Cosmetic Surgery: A Common and Accepted Form of Self‐Improvement?1

The pursuit of beauty through alteration of physical appearance is a growing trend. Rates of cosmetic surgery have soared, suggesting that surgery is a common, acceptable solution to the desire for self‐improvement. Despite indications that surgeries are increasing in frequency, there have been few empirical investigations about popular attitudes toward cosmetic surgery. In the present study, 302 female undergraduate students were surveyed. Approximately 3% of the sample had undergone cosmetic surgery themselves, and half knew at least 1 person among their friends and family who had undergone cosmetic surgery. As hypothesized, approval and reported future likelihood of cosmetic surgery were predicted by greater media exposure, greater vicarious experience of cosmetic surgery, and greater importance of appearance to self‐worth. No significant differences among ethnic groups were found.     

Internalization of Appearance Ideals and Cosmetic Surgery Attitudes: A Test of the Tripartite Influence Model of Body Image

The Tripartite Influence Model of Body Image was adapted to examine the role of body satisfaction, perceived pressure to have cosmetic surgery, and internalization of societal appearance ideals in understanding cosmetic surgery attitudes. Participants were 2,048 men (N?=?445) and women (N?=?1,603) American college students from Florida who completed a range of measures that assessed levels of body satisfaction, perceived appearance pressures, internalization of appearance standards, and cosmetic surgery attitudes. A structural equation model was used to test hypothesized relations independently for men and women. Results indicated a moderate-good fit to the data, with both internalization and body satisfaction mediating the effect of perceived pressures on cosmetic surgery attitudes. Invariance testing revealed significant differences in pathway estimates between samples of men and women. The findings offer further support for the Tripartite Influence Model of Body Image and indicate potential factors that may influence cosmetic surgery attitudes.     

Acceptance of cosmetic surgery: scale development and validation

We conducted a set of four studies with a total of 1288 adult and undergraduate women and men to develop the Acceptance of Cosmetic Surgery Scale. These studies provide evidence of this scale's reliability, as well as convergent and discriminant validity. Initial explorations using this 15-item scale indicate that acceptance of cosmetic surgery is negatively related to satisfaction with physical appearance and positively related to attitudes about make-up use. The acceptance of cosmetic surgery may be more related to fears about becoming unattractive than to hopes of becoming more attractive. Cosmetic surgery attitudes were positively related to age for women but not for men. The study's limitations and implications are discussed.     

A correlational and experimental examination of reality television viewing and interest in cosmetic surgery

Two studies are presented that examine the influence of media messages about cosmetic surgery on youths’ interest in altering their own physical appearance. In Study 1, 170 participants (59% female; M age = 19.77 years) completed surveys assessing their impression of reality television shows featuring cosmetic surgery, appearance satisfaction, self-esteem, and their interest in cosmetic surgery. Results indicated that participants who reported favorable impressions of reality television shows featuring cosmetic surgery were more likely to indicate interest in pursuing surgery. One hundred and eighty-nine participants (51% female; M age = 19.84 years) completed Study 2. Approximately half of the participants were exposed to a television message featuring a surgical make-over; the other half was exposed to a neutral message. Results indicated that participants who watched a television program about cosmetic surgery wanted to alter their own appearance using cosmetic surgery more than did participants who were not exposed to this program.     

MATERIALISM, SOCIOCULTURAL APPEARANCE MESSAGES, AND PATERNAL ATTITUDES PREDICT COLLEGE WOMEN'S ATTITUDES ABOUT COSMETIC SURGERY

Rates of cosmetic surgery procedures have increased dramatically over the past several decades, but only recently have studies of cosmetic surgery attitudes among the general population begun to appear in the literature. The vast majority of those who undergo cosmetic surgery are women. We examined cosmetic surgery attitudes among 218 undergraduate women, most of whom were White. Specifically, we examined their acceptance of cosmetic surgery and expressed desire to undergo cosmetic surgery procedures, and several potential predictors: appearance attitudes of mothers, fathers, and friends; awareness and internalization of sociocultural appearance messages; and materialism. Multiple regression analyses indicated that materialism and internalization of sociocultural messages consistently emerged as significant predictors of acceptance of cosmetic surgery and desire for cosmetic surgery procedures. Paternal attitudes positively predicted acceptance of cosmetic surgery for social reasons and desire for cosmetic surgery; nonmaterialism negatively predicted considering cosmetic surgery and the desire for cosmetic surgery procedures.     

