Body image, cosmetic surgery, and minimally invasive treatments

Interplay Between Health-Promoting Lifestyle, and Cognitive Emotion Regulation with Risk of Cosmetic Surgery Seeking in Young Women

OBJECTIVES

This study investigated the relationship between lifestyle and cognitive regulation of emotion and the risk of seeking cosmetic surgery in young women.

METHODS

The current study was a cross-sectional study. The outcome variable in this research was cosmetic surgery seeking. The association between sociodemographic and health behaviors with risk of cosmetic surgery seeking investigated. The multinomial logistic regression was used to examine the association between health promotion lifestyle and cognitive emotion regulation with cosmetic surgery seeking.

RESULTS

Underweight was associated with cosmetic surgery seeking [5.50; 95% CI 1.90-15.92; P<0.005]. Other risk factors were former smoking, alcohol use, and poor sleep quality. An increase in poor lifestyle is associated with an increased risk of cosmetic surgery seeking [30.41; 95% CI 4.87-189.84; P<0.001]. Adaptive cognitive emotion regulation protects against cosmetic surgery seeking [0.36; 95% CI 0.15-0.84; P<0.001].

DISCUSSION

Lifestyle and adaptive cognitive emotion regulation played a significant role in people who were looking for cosmetic surgery, and therefore, like in other areas of disease and health, lifestyle and adaptive cognitive emotion regulation are important in cosmetic surgery, and it is necessary to pay attention to the effects of each of them.

LEVEL OF EVIDENCE II

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.

"We are no drawings, no clay dolls": A qualitative exploration of adolescents' attitudes towards cosmetic procedures

Most previous research into cosmetic surgery acceptance/intention is quantitative in nature and focuses on (female) adults. Yet, qualitative explorations of adolescents are required, as they form the next generation of cosmetic consumers and are growing up in a culture in which procedures are unprecedentedly normalized. Moreover, the number of young people undergoing cosmetic procedures is increasing. This study explores adolescents' attitudes towards cosmetic procedures and (future) cosmetic procedure intention through 13 focus groups with a total of 42 adolescents (aged 15-19). The sample included variation in terms of gender identity, educational level/attainment, and regionality. The focus groups were analyzed using reflexive thematic analysis, which resulted in five main themes, providing a comprehensive overview of adolescents' attitudes towards cosmetic procedures. The first theme, information (sources) illustrates adolescents' knowledge of cosmetic procedures and how adolescents obtain information related to cosmetic procedures, which may also explain some of their views and attitudes. The second theme, normalization of a commercial industry, explores the adolescents' discussion of the normalized status of cosmetic procedures, both in the Netherlands and abroad. The third theme, attitudes towards cosmetic procedures, engages with the varied, variable, and context-specific (dis)approval and evaluation of cosmetic procedures. Following this, the fourth theme - cosmetic procedure intention - elaborates on the adolescents' expressions of their own (lack of) intention to undergo cosmetic procedures. The fifth and final theme was construction and identification of 'the cosmetic consumer', where adolescents distanced themselves from the cosmetic surgery industry and/or shared particular (stereotypical) constructions of recipients of cosmetic procedures. This study provides an examination of adolescents' perceptions of and attitudes towards cosmetic procedures. Importantly, we found that adolescents' attitudes can be characterized as complex and ambiguous. To explain this ambiguity, we consider insights from Cultivation Theory (Gerbner et al., 2002), the cosmetic surgery paradox (Bonell et al., 2021), and connect the adolescents' discussions to issues of diversity.

Investigation of Appearance Anxiety Levels and Influencing Factors in Patients Undergoing Minimally Invasive Facial Cosmetic Procedures

OBJECTIVE

This study aimed to investigate appearance anxiety and its influencing factors in patients undergoing minimally invasive facial cosmetic procedures.

METHODS

A convenience sampling method was used to select 351 patients who attended the outpatient clinic of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January to August 2023. Patients completed self-administered and social appearance anxiety questionnaires before treatment.

