Insider created a TikTok account and set the age at 14 to test how long before a plastic surgeon's promotional video appeared. It only took eight minutes.

• Posting videos showing the before-and-after stages of rhinoplasty has become a viral trend on TikTok.
• #NoseJobCheck has over one billion views on the social media platform.
• Videos promoting rhinoplasty are appearing on the For You Page of teenagers as young as 14.
• Plastic surgeons are enlisting the help of marketing agencies to ensure that these videos reach a younger audience.
• Charities have expressed their concern that minors are seeing "completely unacceptable" videos.
• TikTok has banned cosmetic surgery adverts but these videos appear to bypass those rules.

TikTok, the viral video-sharing app that is famously popular with young teenagers, claims to have banned plastic surgery adverts.

Cosmetic surgeons, however, have found a way to bypass the app's existing rules and regulations and promote major surgery that can be psychologically damaging to TikTok's youthful audience.

So many have been successful in doing this that videos promoting various plastic surgery procedures - particularly rhinoplasty, changing the shape of the nose - are widely available and incredibly popular.

Many health professionals find this deeply troubling and even predatory.

To test how readily these videos were available to minors, Insider created a TikTok account, set the age at 14-years-old, and used the application to see how long it would take for one of these videos to appear.

After just eight minutes of scrolling, a promotional video for a US-based plastic surgeon was posted on our For You Page - TikTok's personalized feed of relevant videos.

The popularity of plastic surgery videos on TikTok

Plastic surgery videos are endemic on TikTok. The hashtag #plasticsurgery has over 3.8 billion views.

One particular procedure, however, has become a viral trend on the app - rhinoplasty.

The hashtag #nosejobcheck, which mainly consists of videos showcasing before-and-after clips of nasal surgery, has accumulated over one billion views on the platform. The hashtag #nosejob, which hosts similar videos, has over 1.6 billion views.

There's even a unique 'nose job check' sound. Over 120,000 videos using this sound have been published on TikTok since last October.

The platform's most popular user, 16-year-old Charli D'Amelio, used the sound after getting reconstructive surgery on her nose in July. She broadcast her transformation video to her fanbase, which has now received 14.8 million likes.

The videos, typically only 15 seconds in length, show the patient's pre-surgery nose, post-surgery bandages, and - finally - the reshaped nose.

This trend's popularity means that these videos are appearing on the For You Pages (FYP) of millions of TikTok users. The FYP is a personalized feed of content, where a combination of popular and recommended content appears.

TikTok's young users are being exposed to plastic surgery videos

While #nosejobcheck is primarily used by creators sharing their experiences of getting nose jobs, plastic surgeons are also using it to market their work and appear on the FYPs of potential patients.

Some of those on the receiving end of these marketing videos are inevitably very young, given TikTok's target audience.

Teenagers and children make up the largest group of active TikTok users, according to the consumer data agency Statista. Statista estimates that under-19s make up 32.5% of all users. According to The New York Times, a third of its' users may even be 14 or under.

The app requires TikTok users to be 13 but a lack of age verification makes this easy to bypass.

While the app has an infrastructure to prevent minors from seeing unsuitable content, cosmetic surgery videos that aren't paid adverts and don't violate TikTok's community guidelines are technically allowed.

As long as the videos are not "graphic" and don't contain "gore," they do not appear to breach TikTok's rules.

Plastic surgeons are promoting these procedures to teenagers

Dr. Kim Patrick Murray, a Miami-based plastic surgeon, is one of the medical practitioners who uses the app to promote his followers' surgery. In recent months, he has seen an uptick in preliminary consultation thanks to social media.

Some of these consultation requests are coming from under-18s.

This doesn't bother him.

"Rhinoplasty is a relatively tame topic compared to a lot of other stuff on TikTok," he told Insider. "If you want to look at the negatives, you have worse things like teenagers dancing in bikinis."

Murray performs the surgery on patients as young as 14.

"Operating on somebody that young could be a little controversial," he said. "But for me, the advantages of considering rhinoplasty at that young age allow the person to grow and be comfortable in their own skin and that far outweighs the negatives," Murray added.

The plastic surgeon said that if a teenager was struggling with their self-esteem due to an overly-pronounced nose, saw one of his TikToks, and decided to seek surgery, he'd view that as a "positive" thing.

Dr. Antonis Kousoulis, a director at the Mental Health Foundation, disagrees. He believes the promotion of cosmetic surgery to minors is deeply troubling.

He told Insider: "Whether it's through paid promotion or medical practitioners using hashtags, we think it's completely unacceptable and inappropriate that videos like these are reaching young people under the age of 18."

Kousoulis continued: "A lot of the time, these operations are promoted based on wellbeing, saying that they will improve how you will feel about yourself. I would like medical practitioners to be more conscious of who might see their content and to show more thoughtfulness to psychological reasons as to why people are seeking these operations."