Eating disorder and obsessive–compulsive symptoms in a sample of bulimic women: Perfectionism as a mediating factor

The present study aimed to investigate whether perfectionism mediates the association between obsessive–compulsive (OC) and eating disorder (ED) symptoms. Analyses were conducted using data collected among a national sample of eating disordered women diagnosed with BN or a subclinical variant of BN (N = 204). Each participant completed a series of self-report inventories on perfectionism, as well as OC, ED, and depressive symptoms. Higher ED symptoms were significantly associated with greater levels of perfectionism (p < .01) and OC symptoms (p < .05). As hypothesized, perfectionism significantly mediated the relationship between ED and OC symptoms, controlling for depression. Findings indicate that perfectionism may be considered a shared etiological or phenomenological factor in ED and OC symptoms.     

Predicting consideration of cosmetic surgery in a college population: a continuum of body image disturbance and the importance of coping strategies

Elective cosmetic surgeries are increasing in the American population with reasons linked to body image disturbance and body dysmorphic disorder (BDD). Little research exists documenting the continuum of body image disturbance and its relationship to seeking surgery. The present research examined data from 544 participants, 55 of whom were diagnosable with BDD. Using assessments for body image disturbance, problematic coping strategies, and BDD symptomatology, results provided evidence for a continuum of body image distress. Logistic regression analysis supported the hypothesis that increased levels of body image disturbance and one type of problematic coping strategy (Appearance Fixing) predicted consideration of cosmetic surgery. Of participants diagnosable with BDD, those who considered cosmetic surgery showed more severe body image disturbance and problematic coping than those who did not consider surgery. These results have implications for pre-surgical assessment as well as psychological interventions rather than invasive medical interventions.     

Mental body distance comparison: A tool for assessing clinical disturbances in visual body image

Despite numerous body size estimation studies, it cannot be concluded that the disturbance of body image in anorexia nervosa (AN) is specifically one of the visual body images.We adopted a visual imagery method, the Distance Comparison task, to enable across-population testing of differences in visual body image with respect to shape. Participants were asked to mentally scan across two body widths (e.g. hips and shoulders) and to decide as quickly as possible which one was longer or shorter. If the mental representation accessed to make such comparisons is visual, an inverse relation would be expected between RT and distance difference on the body to be judged (i.e. actual difference in size between the two body widths), with accuracy increasing with increasing distance difference. Females with high body shape concern (scoring high on the Body Shape Questionnaire: BSQ, n = 23) were compared to females with low body shape concern (scoring low on the BSQ, n = 19).RT and distance differences on the body demonstrated standard distance differences effects: RT increased and accuracy decreased with decreasing distance differences on the body. Groups differed with respect to accuracy, in that females high on body shape concern were significantly less accurate than females low on body shape concern when making evaluations involving small (?9 cm) differences, which implies a less appropriate visual image of the own body in the former group. With respect to the relation between RT and body distance difference, on the other hand, there were no differences between groups. We concluded that evaluations of own body size employ visual imagery and that the distance comparison task holds promise for the assessment of visual disturbances in body image in clinical populations.     

Predicting excessive body image concerns among British university students: The unique role of Appearance-based Rejection Sensitivity

The present research examined the extent to which interpersonal concerns about rejection based on appearance, or Appearance-based Rejection Sensitivity (Appearance-RS), serves as an indicator of risk for excessive body image concerns. Extending previous research, we examined the association between Appearance-RS and symptoms of body dysmorphic disorder (BDD) and cosmetic surgery attitudes among 106 British university students. Consistent with predictions, Appearance-RS uniquely predicted greater degree of BDD symptoms after controlling for other known predictor variables. Also, as expected, Appearance-RS uniquely predicted acceptance of cosmetic surgery for both intrapersonal and social reasons and greater consideration of having cosmetic surgery in the future. These findings highlight the importance of assessing individuals’ sensitivity to rejection from others based on their physical appearance in investigations of excessive body image concerns.     

Predicting interest in liposuction among women with eating problems: a population-based study

The purpose of this paper was to examine predictors of an interest in liposuction among women with eating problems. A questionnaire was sent to 3500 women aged 18-35 years, whereof 378 of 1861 responders screened positively on eating problems. Assessments included sociodemographic status, social network, physical exercise, attitudes towards cosmetic surgery, teasing history, body dysmorphic disorder-like symptoms, body image, self-esteem, personality, interpersonal attachment and emotional distress. Fifty-two percent reported an interest in liposuction, which was independently predicted by appearance orientation, appearance evaluation, being critical/quarrelsome, teasing history, wish for a better relationship with father, low education and being unmarried. Predictors differed somewhat from those previously found in the general population. Considering that our sample consisted of women with self-reported eating problems, the association between liposuction and eating behaviors should be further examined in a sample of patients with a formal eating disorder diagnosis.     