RESULTS

The mean appearance anxiety score was 2.49±0.85, indicating a moderate level of anxiety. Significant differences in appearance anxiety levels were observed based on age (p = 0.010), gender (p = 0.026), marital status (p = 0.032), number of children (p = 0.019), facial wrinkle removal procedures (p = 0.023), self-pleasure (p = 0.043), and special attention to the treatment area (p = 0.042). Multiple linear regression analysis identified facial wrinkle removal (p = 0.018), facial depression filling (p = 0.049), and special attention to the treatment area (p = 0.034) as significant factors.

CONCLUSION

Younger populations are more likely to seek improved appearance for better opportunities. The uncertainty of treatment outcomes may also increase social appearance anxiety in patients. Patients can reduce this anxiety by increasing their self-efficacy and self-confidence.

LEVEL OF EVIDENCE IV

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 .

Exploring the Intersection of Body Dysmorphic Disorder (BDD) and Dermatological Conditions: A Narrative Review

This narrative literature review examined the intricate relationship between body dysmorphic disorder (BDD) and dermatological conditions, with a brief focus on those characterized by conspicuous skin irregularities such as acne vulgaris, psoriasis, and vitiligo. Highlighting the significant prevalence of BDD among individuals afflicted with dermatological issues, our analysis illuminated the profound psychological repercussions stemming from an exaggerated preoccupation with perceived skin imperfections. Through an exploration of the underlying BDD symptoms, we analyzed the complex dynamics between skin health and mental well-being, emphasizing the disorder's impact on patients' psychological and social functioning. This narrative review further investigated the consequential effects of BDD on essential aspects of dermatological treatment, including patient adherence to therapeutic regimens, overall quality of life (QOL), and the effectiveness of available treatments. In addition to presenting current therapeutic approaches, we advocate for the integration of psycho-dermatological interventions tailored to mitigate the dual burden of skin conditions and psychological distress. Future research directions proposed include longitudinal studies to assess the long-term effects of BDD on skin disease prognosis and psychosocial well-being, which aim to refine and optimize treatment modalities to contribute to a more holistic understanding of BDD within dermatological practice.

Pursuing beauty: socio-cultural and labor-economic determinants of cosmetic surgery consideration among female college students in China

BACKGROUND

Cosmetic surgery has a profound impact on health and other aspects. As a means of enhancing physical attractiveness, it is increasingly being considered by female college students in China. However, current knowledge about the determinants of cosmetic surgery consideration among Chinese female college students still needs to be improved due to the lack of systematic perspectives and large-scale representative data sets. This study aimed to contribute to the literature in these two aspects.

METHODS

We framed cosmetic surgery consideration as a function of two broad sets of determinants: socio-cultural and labor-economic. We used data from a large, nationally representative sample of female college students in China (N = 6658, mean age = 20.3 years).

RESULTS

In terms of socio-cultural oriented factors, we found that family socioeconomic status, peers' cosmetic surgery practices, and media exposure were positively associated with the likelihood of considering cosmetic surgery. In terms of labor-economic oriented factors, we found that self-rated physical appearance, higher grades, and expected income after graduation were positively associated with a higher likelihood of considering cosmetic surgery.

CONCLUSIONS

These findings suggest that the decision-making process for cosmetic surgery among Chinese female college students goes beyond personal factors and is significantly influenced by structural factors.

The effect of desire to be liked and social appearance anxiety on aesthetic surgery acceptance in female nurses

BACKGROUND

A rapid increase has been observed in aesthetic surgery procedures in recent years and it has been determined that females have more aesthetic procedures. While different groups of female groups were taken as a sample in the studies, no study on female nurses was found. In this study, it is thought that psychological reasons such as stress, anxiety, desire to be liked and lack of self-confidence that lead women to plastic surgery will reduce the professional performance of nurses and this situation will create additional workload for other colleagues. Therefore, the aim of the study is to reveal the effect of desire to be liked and social appearance anxiety on the acceptance of female nurses to plastic surgery.

