There’s something weird going on in Apple’s App Store.

Last week, I called attention to Dental Surgery, an unbelievably bizarre iPad app, which had somehow risen to become one of the most popular free apps in the store. Within hours, it was gone. This week, a new app called Nose Surgery found its way in the top ten, apparently from the same developer using a different name. What’s the deal?

To its credit, Nose Surgery is considerably more playable and less spammy-looking than Dental Surgery was. The latter was apparently yanked by Apple due to trademark infringement because, as one diligent ReadWrite commenter pointed out, the game borrowed names and likenesses from a show on Nick at Nite. Nose Surgery doesn’t appear to steal anyone’s intellectual property, but it’s still pretty weird.

Like Dental Surgery and other games produced by this developer (who goes by various names in the App Store), Nose Surgery is very crudely designed with cheap-looking graphics and simplistic, often odd gameplay. And like Dental Surgery, Nose Surgery is loaded with negative, one-star reviews from users, most of whom are baffled by the game.

What’s most striking about these games is not just that they’re crappy and sort of strange. It’s that they’ve managed to occupy the App Store’s list of top ten free apps, a coveted achievement that most app developers only dream of. It’s an honor currently shared with the likes of YouTube, Angry Birds, Skype and Google Earth. Sure, there are plenty of games toward the top of the charts, some of which are pretty banal, but nothing quite as crummy or bizarre as these surgery simulation apps.

When I first came across Dental Surgery, I thought, “Oh, Gawker or some tech blog clearly wrote about how bizarre this is. That’s why it’s the third most popular free app for iPad.” That wasn’t the case. In fact, other than my story last week, none of these crude, weird games have gotten any press coverage. Something else is up.

Gaming The App Store For Fun and Profit

One way or another, these guys are gaming the system. Not unlike Web search engines, app store rankings can be influenced using everything from white hat optimization techniques to sketchy paid services that artificially inflate downloads and positive reviews. That’s nothing new. In fact, it’s been going on long and aggressively enough that Apple had to explicitly decry the practice earlier this year, threatening to the revoke developer program memberships of anybody caught doing it.

With the launch of iOS 6, Apple introduced a number of new measures designed to thwart spammers and make these ranking manipulation techniques less effective. The names of in-app purchases, for example, now weigh less in App Store searches, eliminating a common source of spammy tactics. Apple has also decreased the value of an app’s total number of downloads, making it less fruitful to utilize third party schemes that try to drive rankings by driving bogus installs.

So who’s the developer behind Nose Surgery and Dental Surgery? It’s hard to tell. Apple lists the developer as Florene Mitchell (it used to be Maura Thompson), and the “App Support” button links to a MyLife.com profile for Ms. Mitchell who appears to be a 78-year-old woman from Wilson, North Carolina.

It’s theoretically possible that people are downloading Nose Surgery out of some morbid curiosity. Maybe there’s some contingent of iPad-toting cosmetic surgeons-in-training who love slicing up nostrils on a touch screen, as a fun form of pseudo-educational preparation. I highly doubt it, though. Getting an app into the top ten is no small feat to accomplish once, let alone twice.

Something is definitely up.

Have you noticed anything fishy in the iOS App Store lately? Let us know in the comments.