Acceptance of cosmetic surgery,body appreciation,body ideal internalization,and fashion blog reading among late adolescents in Sweden

This study examined adolescents’ attitudes of cosmetic surgery, as well as the relationships between these attitudes, body appreciation, body ideal internalization, and fashion blog reading. The sample comprised 110 (60 boys, 50 girls) late adolescents (mean age 16.9 years) from a Swedish high school. The results indicated that younger adolescents seem somewhat more accepting of cosmetic surgery. This was especially the case for boys’ acceptance of social motives for obtaining cosmetic surgery (boys’ M = 2.3 ± 1.55 vs. girls’ M = 1.7 ± 0.89). Girls’, and to a limited extent boys’, internalization of the thin ideal was related to more favorable cosmetic surgery attitudes. Athletic ideal internalization and body appreciation were unrelated to these attitudes. Finally, girls who frequently read fashion blogs reported higher thin ideal internalization, and also demonstrated a slight tendency of more cosmetic surgery consideration.     

ATTITUDES TOWARD COSMETIC SURGERY IN MIDDLE-AGED WOMEN: BODY IMAGE, AGING ANXIETY, AND THE MEDIA

Our study investigated factors that influence attitudes toward cosmetic surgery in middle-aged women. A sample of 108 women, aged between 35 and 55 years, completed questionnaire measures of body dissatisfaction, appearance investment, aging anxiety, media exposure (television and magazine), and attitudes toward cosmetic surgery (delineated in terms of general attitudes, social motivations, and actual consideration). Body dissatisfaction, appearance investment, aging anxiety, and both media variables predicted some facet of attitudes toward cosmetic surgery. Specifically, appearance investment, aging anxiety, and television exposure were unique predictors of endorsement of social motivations for cosmetic surgery, whereas body dissatisfaction, appearance investment, and television exposure were unique predictors of actual consideration of cosmetic surgery. Regression analysis revealed that the effects of media on cosmetic surgery attitudes were primarily direct. We concluded that there are multiple influences on attitudes toward cosmetic surgery for women of middle age.     

Beyond Body Size: Focusing on Body Functionality to Improve Body Image Among Women Who Have Undergone Bariatric Surgery

This study investigated a novel technique to improve body image among women who have undergone bariatric surgery—namely, by having them focus on their body functionality (everything the body can do, rather than how it looks). Participants were 103 women (M_age = 46.61) who had undergone bariatric surgery 5–7 months prior to the study. They were randomized to the 1-week online intervention, comprising three functionality-focused writing exercises (Expand Your Horizon; Alleva et al., 2015), or to a wait-list control group. Body appreciation, appearance and functionality satisfaction, body awareness, self-objectification, self-esteem, and self-kindness were assessed at pretest, posttest, and at 1-week and 3-month follow-up. Multilevel modeling analyses showed that, compared to the control, the intervention group experienced improved body appreciation at posttest, and these improvements persisted at both follow-ups. These findings were nonsignificant when intent-to-treat analyses were performed. Both available case and intent-to-treat analyses showed that all participants experienced improvements in facets of body image across time. Qualitative analyses of participants’ responses to the intervention writing exercises provided more insight. Via coding reliability thematic analysis, we identified 11 themes that together provide evidence that intervention participants experienced facets of a more positive body image, while also facing challenges to their body image and well-being. Together, findings suggest that focusing on body functionality may contribute to improved body image among women who have undergone bariatric surgery, but effects may be nuanced compared to prior functionality research among general samples of women. The study was registered retrospectively (ClinicalTrials.gov; identifier NCT04883268).     

The role of media and peer influences in Australian women's attitudes towards cosmetic surgery

The study aimed to examine the influence of media and peers on attitudes towards cosmetic surgery using a sociocultural framework. A sample of 351 Australian women aged 18–69 years completed measures of media exposure, friend conversations, internalisation of appearance ideals, appearance comparison, body dissatisfaction, and attitudes towards cosmetic surgery. Correlational analysis showed that almost all media and friend variables were significantly correlated with positive attitudes towards cosmetic surgery. A structural equation model based on the sociocultural model showed a good level of fit to the data. The effects of media exposure and friend conversations on body dissatisfaction and attitudes towards cosmetic surgery were mediated by internalisation. We concluded that media exposure and friend conversations affected attitudes towards cosmetic surgery both directly and indirectly. Our results contribute to the understanding of the sociocultural mechanisms underlying women's motivations for cosmetic surgery.     

Objectification Theory Predicts College Women’s Attitudes Toward Cosmetic Surgery

This study investigated cosmetic surgery attitudes within the framework of objectification theory. One hundred predominantly White, British undergraduate women completed self-report measures of impression management, global self-esteem, interpersonal sexual objectification, self-surveillance, body shame, and three components of cosmetic surgery attitudes. As expected, each of the objectification theory variables predicted greater consideration of having cosmetic surgery in the future. Also, as expected, sexual objectification and body shame uniquely predicted social motives for cosmetic surgery, whereas self-surveillance uniquely predicted intrapersonal motives for cosmetic surgery. These findings suggest that women’s acceptance of cosmetic surgery as a way to manipulate physical appearance can be partially explained by the degree to which they view themselves through the lenses of sexual and self-objectification.     

