Accepted for/Published in: JMIR Infodemiology
Date Submitted: Nov 21, 2025
Date Accepted: Jun 19, 2026
A Tale of Two Tiers: a Comparative Content Analysis and Expert Physician Risk Assessment of Aesthetic Procedures Promoted on TikTok in Taiwan
ABSTRACT
Background:
Algorithm-driven social media platforms increasingly stratify the market for aesthetic procedures, influencing patient decision-making and safety. In Taiwan, TikTok hosts two parallel markets: a formal tier promoting medical tourism to citizens and a clandestine tier targeting Southeast Asian migrant workers with informal, high-risk services.
Objective:
This study aims to quantify the safety risks associated with these stratified markets and demonstrate how digital platforms can reinforce health disparities through algorithm-driven content delivery.
Methods:
We conducted a dual-track content analysis of 60 TikTok videos (n=30 per tier). A panel of six board-certified physicians independently assessed the videos using the novel Clinical Legitimacy and Risk Score (CLRS), which evaluates content across four domains: Depicted Environment, Operator Identity, Risk Communication, and Communication Channel. Inter-rater reliability was assessed using Fleiss’ kappa.
Results:
The physician-rated CLRS revealed a significant safety disparity between the two groups. The medical tourism tier (Mode A) had a mean score of 3.2 (SD 0.7), predominantly featuring "Surgery Journey Vlogs" (30%) that projected professionalism while often obscuring potential dangers. In contrast, the migrant worker tier (Mode B) scored a critically low mean score of 1.1 (SD 0.3), indicating a complete departure from medical standards (P<.001). Mode B was dominated by "At-Home Procedure Demonstrations" (50%). The inter-rater reliability for the CLRS was strong (Fleiss’ kappa = 0.85, P<.001).
Conclusions:
TikTok operates as a stratified marketplace that algorithmically tailors health risks to pre-existing social inequalities. The informal tier targeting migrant workers poses a severe and immediate public health threat. These findings underscore the urgent need for culturally competent public health interventions and a re-evaluation of platform liability in moderating high-risk medical content. Clinical Trial: nil
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