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

Self-objectification and cosmetic surgery consideration among Chinese young women: The mediating roles of alienation and body image inflexibility

The behavior of undergoing cosmetic surgery is a coping strategy for body-image threats and challenges. Self-objectification is associated with alienation and body image inflexibility, and all of these are associated with stronger cosmetic surgery considerations. This study evaluated the relationship between self-objectification and cosmetic surgery consideration, and whether this relationship was mediated by alienation and body image inflexibility. The participants were 650 Chinese female college students. Serial mediation analysis indicated that the relationship between self-objectification and cosmetic surgery consideration was significantly mediated by alienation followed by body image inflexibility. The total mediating effect value was 0.424, accounting for 57.5% of the total effects. These results suggest that reducing alienation and improving the flexibility of body image can reduce the influence of self-objectification on young women's willingness to undergo cosmetic surgery. These findings provide a basis for intervening or preventing the self-objectified young women's willingness for cosmetic surgery.

Exploration of parental consent for adolescent involvement in genital body image education research

Genital body image is a highly understudied concept but is important for sexual health and broader body image satisfaction. Effective genital body image interventions for adolescents have been developed, however, parental consent can be a barrier to adolescent participation. The aim of this study was to conduct a novel exploration of parental consent for genital body image education research and factors related to this consent. Participants were 125 parents of adolescents in Australia who completed an online questionnaire including measures of demographic characteristics, personality traits and attitudes, and likelihood of consent for an adolescent son and daughter participating in hypothetical genital body image education research. The vast majority of parents indicated that they definitely would consent to their adolescent sons' and daughters' involvement in this hypothetical research. There was no significant difference in likelihood of consent based on the gender of the adolescent. Parents having more conservative attitudes towards sex was the only factor tested that reduced the likelihood of providing consent. Overall, our results suggest parents are generally supportive of adolescent involvement in genital body image education research. This concept should be included in broader body image educational programs so adolescents gain exposure to this important but neglected topic.

Sociocultural pressures and engagement with cosmetic products and procedures in adult women

Previous studies have shown that cosmetic procedures and products that perpetuate Western hegemonic beauty standards among women have become increasingly popular, and pressures from sociocultural agents to utilize them are significant. However, little work has documented the relationship between perceived sociocultural pressures and use of cosmetic procedures and products among a larger age range of adult women. A community sample of 308 women aged 18-66, mean (SD) age of 35.7 (9.7), reported on the cosmetic procedures they had considered or used, as well as perceived pressures from the media, peers, romantic partners, and health and beauty professionals. Findings revealed that, among those investigated, the most frequently utilized products and procedures were supplements and hair removal. However, a significant minority reported considering more invasive procedures, including cosmetic surgery. Media was the predominant source of pressure, while partners were the least frequently endorsed. While pressure from professionals and peers had small-to-moderate associations with utilization of cosmetic products and procedures, pressure from partners had the largest association with their use. This work frames important future directions for examining the impact of sociocultural pressures on women's willingness to utilize cosmetic products and procedures that are sometimes underregulated and risky for physical and mental health.

Watermelons, Syringes, and Regulation: Instagram Marketing by Cosmetic Clinics in the UK and the Netherlands

BACKGROUND

Cosmetic clinics use social media to inform and market to prospective patients. Evidence from social media posts by the UK and Dutch cosmetic clinics illustrates the precarious balance between professionalism and commercialism, and raises important questions for the regulation of these marketing communication efforts.

METHODS

A random selection of Instagram posts by Dutch and the UK clinics which offer (non-) invasive cosmetic procedures were selected for a qualitative content analysis. The corpus of data comprised 395 posts by six Dutch and four UK clinics, published between January 2018 and July 2019. The method of analysis was inspired by previous qualitative studies into the marketing of cosmetic procedures and can be described as a (discursive) thematic analysis.

RESULTS AND CONCLUSIONS

The tension between the medical-professional and commercial nature of cosmetic procedures was evident in the Instagram posts by Dutch and UK clinics. Despite calls for 'ethical' marketing on social media, this study illustrates that marketing materials are not always in line with current advertising guidelines. Whereas advertising standards authorities have warned against the trivialization of cosmetic procedures, posts by clinics backgrounded the medical nature of procedures in favor of more commercial advertising appeals. Furthermore, the posts demonstrated little diversity in terms of models' gender, ethnicity and body type, which reinforces narrow contemporary beauty ideals.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Selfie behavior and cosmetic surgery consideration in adolescents: the mediating roles of physical appearance comparisons and facial appearance concern

Selfie activity may contribute to the acceptance of cosmetic surgery in adolescents, although few empirical studies exist. Based on social comparison theory, this study examined the association between selfie behavior and cosmetic surgery consideration among Chinese adolescents and further tested the possible mediating roles of social comparison and facial appearance concern in this relationship. A sample of 537 adolescents (339 girls and 198 boys) were recruited voluntarily to complete questionnaires on selfie behavior, upward physical appearance comparison, facial appearance concern and cosmetic surgery consideration. Linear regression and mediation analyses were conducted. The results showed that selfie behavior predicted higher level of adolescents' cosmetic surgery consideration. Moreover, this relationship was sequentially mediated through upward physical appearance comparison and facial appearance concern. These findings expand the existent literature by suggesting that selfie behavior may trigger upward social comparison in adolescents, which in turn increase their acceptance of cosmetic surgery.