Body image and explicit and implicit anti-fat attitudes: the mediating role of physical appearance comparisons

Prejudice against overweight people is rife. However, there is a paucity of research on the underlying reasons for it. In two studies the relationship between body image, the tendency to make physical appearance-related comparisons (PACS), and both explicit and implicit anti-fat attitudes was examined. In Study 1 (n = 227) people with a high tendency to make physical appearance-related comparisons (high PACS scorers) reported lower self-appearance evaluation, but higher appearance orientation and explicit anti-fat attitudes. The PACS fully mediated the relationship between appearance orientation and explicit anti-fat attitudes. Study 2 (n = 134) found that the PACS also mediated the relationship between appearance orientation and implicit anti-fat attitudes. Thus, individual differences in factors such as body image and the tendency to make appearance-related comparisons, appear to play a central role in both explicit and implicit anti-fat attitudes.     

Upward and downward physical appearance comparisons: Development of scales and examination of predictive qualities

Despite good theoretical and empirical rationale for assessing tendencies to make upward and downward physical appearance comparisons no measure for these specific constructs exists. The present work developed and tested the psychometric properties of upward and downward physical appearance comparison scales. The scales were administered to participants (N = 224) along with measures of general appearance comparison tendencies, body image, disordered eating, Antifat and Antigay attitudes. The scales displayed good psychometric properties. Importantly, the upward but not downward physical appearance comparison scale predicted lower Appearance Evaluation and higher EAT-26 scores. Conversely, the downward but not upward physical appearance comparison scale predicted higher Appearance Evaluation and greater Antifat Attitudes (Dislike). The scales were unrelated to a nonappearance related construct. These new measures fill a gap in the literature and may be of benefit to researchers interested in body image, appearance concerns, eating disorders, social comparison, and obesity prejudice.     

Body image in social anxiety disorder,obsessive–compulsive disorder,and panic disorder

Body dysmorphic disorder falls under the category of obsessive–compulsive and related disorders, yet research has suggested it may also be highly associated with social anxiety disorder. The current study examined body image variables among 68 outpatients with primary obsessive–compulsive disorder (OCD; n = 22), social anxiety disorder (SAD; n = 25), and panic disorder (PD; n = 21). Participants filled out self-report measures of body image disturbance, attitudes toward one's appearance, and anxiety. Body image disturbance and attitudes toward appearance did not significantly differ between the groups. However, SAD symptoms predicted body image disturbance, Appearance Evaluation and Body Areas Satisfaction, and OCD symptoms predicted Appearance Orientation. These findings suggest that SAD and OCD may be associated with different facets of body image. Implications for the treatment of anxiety disorders and for future research are discussed.     

Attitudes toward cosmetic surgery patients: the role of culture and social contact

Cosmetic surgery is increasingly popular globally, but how cosmetic surgery patients are socially evaluated is largely unknown. The present research documents attitudes toward these patients in multiple cultures (Hong Kong, Japan, and the United States). Across these cultures, attitudes toward cosmetic surgery patients were predominantly negative: Participants ascribed more negative attributes to cosmetic surgery patients and found cosmetic surgery not acceptable. Also, participants in Hong Kong and Japan were not willing to form social relationships, particularly intimate ones, with these patients. These attitudes were less negative in the United States than in Hong Kong and Japan, partly because social contact, which reduced negativity in attitudes toward cosmetic surgery patients, was more prevalent in the United States. These findings bear important implications for the subjective well-being of cosmetic surgery patients, who very often expect improvement in their social relationships through the surgery.     

The harmful and beneficial impacts of weight bias on well-being: the moderating influence of weight status

Weight bias is evident among normal weight and obese individuals. This weight bias may be associated with comparisons to others, which may enhance feelings of self-worth. However, the ego-enhancing versus ego-diminishing influence of these evaluations may be moderated by the individual's weight status, and the strength of these effects may be moderated by gender. Eight-five participants completed the Implicit Associations Test, questionnaires assessing explicit weight bias, body image, and self-esteem, and height and weight assessments. Implicit weight bias was prevalent among all individuals, p < .001, and was associated with a more positive body image, ps < .05, and higher self-esteem, ps < .01, for thinner individuals but a more negative body image and lower self-esteem for heavier individuals. Gender moderation effects were not observed. It is arguably problematic that the positive benefits to normal weight individuals’ self-esteem and body image appear to come via negative comparisons with overweight individuals.