METHODS

The population of the cross-sectional study consisted of 243.565 nurses working in public, private and university hospitals in Turkey. A questionnaire form was used as a data collection tool in the study. In the first part of the form, there are statements aiming to reveal the socio-demographic characteristics, social media usage levels and aesthetic surgery experiences of nurses, and in the second part, there is a desire to be liked scale, social appearance anxiety scale and aesthetic surgery acceptance scale. The 1004 questionnaire forms collected as a result of the study were subjected to percentage, frequency, correlation and regression analysis.

RESULTS

41.2% of the nurses have had aesthetic procedures before and 68.4% of them want to have aesthetic procedures when there is an area they do not like in their body. A strong positive relationship was found between the desire to be liked, social appearance anxiety, and aesthetic surgery acceptance (r > 0.500, p < 0.01). Aesthetic surgery acceptance is affected by the desire to be liked and by social appearance anxiety.

CONCLUSION

In the study, it was determined that social appearance anxiety and the desire to be liked led female nurses to plastic surgery. According to the results of similar studies conducted in different groups, it may be recommended that awareness training be organized both in schools and through digital media about the consequences of unnecessary plastic surgery.

Social Media Influence on Body Image and Cosmetic Surgery Considerations: A Systematic Review

Social media platforms like Instagram (Meta Platforms, Inc., Menlo Park, California, United States) and Snapchat (Snap Inc., California, United States) significantly influence motivations for aesthetic surgery by promoting idealized and digitally enhanced images. Understanding their impact on body image dissatisfaction and acceptance of cosmetic procedures is crucial. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines explored the link between social media, body image dissatisfaction, and cosmetic surgery. The review included 25 studies with 13,731 participants. Specific findings revealed that 70% of young adult women and 60% of young adult men report dissatisfaction with their bodies, leading to increased surgical considerations. The search process utilized databases such as PubMed, ScienceDirect, and Google Scholar, employing keywords like "cosmetic surgery," "social media," and "body image dissatisfaction" for articles published between January 2013 and December 2023. Both men and women show increased dissatisfaction with body parts, leading to surgical considerations. Social media's emphasis on visual aesthetics fosters body dissatisfaction and social appearance anxiety, especially through selfies. Cultural norms and celebrity influence further shape beauty perceptions. While social media promotes cosmetic surgery acceptance, ethical concerns about misleading advertisements, unrealistic beauty standards, and patient privacy persist. This underscores the need for strategies to promote healthy body image and informed choices in the digital age.

A Prospective Investigation of Patient Satisfaction and Psychosocial Status Following Facial Bone Contouring Surgery using the Face-Q

OBJECTIVE

The objective of this study was to assess satisfaction and psychosocial status before and after facial bone contouring surgery using the Face-Q.

METHODS

The Face-Q, a multimodular patient-reported outcome (PRO) instrument, comprises independently functioning scales and checklists designed to assess outcomes in facial aesthetic patients. A prospective cohort study was conducted from November 2020 to May 2022. Participants undergoing facial bone contouring surgery (reduction mandibuloplasty and/or malarplasty) were asked to complete the Face-Q preoperatively and 12 months postoperatively. Comparative analyses were conducted using normative Face-Q data from 534 matched normal individuals. Face-Q scores were evaluated for each domain on a scale of 0 to 100, with higher scores indicating greater satisfaction with appearance or a superior quality of life.

RESULTS

A total of 284 patients (274 female and 10 male) completed the Face-Q preoperatively and 12 months postoperatively. Of these, 146 underwent reduction mandibuloplasty, 18 underwent malarplasty, and 120 underwent both procedures. Post-surgery, patients experienced significant improvements in overall appearance, features altered by surgery, and quality of life, excluding the patient-perceived age. Preoperatively, patients demonstrated significantly lower scores compared to normative data, with scores significantly increasing postoperatively to levels representative of the general population. Satisfaction with outcome was significantly correlated with postoperative Face-Q measurements but not preoperatively.

CONCLUSION

Facial bone contouring surgery significantly improves the satisfaction and quality of life in patients with square faces, reaching a level at least equivalent to the normative population. The use of Face-Q should be highlighted in the clinic practice.

LEVEL OF EVIDENCE IV

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.