"I wanna look like the person in that picture": Linking selfies on social media to cosmetic surgery consideration based on the tripartite influence model

Based on the tripartite influence model, the present study linked investment in others' selfies on social media to facial dissatisfaction and cosmetic surgery consideration. We also tested the mediating role of appearance comparisons and general attractiveness internalization in these relationships. Additionally, potential gender differences in the proposed model were examined. A sample of 884 Chinese adolescents (mean age = 16.80 ± 0.92, ranging from 14 to 19 years old) completed self-reported measures of investment in others' selfies, appearance comparisons, general attractiveness internalization, facial dissatisfaction, and cosmetic surgery consideration. Results showed that investment in others' selfies was positively associated with facial dissatisfaction and cosmetic surgery consideration. Path analysis further revealed that investment in others' selfies was associated with appearance comparisons and general attractiveness internalization, which in turn were associated with facial dissatisfaction, and then facial dissatisfaction was related to cosmetic surgery consideration. Additionally, there were indirect associations between investment in others' selfies and cosmetic surgery consideration via general attractiveness internalization and facial dissatisfaction respectively, but not via appearance comparisons. No gender difference was found in the proposed model. Findings of the present study provide preliminary support for the tripartite influence model in the context of investment in others' selfies on social media and cosmetic surgery consideration and enrich the literature on body image and cosmetic surgery in the Chinese context.

Motivations for Seeking Cosmetic Enhancing Procedures of the Face: A Systematic Review

BACKGROUND

Cosmetic enhancing procedures continue to grow in demand. Physicians should understand the complex factors that drive patient motivation for seeking such procedures.

OBJECTIVE

In contrast to a lens of psychopathology, this review reveals the driving power of everyday intrapersonal, social, and behavioral factors that motivate interest in elective facial cosmetic procedures.

MATERIALS AND METHODS

The review was conducted according to PRISMA guidelines and included studies with at least 50 adult patients seeking facial cosmetic enhancements between January 1, 2000, and July 1, 2022.

RESULTS

Among 1,239 identified publications, 21 studies with 9,005 participants were selected for inclusion. The review documents everyday factors as patient motivators for pursuing cosmetic enhancements of the face, with the majority of work focusing on intrapersonal factors (17 of 21 studies), such as preventing aging or negative appearance based self-appraisals. For studies reporting social factors (15 of 21 studies), the most common motivators were the patient's social network and a desire to promote social standing. Behavioral factors revealed that social media and media consumption impact patient motivation for cosmetic enhancements (5 of 21 studies).

CONCLUSION

In summary, this review demonstrates that patient motivations for facial cosmetic enhancements may be best understood through everyday intrapersonal, social, and behavioral factors.

Teaching vulval anatomy in the twenty-first century: The Australian experience

Anatomy has often been regarded as an immutable discipline where everything that needs to be known is known. This article focuses on the teaching of vulval anatomy, the diversification of gender in contemporary society, and the increasing popularity of the Female Genital Cosmetic Surgery (FGCS) industry. The binary language and singular structural arrangements contained in lectures and chapters on "female genital anatomy" are nowadays rendered exclusive and incomplete. A series of 31 semi-structured interviews with Australian anatomy teachers identified barriers and facilitators for teaching vulval anatomy to contemporary student cohorts. Barriers included lack of connection to contemporary clinical practice, time and technical difficulty involved in regularly updating online presentations, the crowded curriculum, personal sensitivity to teaching vulval anatomy, and reluctance to introduce inclusive terminology. Facilitators included lived experience, regular use of social media, and institutional initiatives toward inclusivity including the support of queer colleagues.

Follow, filter, filler? Social media usage and cosmetic procedure intention, acceptance, and normalization among young adults

Today, young people spend much of their lives online where they encounter abundant appearance-focused content. In light of the important role that social media platforms like Instagram play in young people's attitudes towards the cosmetic surgery industry, this study investigates passive and active social media usage in relation to young adults' perceptions of cosmetic procedures. In a cross-sectional survey study among 470 Instagram users aged 18-25 years (M_age = 21.00, SD_age = 2.26), young adults indicated a low cosmetic procedure intention themselves, but overestimated the prevalence of cosmetic procedures undertaken by others. Considering passive social media use, young adults who follow influencers who had undergone cosmetic procedures reported higher intentions to have cosmetic procedures themselves, and following influencers who had not undergone procedures was related to lower intentions. In terms of active social media usage, frequency of Instagram posting was generally insignificant in relation to acceptance of and intention to undergo cosmetic procedures. Yet, those who used filters to edit pictures more frequently reported increased cosmetic procedure acceptance and intention. Overall, this paper offers a nuanced perspective on the relation between young adults' perceptions of cosmetic procedures and their social media behaviors, highlighting the importance of specific appearance-oriented social media usage.

The Importance of Media on Decision to Undergo Cosmetic Surgery Operation

BACKGROUND

How media disseminates ideal beauty, and its effect on the decision-making process of cosmetic procedures are among the most discussed topics in the literature. This study aimed to investigate the effects of media on patients' decisions to undergo cosmetic surgery.

MATERIALS AND METHODS

Between March and September 2021, 82 patients participated in this study and informed consent was obtained from all patients. A questionnaire containing three different parts was developed by a consultant plastic surgeon and a public relations and marketing specialist, according to the literature. All statistical analyses were performed using SPSS version 22.0.

RESULTS

The majority of patients underwent rhinoplasty (31.7%), breast reduction (25.6%), and breast augmentation (12.2%). Some of the patients underwent two different operations (6%). The correlation analysis results showed that, there was a medium, positive correlation between wanting to be attractive and thinking that media is an important tool in the decision to undergo cosmetic surgery (r=.307, p<.01). Want to look like people on the media and compare themselves with those showing a positive and strong correlation (r=.640, p<.01). The photographs on the magazines affected the patients aged between 40-49 and 50-59 more (χ²(4) = 11,378, p<.05); however, the published news on the Internet affected the younger sample (30-39 and 21-29) more than the other age groups (χ²(4)= 11,808, p<.05). The participants aged 30-39 and 21-29 tend to compare themselves with people on the Internet.