"We know that a lot of these clinics use fairly predatory techniques when it comes to self-promoting their work and that is a concern," he added.

Some plastic surgeons enlist the help of marketing firms

Plastic surgeons are enlisting marketing firms' help to aggressively promote their procedures to as wide an audience as possible. Frank Olivo, the digital marketing agency sagapixel, advises plastic surgeons on how to go viral on the application.

Olivo's company's website offers a guide for plastic surgeons on how to use Tik Tok effectively. In the guide, plastic surgeons are advised on how to reach a younger audience.

It reads: "You always want to tailor content to what will provide value to its audience, so procedures that are most popular for younger audiences will perform the best on TikTok."

Olivo thinks TikTok is a great marketplace for plastic surgeons to reach all kinds of clients, including young people. "It lends itself to highly visual marketing like plastic surgery," he told Insider.

But he admits that, personally, he'd prefer his children not to be exposed to #nosejobcheck videos.

He said: "As a parent, I'm not crazy about my daughter growing up and seeing these sorts of videos."

Ashton Collins, the director of the responsible plastic surgery charity Save Face, shares these concerns. She told Insider: " The process of getting plastic surgery is being glorified. These videos are absolutely damaging and trivializing."

She added: "You'd expect regulated plastic surgeons to have more accountability having first-hand seen the negative impacts that plastic surgery can have on someone's psychology."

The negative impact of videos promoting plastic surgery

One person who has experienced plastic surgery's negative impacts is Mariamane Akopyan, a college student from San Jose, Ca.

As a minor, she wanted to get plastic surgery after seeing "perfect nose jobs" online. At 18, she went to Ukraine to get rhinoplasty surgery. This resulted in a botched job, which left her unable to breathe properly and with a "bit of a crooked nose."

Akopyan had to get corrective surgery and shared the video on her TikTok. "It was honestly terrifying that so many of the people that were asking questions about getting a nose job were really young girls," she told Insider.

Ruby Mann, who had rhinoplasty surgery three months after seeing #nosejobcheck videos on TikTok, agrees.

"These videos make nose jobs look easier than they actually are. Major surgeries, like mine, are not to be taken lightly. I had a painful nose for two weeks, it hurt even with medication, and it can take almost a full year to recover," she told Insider.

Mann continued: "I think the hashtag could make someone want to get a nose job after watching them. I just hope that young, teenage girls don't feel encouraged to get it done and instead grow up to feel happy and confident with who they are as women."

To counter the procedure being trivialized in short videos, Mann posted a more thorough recovery process video.

What's being done to protect young people on TikTok

Dr. Anthony Youn, a plastic surgeon who has over 2 million followers on TikTok, thinks these worries are overfraught. He believes sufficient obstacles are in place to stop teenagers from actively seeking surgery. "For a minor to have cosmetic surgery like this, their parents would have to sign consent forms," he told Insider.

In the US, there are no specific laws that prevent teenagers from getting cosmetic surgery. However, parental consent is required for patients under the age of 18.

"Ultimately, it comes down to parenting and surgeons being responsible and not performing surgeries on children who don't understand the ramifications of this," he said.

Youn, unlike other plastic surgeons on TikTok, uses his videos to educate rather than promote surgery.

In one video, he notes: "She's a beautiful young woman, she doesn't need anything done... but she went ahead and did it."

TikTok has, in recent months, made strides to protect minors from videos that may negatively impact their self-esteem. In September, it banned advertisements for fasting applications and weight-loss supplements.

Since then, a spokesperson told Insider that TikTok has also banned adverts for cosmetic surgery. According to the official advertising guidelines on their website, cosmetic surgery ads are only banned in Mexico, Taiwan, and Brazil.

A TikTok spokesperson said: "TikTok was built to provide a positive place for creativity, and we prioritize the safety and wellbeing of our users. We do not allow advertisements for cosmetic surgery or weight-loss supplements as they don't support the positive, inclusive safe space we strive for on TikTok."

#Nosejobcheck videos, for example, are not normally classified as ads. They, instead, fall under content. As long as they don't breach community guidelines, they are deemed to be acceptable.

To protect minors on the app, the TikTok spokesperson recommends that parents enable Restricted Mode.

They said: "Parents and guardians can also enable Restricted Mode, which limits the appearance of content that may not be appropriate for all audiences. We are constantly enhancing our safety policies and features to ensure that TikTok can continue to be a safe and fun home for creative expression."

Insider returned to the TikTok account we created, enabled Restricted Mode, and scrolled to see whether any plastic surgery videos would appear. A video promoting a successful "tummy tuck" appeared on our FYP after just six minutes of scrolling.