Self-awareness and Social Influences as Predictors of Body Dissatisfaction and Acceptance of Cosmetic Surgery for Social Reasons Among Men

BACKGROUND

Body dissatisfaction and the use of surgery for purely aesthetic reasons among men is steadily increasing. Nevertheless, compared to women, few studies have focused on specific sociocultural and individual factors predicting men's body dissatisfaction and interest in cosmetic surgery procedures. The present study investigated the role of media, significant others, public and private self-awareness in predicting men's body dissatisfaction and acceptance of cosmetic surgery for social reasons.

METHODS

Participants were 203 men (mean-age 24 years), who completed a questionnaire containing the Sociocultural Attitudes Toward Appearance Questionnaire-4R, the Situational Self-Awareness Scale, the Muscular internalization subscale, the Male Body Attitudes Scale, and the Social subscale of the Acceptance of Cosmetic Surgery Scale. A path analysis was performed.

RESULTS

The influence of significant others and public self-awareness predicted men's body dissatisfaction directly and indirectly, via muscularity internalization, while media was only directly associated with body dissatisfaction. A significant link between private self-awareness and body dissatisfaction was found. Moreover, media was not associated with cosmetic surgery either directly or indirectly and public self-awareness showed only a significant association with internalization.

CONCLUSIONS

These findings provide information about the role that self-awareness and sociocultural factor play on body dissatisfaction and acceptance of surgery for social reasons among men. The study highlighted the importance of designing preventive programs aimed at enhancing men's ability to resist various forms of pressure regarding body image and its management. Moreover, the advantages of focusing one's attention on internal states and feelings can limit body dissatisfaction and can discourage consideration of cosmetic surgery for social benefits.

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 .

Changing to Impress: Testing a Mediation Model from Instagram Self-presentation to Cosmetic Surgery

BACKGROUND

This study examined the relationship between false self-presentation on Instagram and consideration of cosmetic surgery through the mediating role of body image control in photos (BICP), photo manipulation, and body shame. We predicted that false self-presentation on Instagram was indirectly associated with cosmetic surgery intentions through the aforementioned constructs.

METHODS

A total of 504 young Italian adults (28.2% males, 18-30 years) completed an online survey. They completed a questionnaire containing the Self-presentation on Instagram Questionnaire, the Body Image Control in Photos Questionnaire-revised, the Photo Manipulation Scale, the Objectified Body Consciousness Scale, and the Acceptance of Cosmetic Surgery Scale. The pattern of associations between the constructs was analyzed via path analysis.

RESULTS

The results show that false self-presentation on Instagram was associated with photo manipulation, both directly and indirectly, through BICP. Furthermore, photo manipulation was linked to body shame, but neither of them was associated with cosmetic surgery intentions. Finally, false self-presentation on Instagram was associated with the consideration of cosmetic surgery only through the mediation of BICP.

CONCLUSION

Findings indicate that self-presentation styles might affect Instagram photo behaviors and individuals' cosmetic surgery intentions, suggesting that surgeons should fully examine patients' motivations before providing them with services. Furthermore, intervention programs encouraging users to present a more authentic version of themselves online might reduce the risk of self-objectification and reduce the consideration of procedures aimed at modifying one's body for purely aesthetic reasons.

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 .

Validation and psychometric testing of the Chinese version of the prenatal body image questionnaire

BACKGROUND

The body image during pregnancy potentially affects both short- and long-term maternal and child health outcomes, including pregnancy mood, postpartum weight recovery, and the quality of mother-child interactions. However, research on the impact of body changes during pregnancy in the Chinese population is scarce. A comprehensive, practical, and reliable tool for assessing pregnant women is needed to detect, intervene in, and implement the reduction of physical dissatisfaction risk. This study translated the Prenatal Body Image Questionnaire (PBIQ) into the Chinese version (PBIQ-C) to assess the body image of pregnant women and evaluated its reliability and validity.