CONCLUSION

The study concludes that media is not only important for disseminating beauty ideals but is also an important source during decision making. However, further studies with more participants and objective scales are needed to verify our results.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Does #beauty have a dark side? Testing mediating pathways between engagement with beauty content on social media and cosmetic surgery consideration

Beauty content on social media has grown exponentially, however research has yet to investigate its association with appearance concerns. This study drew on components of the tripartite influence model to test the associations between young women's engagement with beauty content on social media and cosmetic surgery consideration. A sample of 399 undergraduate women aged 17-25years (M_age = 19.36) completed measures of beauty social media engagement, upward appearance comparison, general attractiveness internalization, dysmorphic appearance concerns, and consideration of cosmetic surgery. Path analysis was used to test direct and indirect associations. In line with the tripartite influence model, results supported a serial mediation model that comprised significant paths from beauty social media engagement through in turn, upward appearance comparison, general attractiveness internalization, and dysmorphic appearance concerns, to cosmetic surgery consideration. However, neither general attractiveness internalization nor dysmorphic appearance concerns mediated the link between beauty social media engagement and consideration of cosmetic surgery. Findings provide new insights into the links between engagement with the growing beauty social media trend and cosmetic surgery consideration.

Effects of short-video use on undergraduates’ weight- loss intention: a regulatory mediation model

This research intends to explore the effects of short video use on college students’ weight loss intentions, and its intrinsic mechanism of action, based on the responses of 1268 students from three universities in southwest China to questionnaires with the instruments of a sports participation scale, body image scale, self-esteem scale and weight loss intention scale. The findings are listed as follows: 1) Short video use can significantly and positively predict weight loss intention; 2) Body image mediates the relationship between short video usage and weight loss intentions; 3) Self-esteem plays a regulatory effect as the direct path between short video use and weight loss intention as well as partial mediation effect of body image. The direct effect of short video use on weight loss intentions and the mediating effect of body image gradually increased with the decrease of self-esteem. The results of the study suggest that short video use can affect the weight loss intentions of college students through either a direct or indirect path created by the mediating role of body image. Meanwhile, the influence of self-esteem on weight loss intention can’t be ignored, which is another key factor that affects college students’ weight loss intentions beyond short video use and body image.

Media Internalized Pressure and Restrained Eating Behavior in College Students: The Multiple Mediating Effects of Body Esteem and Social Physique Anxiety

Background

Restrained eating behavior has become the norm in college students' lives, and considering the harm it causes to college students, it is necessary to explore the factors associated with it. The aim of this study was to explore the association between media internalized pressure, body esteem, social physique anxiety, and restrained eating behavior.

Methods

The participants in this study were 1,032 Chinese college students (439 males and 593 females) and had a mean age of 20.22 years (SD = 1.277). They completed the Sociocultural Attitudes Toward Appearance Questionnaire-3, Body Esteem Scale (BES), Social Physique Anxiety Scale (SPAS), and Dutch Eating Behavior Questionnaire (DEBQ).

Results

The results showed that media internalized pressure was significantly and positively associated with college students' restrained eating behavior, that body esteem and social physique anxiety played a mediating role between media internalized pressure and restrained eating behavior, respectively, and that body esteem and social physique anxiety can also play a chained mediating role.

Conclusion

This study reveals the relationship between media internalized pressure and restrained eating behavior, and the important role played by body esteem and social physique anxiety. Future interventions targeting restrained eating should focus on the aspects of body esteem and social physique anxiety.

The Real Ideal: Misestimation of Body Mass Index

In Western cultures, the ideal body for women is thin and toned. Idealization of thinness has led many women to desire bodies with an underweight body mass index (BMI). The present study investigated women's knowledge of BMI, particularly relating to their own body ideals, to determine whether women knowingly idealize bodies categorized as “underweight.” In August 2020, one-hundred and forty-seven US women aged 18 to 25 completed two online tasks in a repeated-measures design. First, participants estimated the BMIs of a series of bodies. Then, participants selected representations of their own and ideal bodies from a figure rating scale and estimated the BMIs of their selections. Participants generally mis-estimated the BMI of bodies, but did so to a greater extent when viewing bodies as an extension of their own, i.e., following the figure rating scale task. Further, if participants selected an underweight or overweight ideal body, they were likely to estimate this body was within a “normal” weight BMI range, demonstrating that women who idealize underweight–or overweight–bodies do so unknowingly. These findings suggest misperceptions of women's own ideal body size are often greater than misperceptions of other bodies, potentially driving the tendency to idealize underweight bodies.

Self-Reported Total Screen Time and Viewing Modes Are Associated with Body Dissatisfaction, Disordered Eating, and Cosmetic Surgery Intentions among Young Adults

While numerous studies have shown that media exposure is linked to body dissatisfaction and disordered eating behavior, limited research has examined these associations by screen-viewing mode. This study examined associations of total screen-time and screen-viewing modes with body dissatisfaction, disordered eating, and cosmetic surgery intention among young adults. Men (n = 3466) and women (n = 7300), aged 19 to 34 years, self-reported their screen-time on various TV viewing modes, and their body dissatisfaction, overeating, disordered weight control behaviors, and cosmetic surgery intentions. We fit linear, logistic, and multivariate models to examine cross-sectional associations between total screen-time and screen-viewing modes and body dissatisfaction, disordered eating, and cosmetic surgery intention. Handheld viewing was associated with body dissatisfaction for women only, and online viewing was associated with greater body dissatisfaction among both men (βˆ = 0.40; 95% CI, 0.15 to 0.65) and women (βˆ = 0.25; 95% CI, 0.10 to 0.40). Downloaded viewing was associated with higher odds of overeating behaviors among both men (OR = 1.24; 95% CI, 1.10 to 1.40) and women (OR = 1.21; 95% CI, 1.12 to 1.32), respectively. Although total screen time was associated with greater cosmetic surgery intention for both men (βˆ = 0.24; 95% CI, 0.09 to 0.39) and women (βˆ = 0.43; 95% CI, 0.28 to 0.58), sex differences were found for the viewing modes. Our results suggest that different viewing modes may be differently associated with men and women’s body image, disordered eating behavior, and cosmetic surgery intention. Future research should consider all modes of screen-viewing in our media environment.

