he receives alerts that his posts—typically B&As of breast and body procedures (with sensitive areas covered)—have either been removed or cannot be shown to non-followers. Via in-app notifications, he learns that this is because they “may contain nudity or sexual activity,” and that many of his posts have been labeled “sexually explicit or suggestive.” Dr. Placik is then given the option to appeal Instagram’s decision or to modify or remove the posts. At this point, he says, “I’d have to delete all of my content in order to be compliant.” And the appeals process, according to Meta itself (in this recent statement), can be “frustratingly slow and doesn’t always get to the right outcome.” In the same announcement, Meta also explains, “We’ve added extra staff to this work and in more cases, we are also now requiring multiple reviewers to reach a determination in order to take something down.”
According to the doctors I interviewed, there’s often no apparent rhyme or reason for what content gets dinged and what sails through. “For a long time, almost every B&A I posted to Instagram got flagged,” says Dr. Chidester. Then, about eight months ago, his content was suddenly being accepted without issue, even breast and body B&As. But not everyone has been so lucky: “My posts from just a couple days ago are still being flagged as ‘sexually explicit,’” says Dr. Placik.
Whether or not surgeons edit or appeal flagged posts, violating guidelines may have a ripple effect: “You’ll typically have less engagement for some time after,” says Dr. Chidester. “They’ll take away features, too, like, you can’t do Lives for 30 days or you can’t do branded content for a time. They strip down your account and it does a lot of damage.”
Daniel J. Gould, MD, a board-certified plastic surgeon in Beverly Hills, believes he’s been similarly targeted by Meta as well as TikTok, which he finds to be even less tolerant of his plastic surgery content. After rejecting a number of his posts, including a facelift B&A (with no nudity, for obvious reasons), TikTok issued a 10-year suspension on his ability to use “promotional tools” or “boost” his videos in order to increase their visibility, which he says crippled his account, and also limited his brand collaborations. Since nudity wasn’t the issue here, what might it have been? “The app said that plastic surgery is a ‘prohibited industry,’” says Dr. Gould. “We’ve emailed them for more information, but haven’t yet gotten a response.” Dr. Gould’s social media manager tells me that views on his posts have plummeted since the suspension: “With an account of over 160K followers, our content shouldn’t have 1K views unless it’s shadow-banned.”
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.)
TikTok’s rules (as outlined in its community guidelines) are less open to interpretation. To shield minors from potentially harmful messaging, it restricts to over-18 accounts and bans from the For You feed any content “showing or promoting cosmetic surgery that does not include risk warnings, including before-and-after images, videos of surgical procedures, and messages discussing elective cosmetic surgery.” (For this reason, Dr. Gould adds a disclaimer to his TikTok captions: “Remember, cosmetic surgery comes with risks, including rare but serious outcomes.”) Additionally, the company tells Allure, any content (with warnings or not) that is “boosted” using the “promote” function technically qualifies as an ad, and since TikTok does not allow for advertising of cosmetic surgeries in the US, it rejects or removes those posts. It also restricts posts that show blood or “semi-nudity of adults, such as wearing only nipple covers or underwear that does not cover the majority of the buttocks.”
As Allure previously reported, B&As are commonly manipulated by the content creators and doctors who post them. A 2022 study found that as many as 40 percent of B&As on social media are potentially deceptive—that’s one legitimate reason to question the prevalence of B&As on social media. Here’s another: Those images may be more influential than you think. Another study published in the Journal of Clinical and Aesthetic Dermatology found that time spent on social media—including following influencers and celebrities, using photo editing tools, and looking at feeds featuring aesthetic treatments—could “contribute to [the] desire to undergo a cosmetic procedure.”
The surgeons I interviewed understand the good intentions behind social guidelines—namely, protecting young people from preposterous beauty standards that erode self-esteem and breed anxiety—but feel it’s unfair to scapegoat plastic surgeons for the prevalence of mental health disorders, including body dysmorphia, among social-media users.
“I get it,” says Dr. Placik, “but I’m showing honest, unmanipulated photographs, plus the cuts, the misery, the recovery [of plastic surgery], so people understand this is what it takes to go from before to after.” Meanwhile, he adds, influencers commonly “utilize filters that create unrealistic expectations and pressures on potentially vulnerable populations.” Plastic surgeons have sent me numerous examples of uncensored images on Instagram that are brazenly doctored or salacious, from celebrities baring nipples to topless women pretending to breastfeed dolls in fake tutorials that drive viewers to their Only Fans accounts. (Allure provided Meta with links to such content, but the company didn’t offer a comment.)
After experiencing what she describes as a curious shadow-banning episode months ago, board-certified St. Louis plastic surgeon Marissa Tenenbaum, MD, says she’s “pretty much given up on posting B&As.” While logged into her practice’s Instagram account, she clicked over to her personal page and saw that her most recent B&A was hidden from view—completely absent from her grid, without a word from Meta. It’s disheartening, she adds, to see straight-forward plastic surgery content—B&As that detail the nuances of procedures or reveal what to expect during recovery—attract so few eyeballs while frivolous posts of peers “juggling breast implants” go viral, “further skewing the public’s perception of plastic surgery in a negative direction.”
While censorship may hurt surgeons’ metrics and bottom lines, the societal ramifications are far more profound. Dr. Chidester, who says he grew his practice on Instagram after arriving in Utah “with nothing,” credits social media for breaking down the stigma around plastic surgery in his community and giving patients a place to share their experiences. Now, he argues, when board-certified plastic surgeons are silenced, less credentialed voices can ultimately dominate and misinformation can run amok. Some of these content creators “aren’t out to educate—they’re out to fearmonger and push their own agendas,” says Dr. Chidester. “There’s a functional medicine doctor on Instagram telling everybody that if they go into a sauna with implants, they’re going to have gel bleed [silicone leakage] and get sick. There’s no scientific evidence for that—everything she’s saying is categorically false—but now I have panicked patients sending me this post and being like, ‘Is this true? Are my implants going to leech?’” Who’s going to call out the fake news if plastic surgeons are put on mute?
“Education is a critical part of our specialty and a necessary part of the patient journey,” says Steven Williams, MD, a board-certified plastic surgeon and the immediate past president of the American Society of Plastic Surgeons. “Patients rely on social platforms for information that can significantly affect their surgical outcomes and overall health. It’s important that honest information not be censored.” (Social media, for example, influences 40 percent of patients when they are deciding which plastic surgeon to select, according to Dr. Chidester’s study.) “We’re always ready to meet with the [social media] industry and work out solutions that benefit patient education and safety,” says Dr. Williams.
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