METHODS

An improved Brislin translation model was used for the translation. A panel of experts determined the content validity. A convenience sample of 429 pregnant women was chosen from three third-class hospitals in different regions of Fujian Province, China. Factor analysis, Pearson's correlation, retest reliability, and Cronbach's alpha were employed to evaluate structural validity and reliability.

RESULTS

The final PBIQ-C had five dimensions with 21 items. Exploratory factor analysis obtained a five-factor solution, which accounted for a total of 60.34%. Confirmatory factor analysis showed that the model fit of the five-factor model also reached a satisfactory model fit after modifying: The Comparative Fit Index was 0.93, and the Tucker-Lewis Index was 0.92; the Root Mean Square Error of Approximation was 0.079. The content validity index of the scale ranged from 0.63 ~ 1.00. The Cronbach's alpha coefficient was 0.95 for the total scale, and the test-retest reliability was 0.80.

CONCLUSIONS

The findings indicated that the PBIQ-C is a valid and reliable instrument for assessing women's body image during pregnancy, which helps in the early identification of body dissatisfaction during pregnancy and enables the early prevention of postpartum depression.

Easy Anthropometric Measurements Are Representative of Baseline Values of Breast Q Values in Asymptomatic Women

BACKGROUND

Measurements of breast morphology are a determinant of the assessment of any surgical procedure, either reconstructive or cosmetic. This study aims to investigate the association between easy anthropometric measurements and values of quality of life assessed in a sample of asymptomatic women.

METHODOLOGY

Healthy asymptomatic women were admitted for this study. The following measurements were assessed: height, weight, nipple to sternal notch distance, areola to infra-mammary fold distance (right vs. left), right-left nipple distance. The Breast Q questionnaire (Italian translation V.1, pre-op breast conservation surgery) in the following domains: satisfaction with breasts; psycho-social satisfaction; physical satisfaction; sexual satisfaction, which was used to assess breast-related quality of life.

RESULTS

One hundred and forty-five women responded to the breast Q questionnaire. The mean age of the sample was 44.3 years; the medium BMI was 24.1; Spearman correlation coefficients revealed that all the investigated values were negatively correlated to the "satisfaction with breasts" domain. Psychosexual satisfaction was associated with age; BMI; nipple to sternal notch distance. After normalization for age values, we observed that "satisfaction with breast" was, once again, highly correlated to BMI; nipple to sternal notch distance; areola to IMF distance. In all cases, the higher the values, the lower the scores.

CONCLUSIONS

Distances between easy relevant anatomical landmarks are representative of patients' breast-related quality of life in a population of asymptomatic women. These findings allow us to identify an ideal anthropometric framework that can be used as a validated surgical endpoint for cosmetic and oncological procedures.

Validation of a Latin-American Spanish version of the Body Esteem Scale for Adolescents and Adults (BESAA-LA) in Colombian and Nicaraguan adults

BACKGROUND

Body dissatisfaction (BD) is a growing concern in Latin America; reliable and culturally appropriate scales are necessary to support body image research in Spanish speaking Latin American countries. We sought to validate a Latin-American Spanish version of the Body Esteem Scale for Adolescents and Adults (BESAA; Mendelson et al. 2001).

METHODS

The BESAA was translated, culturally adapted, and validated in a sample of adults in Colombia (N = 525, 65% women, Mage 24.4, SD = 9.28). We assessed factor structure (using confirmatory factor analysis (CFA), exploratory factor analysis (EFA) and exploratory structural equation model (ESEM)), internal reliability (using Cronbach's alpha and omega), validity (using the Body Appreciation Scale BAS and Sociocultural Attitudes Towards Appearance Questionnaire SATAQ), test-retest stability in a small subsample (N = 84, using Intraclass correlations ICC) and measurement invariance across gender. To evaluate the generalizability of the scale, we assessed reliability, validity, and factor structure in a second sample from rural Nicaragua (N = 102, 73% women, Mage 22.2, SD = 4.72), and assessed measurement invariance across Nicaraguan and Colombian participants.