Conflicting Cultural and Religious Views on Cosmesis: The Modern Women's Dilemma

Background

Women from countries with conflicting views on cosmesis may avoid these procedures for the fear of being rejected by the community. Understanding the motives that drive patients from these countries to seek cosmetic procedures helps discern possible causes of postoperative dissatisfaction, which can be prevented by careful selection of patients and individualizing their management protocols.

Objectives

This study helps identify the factors that affect Egyptian Muslim women’s attitude toward cosmetic procedures. The main factors tested were female gender role stress (FGRS), body dysmorphic disorder (BDD), and religious attitude. The secondary factors investigated were health evaluation, life satisfaction, self-satisfaction, social media use, TV exposure, spouse/friends/family influence, and internalization of beauty standards.

Methods

Women willing to undergo cosmetic procedures were compared with those who were not. A survey exploring demographics and the different motives were posted for the public online.

Results

Among 502 participants, 288 were willing to undergo cosmetic procedures and 214 were not. Our findings showed a statistically significant difference for the degree of BDD, FGRS, and religiousness between willing and unwilling groups. Moreover, greater pressure from partner to change appearance, influence of friends and family on opinion regarding beauty of oneself, internalization of beauty standards, and lower ratings of life and self-satisfaction showed statistically significant association with willingness to undergo cosmetic treatment.

Conclusion

BDD, FGRS, and religious attitude are among the highest predictors of the willingness of women to undergo cosmetic procedures together with many other factors. This study is the first of its kind to evaluate several unexplored motives and opens the door for future research.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Body image and acceptance of cosmetic surgery in China and the Netherlands: A qualitative study on cultural differences and similarities

There is an established relationship between acceptance of cosmetic surgery and psychological factors, including body image. However, qualitative research among diverse cultural groups is needed to provide a more fine-grained understanding of the influences on women's attitudes towards cosmetic surgery. In this study, 20 Chinese and 20 Dutch women aged 18-50 years (M_Chinese = 34.20; M_Dutch = 34.70) participated in one-on-one semi-structured interviews. Data were analyzed using reflexive thematic analysis. We identified three themes that captured the factors that women perceived to foster favorable attitudes towards cosmetic surgery: (a) sociocultural pressures (e.g., normalization of cosmetic surgery, appearance-focused peers); (b) intrapersonal characteristics (e.g., beauty-ideal internalization, social comparison); and (c) benefits of beauty (e.g., attracting men, socioeconomic benefits). Conversely, two themes captured the factors perceived to reduce favorable attitudes towards cosmetic surgery: (a) intrapersonal characteristics (e.g., unconditional body acceptance, self-confidence); and (b) external considerations (e.g., health risks, financial costs). Overall, Chinese and Dutch participants shared many similarities in their opinions about what might affect cosmetic surgery consideration. The most striking cross-cultural differences concerned perceived socioeconomic benefits of beauty (mainly Chinese women) and women's conceptualization of body appreciation. This study may enable a more comprehensive understanding about the factors influencing Chinese and Dutch women's attitudes towards cosmetic surgery, and the nuances in these relationships across these cultures.

Photo manipulation as a predictor of facial dissatisfaction and cosmetic procedure attitudes

Photo manipulation (editing photos prior to sharing them) has become increasingly popular on social media. While intended to enhance a photo's quality, this behaviour has been linked to heightened body image concerns. The present study investigated whether social media photo manipulation predicts facial dissatisfaction, attitudes towards cosmetic procedures, and intentions to undergo facial cosmetic procedures in young women, and the moderating role of self-discrepancy therein. Australian women (N = 227, 17-25 years) completed an online cross-sectional questionnaire. Social media photo manipulation was associated with greater facial dissatisfaction, cosmetic procedure attitudes/intentions, and appearance-based self-discrepancy. Photo manipulation was a significant predictor of cosmetic procedure attitudes and intentions, but not of facial dissatisfaction. Appearance-based self-discrepancy significantly moderated the relationship between photo manipulation and facial dissatisfaction, whereby the relationship between photo manipulation and facial dissatisfaction was stronger for those with lower self-discrepancy. Results highlight a key role for photo manipulation and appearance-based self-discrepancies in relation to facial dissatisfaction for young women. They also provide insight into predictors of cosmetic procedure intentions and attitudes. This signals a pressing need to develop effective intervention and prevention programs to help young women limit their appearance-based photo manipulation behaviours for use on social media.

Instagram Sexualization: When posts make you feel dissatisfied and wanting to change your body

Instagram is a visually centered social media that involves the presence of sexualized imagery posted by users. Such Instagram sexualization may have a negative impact on women's body image. The present study examined whether exposure to Instagram sexualization, namely posts of sexualized women along with appearance-related comments, affected women's body satisfaction and cosmetic surgery intentions. In doing so, it also considered the moderating role of Instagram Addiction Proclivity (IAP). Young Italian female participants (N = 247) were randomly exposed to one of four video conditions resulting from the combination of either sexualized or non-sexualized women's pictures on Instagram, paired with appearance or neutral comments. In the sexualized picture condition participants' body dissatisfaction increased compared to pre-exposure levels and to the non-sexualized picture condition. The type of comments did not affect participants' body satisfaction. Moreover, IAP predicted cosmetic surgery intentions and moderated their reactions to Instagram content. Indeed, the higher the IAP, the higher the cosmetic surgery intentions of participants viewing sexualized pictures with neutral comments and non-sexualized pictures with body appearance comments. These findings suggest that female Instagram users should be aware of the negative impacts of viewing sexualized imagery as well as the role that IAP may play.

Body dissatisfaction in midlife women: The applicability of the tripartite influence model

Body image issues and disordered eating are relatively under-researched areas within midlife populations. Accordingly, this study investigated the applicability of the Tripartite Influence Model (TIM) to midlife women. In an online survey, predominately Australian female participants (N = 206) aged 40-55 years (M = 46.75, SD = 4.54) completed measures related to sociocultural pressures, thin-ideal internalisation, appearance comparison, body dissatisfaction, bulimic symptoms, restrained eating, and psychological distress. Path analysis was used to evaluate the model. Greater peer and media pressure were associated with greater appearance comparison, which in turn was associated with greater thin-ideal internalisation, and through this greater body dissatisfaction. Similarly, greater body dissatisfaction was associated with greater restrained eating and bulimic symptoms, which in turn were associated with greater psychological distress. Unexpectedly, family pressure also emerged as an important direct predictor of outcomes, while sociocultural influences were not associated with thin-ideal internalisation, nor was family pressure associated with appearance comparison. Furthermore, appearance comparison was not associated with body dissatisfaction. Overall, the findings provide partial support for applicability of the TIM for midlife women and suggest practical implications such as targeted interventions that may assist body image disturbance and associated outcomes for midlife women.

The Relationship between Obligatory Exercise and Eating Attitudes, and the Mediating Role of Sociocultural Attitudes towards Appearance during the COVID-19 Pandemic

A strong sociocultural context could affect an individual's aesthetic standards. In order to achieve a socially recognized ideal appearance, obligatory exercisers might increase dieting behavior when exercise actions are disturbed, thereby placing the individual at risk of eating disorders. The current study mainly examined the relationship between obligatory exercise and eating attitudes during the COVID-19 pandemic, and considered the mediating role of externalized sociocultural attitudes towards appearance between the two. A total of 342 participants (175 females, 167 males) from various regions of China were invited to fill out the questionnaires including the Obligatory Exercise Questionnaire, the Sociocultural Attitudes Toward Appearance Questionnaire-3, and the Eating Attitudes Test. In total, 51.5% of the participants presented symptoms of an obligatory exercise behavior. Among them, males, young adults, and the participants with lower BMI had higher OEQ scores, whereas females and young adults had higher EAT-26 scores. Meanwhile, 9.4% of the participants might have had an eating disorder. The OEQ score was positively correlated with the EAT-26 total score as well as SATAQ-3 'Pressures' and 'Information' subscales. In addition, the EAT-26 total score was positively correlated with the SATAQ-3 'Pressures' and 'Information' subscales. Externalized sociocultural attitudes towards appearance served as a mediator between obligatory exercise behavior and eating attitudes, and the mediation effect accounted for 56.82% of the total effect. Obligatory exercise behavior may have an indirect effect on eating attitudes through sociocultural attitudes towards appearance. Given the sociocultural information and pressures, in order to maintain or pursue an ideal appearance, many people tend to keep a pathological diet. Thus, forming a positive and healthy social aesthetic orientation is beneficial in helping obligatory exercisers to develop reasonable eating habits.

How cosmetic surgeons portray cosmetic procedures through Instagram? A content analysis on cosmetic surgeons' posts on Instagram

The present study intends to explore the visual and textual content of posts cosmetic surgeons shared on Instagram pages in order to present their cosmetic surgical or non-surgical procedures. To do so, this study employed a qualitative approach using textual and visual content analysis on 200 Instagram posts shared by cosmetic surgeons. The results demonstrated that the content of analyzed posts can be categorized as 12 sub-themes which are clustered around four main themes; "You have got some body imperfections," "Body imperfections are worrisome," "Cosmetic procedure is the solution; we provide it for you" and "It's not a real surgery!."

Body Talk on Social Networking Sites and Cosmetic Surgery Consideration Among Chinese Young Adults: A Serial Mediation Model Based on Objectification Theory

People’s interest in cosmetic surgery has increased in recent years. Drawing from objectification theory, in the present study, we examined the associations of body talk on social networking sites (SNS), body surveillance, and body shame with cosmetic surgery consideration. In particular, we examined the mediating roles of body surveillance and body shame in the relationship between SNS body talk and cosmetic surgery consideration. We also examined potential gender differences in the serial mediation model. Male and female college students in China ( N = 309) completed questionnaires regarding SNS body talk, body surveillance, body shame, and cosmetic surgery consideration. Results showed that SNS body talk, body surveillance, and body shame were positively associated with cosmetic surgery consideration. Body surveillance and body shame mediated the association between SNS body talk and cosmetic surgery consideration both separately and sequentially. Gender did not moderate any of the relations in the serial mediation model. Findings of this study provide new insight into the relationship between SNS use and cosmetic surgery and highlight facets of objectification as potential targets for prevention and intervention regarding appearance concerns.

Research on the Influence of Media Internalized Pressure on College Students' Sports Participation-Chained Intermediary Analysis of Social Physique Anxiety and Weight Control Self-Efficacy

Purpose: Discuss the relationship among college students’ media internalized pressure, social physique anxiety, weight control self-efficacy, and sports participation in providing a reference for promoting college students to develop healthy and confident living habits.

Methods: Take Southwest University in China as the object, select the subjects by stratified random sampling, and process the data with SPSS19.0 and AMOS21.0 statistical software.

Results: (1) Media internalized pressure is positively correlated with social physique anxiety, weight control self-efficacy, and sports participation; social physique anxiety is significantly positively correlated with weight control self-efficacy and sports participation, and weight control self-efficacy is significantly positively correlated with sports participation; (2) media internalized pressure has a direct effect on sports participation (ES = 0.456), and social physique anxiety (ES = 0.136) and weight control self-efficacy (ES = 0.102) play significant mediating roles in the relationship between media internalized pressure and sports participation, respectively; the chained mediating force of social physique anxiety and weight control self-efficacy also reaches a significant level (ES = 0.027).