RESULTS

The scale showed good internal reliability and validity in both samples, and there was evidence of adequate test-retest stability in the Colombian sample. EFA showed a three-factor structure with subscales we labelled 'appearance-positive', 'appearance-negative' and 'weight', that was confirmed using CFA and ESEM in the Colombian sample. Measurement invariance was confirmed across the Colombian and Nicaraguan samples, and across gender within the Colombian sample.

CONCLUSION

The Latin-American Spanish version of the BESAA (BESAA-LA) appears to be a psychometrically sound measure with good reliability, validity and invariance across gender and countries. These results support the use of this scale to measure body satisfaction/dissatisfaction in Latin American adult populations.

The Effect of Social Media Usage, Appearance-Related Social Media Pressure and Body Mass Index on Body Appreciation of Cosmetic Procedure Patients

BACKGROUND

The number of cosmetic procedures has increased in recent years. Social media use and its effects on plastic surgery decisions are among the most widely discussed topics. This study aimed to test a research model that explores the relationship between social media usage frequency, appearance-related social media pressure, and body mass index (BMI) on the body appreciation of patients undergoing cosmetic procedures, and to evaluate their clinical impacts.

METHODS

In total, 136 participants were included in this study, which met and exceeded the sample size requirement. The questionnaire was designed by using reliable scales and demographic data. Partial least squares structural equation modeling was used to test the hypothesized research model.

RESULTS

The mean age of the participants was 35 years, and 70% had normal BMI scores. Among them, 59.6% underwent invasive procedures and 40.4% underwent minimally invasive procedures. BMI negatively affected body appreciation (β = 0.199, p < 0.05). Social media did not have a significant effect on appearance-related social media pressure (β = 0.001, p > 0.05). Appearance-related social media pressure negatively affected body appreciation (β = - 0.280. p > 0.05).

CONCLUSION

Social media is not only an information source but also creates pressure on appearance. Therefore, plastic surgeons should use social media and consider the psychology of patients during their communication.

LEVEL OF EVIDENCE IV

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 .

Mask Adherence and the Relationship Between Masking and Weather-Related Metrics

Little is known about adherence to COVID-19 masking mandates on college campuses or the relationship between weather-related variables and masking. This study aimed to (1) observe students' adherence to on-campus mask mandates and (2) estimate the effect of weather on mask-wearing. Temple University partnered in the Centers for Disease Control and Prevention's observational Mask Adherence Surveillance at Colleges and Universities Project. February-April 2021, weekly observations were completed at 12 on-campus locations to capture whether individuals wore masks, wore them correctly, and the type of mask worn. Fashion and university masks also were recorded. Weekly average temperature, humidity, and precipitation were calculated. Descriptive statistics were calculated for masking adherence overall, over time, and by location. Statistical significance was assessed between correct mask use and mask type and the linear relationships between weekly weather metrics and mask use. Overall, 3508 individuals were observed with 89.6% wearing masks. Of those, 89.4% correctly wore masks. Cloth (58.7%) and surgical masks (35.3%) were most commonly observed and 21.3% wore fashion masks. N95/KN95 masks were correctly worn in 98.3% of observations and surgical and cloth masks were correctly worn ~ 90% of the time. Weekly adherence varied over time and by campus location. Significant inverse linear relationships existed between weekly temperature (r = - 0.72; p < 0.05) and humidity (r = - 0.63; p ≤ 0.05) and masking. Mask adherence and correct use was high. Temperature and humidity inversely affected adherence. Adherence varied by on-campus location, which suggests the locations (e.g., academic buildings, recreational center) and possibly the characteristics of individuals who frequent certain areas impacted adherence.

Prevalence of body dysmorphic disorder in rhinoplasty candidates: A systematic review and meta-analysis

Background

Body dysmorphic disorder (BDD) is a prevalent mental disorder, particularly in those seeking plastic surgery, leading to unnecessary surgeries and postsurgical dissatisfaction. Among the plastic surgeries, rhinoplasty is the most commonly sought, yet the data on prevalence of BDD among the candidates of rhinoplasty is limited. Therefore, this systematic review and meta-analysis aimed to estimate the prevalence of BDD in rhinoplasty candidates.