Conclusion: Media internalized pressure can influence college students’ sports participation through the direct path as well as indirect paths such as social physique anxiety, the intermediary effect of weight control self-efficacy, and chained intermediary effect of social physique anxiety–weight control self-efficacy, and social physique anxiety is another key factor affecting college students’ sports participation except media internalized pressure.

Demographic and Cultural Differences in the Acceptance and Pursuit of Cosmetic Surgery: A Systematic Literature Review

Worldwide, the numbers of cosmetic procedures continue to climb. However, cosmetic surgery (CS) continues to be plagued by negative stigmatization. This study reviews the literature to identify how attitudes toward CS vary by sex, age, race, culture, and nationality, and aims to determine how other factors like media exposure interact with demographics to influence how well CS is accepted.

Methods

A PRISMA-guided systematic review of the literature was conducted to identify all English-language papers reporting on CS or plastic surgery acceptance, attitudes, or stigmatization, specifically examining for data on age, sex, race/ethnicity, culture, and media influence.

Results

In total, 1515 abstracts were reviewed, of which 94 were deemed pertinent enough to warrant a full-text review. Among the potential demographic predictors of CS acceptance, the one with the most supportive data is sex, with women comprising roughly 90% of all CS patients in virtually all populations studied and consistently exhibiting greater CS knowledge and acceptance. Culturally, the pursuit of beauty through CS is a universal phenomenon, although different countries, races, and cultures differ in how willingly CS is embraced, and in the aesthetic goals of those choosing to have it. In countries with culturally diverse societies like the United States, non-Hispanic Whites continue to predominate among CS patients, but the number of CS patients of other races is rising disproportionately. In this trend, social media is playing a major role.

Conclusion

Healthcare practitioners performing cosmetic procedures need to consider demographic and cultural differences of the patients in order to enhance their understanding of their patients' aesthetic goals and expectations.

The ever-changing ideal: The body you want depends on who else you're looking at

The body positivity movement-celebrating bodies beyond the thin ideal-has gained traction on social media. In an online study of North American women, we aimed to determine how ideal body perceptions shift based on the presentation of more diverse body types. In Study 1, women (n = 115, aged 19-75) responded to arrays of bodies ranging from primarily small to primarily large bodies, selecting the body closest to their ideal body. Results showed that the BMI of the ideal body increased as the body sizes in the array increased. Participants were also less likely to select an underweight ideal when viewing larger bodies. In Study 2, women responded to arrays with either primarily small (n = 132, aged 20-68) or primarily large (n = 130, aged 20-75) bodies. Results suggested that ideal body perceptions only shifted around current societal standards, and not to extremes. The participants presented with the larger-bodied arrays were more likely to select a normal weight ideal body than those who saw the smaller-bodied arrays. Results suggest ideal body size is malleable, and shifting toward a more diverse perception of the ideal body is achievable with increased exposure beyond the thin ideal.

Why do selfies increase young women's willingness to consider cosmetic surgery in China? The mediating roles of body surveillance and body shame

The present study was designed to examine a possible two mediator model with both body surveillance and body shame mediating the association of selfie behavior with cosmetic surgery consideration in young adult women. A sample of 588 young adult women participated in this study and completed questionnaires regarding selfie behavior, body surveillance, body shame, and cosmetic surgery consideration. Results indicated that selfie behavior was positively related to cosmetic surgery consideration. In addition, the mediation analysis by PROCESS revealed that body surveillance and body shame mediated the relation between selfie behavior and cosmetic surgery consideration. These findings add to the extant literature by suggesting that selfie behavior may be a new experience of self-objectification, which provide new insights into the relation between selfie activities and cosmetic surgery consideration in young women.

Benefit-Seeking or Risk-Taking? Examining the Portrayal of Cosmetic Surgery in Chinese News, 2000-2019

Analyzing 311 news articles published in representative Chinese newspapers, this study investigated how cosmetic surgery (CS) was represented in Chinese media from 2000 to 2019. Employing a coding scheme based on prior literature and sampled data, the study analyzed both features of the articles and profiles of the patients in the media. Results showed significant differences in media reporting across issue categories, reporting frames (benefit-focused, risk-focused, neutral), sources of information, drivers for and impacts of having surgeries. Among all the reasons for obtaining CS, boosting career confidence was ranked at the top. Additionally, significant differences in reporting were observed across types of the newspapers, gender of the patients, and time periods of the coverage. Implications of the findings for health promotion and regulation were discussed in reference to the social, cultural, and media context in China.

Factor Analysis and Psychometric Properties of the Chinese Translation of the Acceptance of Cosmetic Surgery Scale

This paper describes a Chinese translation and validation of the Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King & Henderson-King, 2005), a questionnaire for assessing attitudes towards cosmetic surgery. Chinese adults (335 women, 240 men; M_age = 33.65) completed the Chinese ACSS and - to investigate construct validity - measures of body appreciation, facial appearance concerns, sociocultural attitudes towards appearance (i.e., internalization of appearance ideals and appearance pressures), and demographics. Exploratory factor analysis revealed that the Chinese ACSS comprised two factors, which were invariant across sex, mirroring results among other non-Western samples. The Chinese ACSS also demonstrated good internal consistency (Cronbach's alphas > .90) and convergent validity via its positive associations with facial appearance concerns and overall sociocultural attitudes toward appearance. Chinese ACSS scores were higher among women, and were positively correlated with age among men. Chinese ACSS scores were not associated with body appreciation or other demographic factors. The ACSS seems to be a valid instrument for use in Chinese adults, and could bring more insight into attitudes toward cosmetic surgery from a cross-cultural perspective.

Body Image and Sociocultural Predictors of Body Image Dissatisfaction in Croatian and Chinese Women

In the current paper, two different studies were designed to investigate body image dissatisfaction and perception of the attractive female body in Chinese and Croatian women and men using the correlational and experimental study research approach. Study 1 comprised 266 Chinese (160 women; 106 men) and 261 Croatian participants (161 women; 100 men). Women from both countries were asked to complete the measures of the Contour Rating Scale, SATAQ - 4, Body Area Scale and demographic data, while men were asked to complete the measures of the Contour Rating Scale and demographic data via online surveys. The obtained results indicated that thin internalization predicted body image dissatisfaction in both samples. Besides, while both samples scored relatively high on thin-ideal internalization, Chinese women, who were also in general less satisfied with their body image, had higher scores. Chinese women also scored higher on musculature internalization and felt more pressure from family, friends, and media to conform to standard beauty norms compared to Croatian women. The samples also differed in their perceptions of preferable body size, where Chinese women had a more negative perception of their actual body size. The obtained results furthermore revealed that Chinese men preferred thinner women compared to Croatian men. Moreover, both samples misjudged what their female counterparts found attractive, thinking that women wanted to have even thinner bodies than they actually reported. Similarly, women from both cultures revealed a preference for thinner figures than the ones selected as the most attractive by the opposite sex. Finally, in Study 2, experimental manipulation of thin-ideal was used to examine whether thin priming affected body image dissatisfaction. The obtained results revealed that when primed with thin-ideal women from both countries felt lower satisfaction with their body size. The observed effect was stronger for Chinese participants. Limitations of the current study are discussed in the conclusion.

Understanding body image from a psychosocial stance: how this connects with patients requesting cosmetic procedures

There are many patients requesting cosmetic procedures who also struggle with mental health issues. These can include body dysmorphia, eating disorders, depression and anxiety. If aesthetic practitioners are able to recognise mental health, it will go some way to protect those for whom cosmetic procedures may not be the most appropriate course of treatment. This article will discuss the factors that contribute to the development of body image. The hope is that it will help practitioners question their own knowledge and understanding of mental health and how it can be connected with requests for cosmetic procedures. Practitioners may also identify areas where they need additional training and or understanding.

Effects of social media use on desire for cosmetic surgery among young women

A large body of research has documented the influence of traditional media formats (e.g. television programs, adverts) on young women’s consideration of cosmetic surgery. However, less is known about how newer forms of media such as social networking sites impact desire for cosmetic surgery. The present study aimed to examine whether exposure to images depicting facial cosmetic enhancements increases the desire for cosmetic surgery among young women. One-hundred and eighteen women, aged 18–29 years, indicated their social media use. This was followed by a task in which they viewed either images of facial cosmetic enhancements (N = 59) or images of travel (N = 59). Participants then indicated their satisfaction with their appearance, their mood and desire to undergo cosmetic enhancement. The results showed that viewing images of females who have undergone cosmetic enhancements affected young women’s desire for cosmetic surgery, especially if they spent a significant amount of time on social media, followed many accounts, and were less satisfied with their appearance. These findings have implications for parents, clinicians, and policy makers for understanding how internet habits, particularly the use of social media, influence the desire for cosmetic surgery, including the psychosocial motivations underlying those intentions.

The South Asian facial anthropometric profile: A systematic review

PURPOSE

Craniofacial anatomy, as measured by facial anthropometric data, varies significantly between races. South Asia, comprised of eight countries, represents a large proportion of the global population and is the fastest-growing region of the world. This systematic review presents the facial anthropometric data collected for populations from this region.

MATERIALS AND METHODS

This systematic review was conducted in accordance with PRISMA guidelines. A systematic review of the literature was conducted by an electronic search of the MEDLINE and Cochran databases, returning 1675 articles. Bibliographies of accepted articles were screened to identify further eligible studies.

RESULTS

A total of 12 articles were considered eligible for the systematic review. Two studies were conducted in Bangladesh, 7 in India, and 3 in Nepal. No facial anthropometric data were found for populations from Afghanistan, Bhutan, Maldives, Pakistan, or Sri Lanka. Qualitative and quantitative parameters from the 12 studies were extracted.

CONCLUSION

There is a paucity of facial anthropometric data for South Asian populations. As South Asia has a significant prevalence of craniofacial anomalies and a burgeoning cosmetic facial surgery market, it is in the interest of both the craniofacial surgeon and the South Asian patient to collect baseline facial anthropometric data for this population.

Materialism, Self-Objectification, and Capitalization of Sexual Attractiveness Increase Young Chinese Women's Willingness to Consider Cosmetic Surgery

Research reveals significant positive associations between materialism and cosmetic surgery consideration, yet little is known about why this relationship exists. To address this question, the present study examined potential mediators of the links between materialism and cosmetic surgery consideration. A sample of 336 Chinese undergraduate women completed measures of materialism, self-objectification, capitalization of sexual attractiveness, and cosmetic surgery consideration. Correlational analysis showed that materialism, self-objectification, and capitalization of sexual attractiveness were significantly positively correlated with cosmetic surgery consideration. The results of path analyses revealed that higher materialism predicted more willingness to consider cosmetic surgery, both directly and indirectly via higher self-objectification and capitalization of sexual attractiveness.

Why are men interested in cosmetic surgery procedures? Examining the role of different forms of peer influence, social comparison, internalization, and body dissatisfaction

The present research examined the roles of different forms of peer influence, internalization, social comparison, and body dissatisfaction in men's interest in cosmetic surgery. Participants were 204 Italian men (M_age = 34.02, SD = 11.21). Regression analyses showed that appearance conversations with friends and peer attribution were associated with consideration of cosmetic surgery for social reasons, while teasing on muscularity (but not teasing on general body and shape) was linked to interest in cosmetic surgery for intrapersonal motives. Social comparison was significantly and positively associated with men's interest in cosmetic surgery, while internalization was not. Dissatisfaction with body fat was linked to men's consideration of cosmetic surgery for social motivations, while muscularity and height dissatisfaction did not emerge as significant correlates of cosmetic surgery attitudes. These findings highlight the importance of psychosocial factors, such as peer influence, body fat dissatisfaction, and social comparison in men's interest in cosmetic procedures.