Methods

The online libraries of Web of Science, PubMed, Cochrane Library, ProQuest, Research Square, Scopus, and Google Scholar were searched up to August 2022. Statistical analyses were performed using STATA software (v. 16). The heterogeneity was determined using the I 2 statistic, and an overall estimated analysis was conducted. Subgroup analyses were performed on study year, age, gender, World Health Organization regional classification, sociodemographic index, country, sample size, and employed diagnostic tool. A meta-regression analysis was performed to identify potential sources of heterogeneity.

Results

Out of 12,999 studies assessed, 18, with a combined sample size of 2132 individuals, met our criteria and were included in the study. The pooled prevalence of BDD was 32.7% (95% CI: 23.6-41.7; I 2 = 96.45%). Subgroup analyses revealed the studies that were conducted in the European region (42.8%), with a sample size of ≥100 (40.2%), utilized the BDD modification of the Y-BOCS (BDD-YBOCS) diagnostic method (47.3%), and with a quality score of ≥6 (34.2%) demonstrated higher prevalence of BDD. The meta-regression analysis identified a higher prevalence in the BDD-YBOCS diagnostic method than in the BDD questionnaire (β: 0.23; 95% CI: 0.04-0.43; p = 0.022).

Conclusions

The prevalence of BDD is high in those seeking rhinoplasty. Clinicians should be aware of BDD symptoms to prevent unnecessary surgery and dissatisfaction. Public awareness through the media and access to affordable medical services should also be provided.

Through Thick and Thin: Exposure to Instagram Advertisements and Willingness to Engage in Appearance-Altering Practices

Instagram is increasingly used in advertising, yet little is known about the unintended consequences of Instagram advertising on women's and girls' body image. Also largely unexplored is if and how curvy models (large breasts and buttocks, wide hips, and small waist) used in this advertising affect women's and girls' body image. We drew on social comparison and cultivation theories to explore if exposure to thin and curvy models through Instagram advertising is associated with late-adolescent girls' willingness to take action to be thinner or curvier, respectively. Two mediation models examined the mechanisms through which any such effects occur. A sample of 284 17-19 year old girls completed self-administered online questionnaires. Results revealed that exposure to thin and curvy models was positively associated with willingness to take action to be thinner and curvier, respectively. These associations were mediated by thin/curvy body preference (model 1), and by thin/curvy body preference, upward physical appearance comparisons, and body dissatisfaction (model 2). Results suggest that although exposure to different body types may be associated with different types of unhealthy (body-altering) actions, the processes underlying these effects are similar. This research highlights possible cultural shifts toward more diverse body ideals and informs tailored body concern interventions and media literacy programs.

The Prevalence and Clinical Features of Body Dysmorphic Disorder Among Dermatology Patients in the Eastern Province of Saudi Arabia

Background and objective Body dysmorphic disorder (BDD), which affects 1.7% to 2.4% of people worldwide, is usually encountered for the first time by nonpsychiatric physicians. Up to 37% of cases have been documented in dermatology clinics. This study aims to estimate the prevalence of BDD among Saudis attending dermatology clinics because the literature is lacking in this field, especially in the Eastern Province. Methods This is a cross-sectional study, conducted in 2023. A total of 412 Saudi Eastern Province residents, aged 18 years and older, were included in the study and given a self-administered web-based questionnaire. The study uses the Body Dysmorphic Disorder Questionnaire as one of its three primary measurements, together with sociodemographic data, and dermatological and previous psychological histories. Results A total of 412 participants were enrolled in this study. Of the total sample, 64.5% had more than one skin condition, with the rest having only one one. The most received cosmetic treatment in this study was topical agents. It was estimated that the prevalence of BDD is 9.5% among the studied population. However, it was found that there are no significantly associated factors with the prevalence of BDD. Conclusions This study reports a prevalence of 9.5% among people visiting dermatological clinics. The prevalence is alarming, which emphasizes the importance of enhancing the awareness of BDD among dermatologists and developing certain guidelines to identify and refer these patients to mental health professionals.