Analysis of the Factors Affecting Men's Attitudes Toward Cosmetic Surgery: Body Image, Media Exposure, Social Network Use, Masculine Gender Role Stress and Religious Attitudes

BACKGROUND

Cosmetic surgery is no longer just for females. More men are opting for cosmetic procedures, with marked increases seen in both minimally invasive and surgical options over the last decade. Compared to females, relatively little work has specifically focused on factors predicting males' attitudes toward cosmetic surgery. Therefore, we evaluated a number of variables that may predict some facet of men's attitudes toward cosmetic surgery according to evidence reported in the literature METHODS: A total of 151 male patients who applied for a surgical or minimally invasive cosmetic surgery procedure (patient group) and 151 healthy male volunteers who do not desire any type of cosmetic procedure (control group) were asked to fill out questionnaires about measures of body image, media exposure (television and magazine), social network site use, masculine gender role stress and religious attitudes.

RESULTS

Our findings showed that lower ratings of body image satisfaction, increased time spent watching television, more frequent social network site use and higher degrees of masculine gender role stress were all significant predictors of attitudes toward cosmetic surgery among males.

CONCLUSION

The current study confirmed the importance of body image dissatisfaction as a predictor of the choice to undergo cosmetic procedure. More importantly, a new predictor of cosmetic procedure attitudes was identified, namely masculine gender role stress. Finally, we demonstrated the effects television exposure and social network site use in promoting acceptance of surgical and nonsurgical routes to appearance enhancement.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Safety of Cosmetic Surgery in Adolescent Patients

Background

Limited surgical literature currently exists that evaluates postoperative complications after cosmetic surgery in adolescents.

Objectives

The purpose of this study was to determine the incidence of major postoperative complications in adolescent patients undergoing cosmetic surgery and compare their complication rates to older patients.

Methods

A prospective cohort of patients undergoing cosmetic surgical procedures between 2008 and 2013 was identified from the CosmetAssure database. Demographics, clinical characteristics, surgical procedures, and major complications in adolescent patients (age 10-19 years) and older patients (≥20 years old) were compared. Risk factors analyzed included age, gender, body mass index, smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures.

Results

Overall, 3519 adolescents and 124,409 older patients underwent cosmetic surgical procedures. The adolescent cohort contained more men (20.0% vs 6.0%, P < 0.01), lower mean body mass index (22.6 ± 4.1 vs 24.4 ± 4.6, P < 0.01), lower prevalence of diabetes (0.8% vs 1.9%, P <0.01), and fewer smokers (5.9% vs 8.3%, P < 0.01) compared to the older patient cohort. Most commonly adolescent patients underwent breast followed by face and body procedures. Overall adolescent patients demonstrated a lower incidence of major postoperative complications compared to older patients after single (0.6% vs 1.5%, P < 0.01) and combined (1.2% vs 3%, P = 0.03) cosmetic procedures. Adolescent patients had lower complications rates after face, breast, and body procedures compared to the older cohort. The most common postoperative complications in adolescent patients were hematoma (0.34%) and infection (0.28%).

Conclusions

Cosmetic surgical procedures in adolescent patients are safe with a lower rate of major postoperative complications compared to older patients.

Level of Evidence

2.

Predictive factors for cosmetic surgery: a hospital-based investigation

BACKGROUND

Cosmetic surgery is becoming increasingly popular in China. However, reports on the predictive factors for cosmetic surgery in Chinese individuals are scarce in the literature.

METHODS

We retrospectively analyzed 4550 cosmetic surgeries performed from January 2010 to December 2014 at a single center in China. Data collection included patient demographics and type of cosmetic surgery. Predictive factors were age, sex, marital status, occupational status, educational degree, and having had children. Predictive factors for the three major cosmetic surgeries were determined using a logistic regression analysis.

RESULTS

Patients aged 19-34 years accounted for the most popular surgical procedures (76.9 %). The most commonly requested procedures were eye surgery, Botox injection, and nevus removal. Logistic regression analysis showed that higher education level (college, P = 0.01, OR 1.21) was predictive for eye surgery. Age (19-34 years, P = 0.00, OR 33.39; 35-50, P = 0.00, OR 31.34; ≥51, P = 0.00, OR 16.42), female sex (P = 0.00, OR 9.19), employment (service occupations, P = 0.00, OR 2.31; non-service occupations, P = 0.00, OR 1.76), and higher education level (college, P = 0.00, OR 1.39) were independent predictive factors for Botox injection. Married status (P = 0.00, OR 1.57), employment (non-service occupations, P = 0.00, OR 1.50), higher education level (masters, P = 0.00, OR 6.61), and having children (P = 0.00, OR 1.45) were independent predictive factors for nevus removal.

CONCLUSIONS

The principal three cosmetic surgeries (eye surgery, Botox injection, and nevus removal) were associated with multiple variables. Patients employed in non-service occupations were more inclined to undergo Botox injection and nevus removal.

LEVEL OF EVIDENCE

Cohort study, Level III.

The Acceptance of Cosmetic Surgery Scale: Confirmatory Factor Analyses and Validation among Serbian Adults

We examined the validity of the Serbian version of the Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King and Henderson-King 2005). A total of 622 Serbian adults completed the ACSS, along with Serbian translations of measures for the discrepancy between actual body weight and ideal body weight, body appreciation, sociocultural attitudes toward appearance, and demographics. Confirmatory factor analyses were conducted to compare how different ACSS models fitted the collected data. A three-factor model provided the best fit to the data relative to two- and one-factor models. The three-factor model had good internal consistency, convergent and discriminant validity, and nomological validity. The ACSS seems to be a valid instrument for use in Serbian populations. Our study will contribute towards better understanding of the acceptance of cosmetic surgery from a cross-cultural perspective.