Psychometric properties of a Romanian translation of the Acceptance of Cosmetic Surgery Scale (ACSS): An examination using bifactor exploratory structural equation modelling

The Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King & Henderson-King, 2005) is a widely used measure for the assessment of attitudes toward cosmetic surgery. Here, we examined the psychometrics of a novel Romanian translation of the ACSS. A total of 1275 Romanian adults (889 women, 386 men) completed the ACSS alongside additional, related measures. Exploratory factor analysis (EFA) with a first split-half subsample supported extraction of the original 3-factor model consisting of Intrapersonal, Social, and Consider dimensions. In a second split-half subsample, we found that a 3-factor bifactor exploratory structural equation model (B-ESEM) had superior fit compared to all alternative models that were tested. This B-ESEM representation had well-defined G-factor with adequate composite reliability, and its S-factors were also generally well-defined. Across subsamples, the optimal model showed strong or partial strong invariance across gender, with women having significantly higher latent means on the Consider factor relative to men. Evidence of convergent validity was also generally good in women, especially for the G-factor of the ACSS, but was attenuated in men. Overall, these findings indicate that the Romanian version of the ACSS has adequate psychometric properties. We also encourage scholars to consider B-ESEM representations of the ACSS in other national settings.

Can Vitamin D Levels Alter the Effectiveness of Short-Term Facelift Interventions?

Facelifting is increasingly popular among the population. It exceeded the limits of post-traumatic facia-reconstruction. Both the demand and the methods available are getting increasingly diverse. The minimally invasive technique revolutionized the facelift, although it took some time to completely comprehend the mechanics. The roles of vitamin D in numerous physiological processes in which it is involved have mostly been elucidated in the last decade. Our hypothesis is based on one of these roles, that is, vitamin D intervenes in changing the type of collagen by changing its location; therefore, collagen will have a supporting role for the subcutaneous tissue. A group of 156 patients with different facelifting methods was followed: 93 minimally invasive (NC), 49 classical surgery (C) and 14 with the combined technique (NC + C). The change in the subcutaneous tissue was monitored by an elastograph. The level of vitamin D was monitored in order to assess the immediate and long-term effects of vitamin D on the progression of subcutaneous fibrosis. It was proven that an optimal level of vitamin D has a beneficial effect in maintaining the volume of subcutaneous tissue in patients from the NC and NC + C groups, the best results being in the NC + C group. An increase in the subcutaneous volume was recorded, which leads to a decrease in elasticity (statistical significance p < 0.05) and the lowering of the subcutaneous tissue, and an increased amount of lowering corresponds to a lowering of vitamin D levels.

"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.

Comparison of body size perception of young women in Korea and the United States

Body size perception among young women in Asian and Western countries is believed to be quite different, however, there are no confirming studies. We analyzed the data from young women aged between 20 and 40 who participated in the National Health and Nutrition Examination Survey (2001-2018) of the United States (US) and Korea. US young women had higher rates of being overweight and obesity than Korean young women, and there was no significant change over 20 years. In both countries, the percentage of properly estimating one's own weight exceeded 70 percent and remained relatively steady. The percentage of overestimating one's own weight was only about 10 percent in Korea in 2001, but increased to 20 percent. In the case of the US, the percentage was about 15 percent in 2001-2002, but has since continued to decline. The percentage of underestimating one's own body weight was about 18 percent in Korea in 2001, but decreased to about 8 percent. In the case of the US, the percentage was very low at about 10 percent in 2001-2002, but gradually increased to about 18 percent in 2017-2018. In conclusion, young women in the US tend to underestimate their body size, and those in Korea tend to overestimate it.

Implications of Socio-Cultural Pressure for a Thin Body Image on Avoidance of Social Interaction and on Corrective, Compensatory or Compulsive Shopping Behaviour

This paper aims to discuss the implications of body talk and socio-cultural pressure for the internalisation of a thin body image in purchase decisions, shopping habits and other outcomes of body dissatisfaction, in particular the proneness to avoid human/social interaction in retail contexts and proneness to engage in corrective, compensatory or compulsive shopping behaviour. This paper conducted an online questionnaire that measured the following constructs: body mass index; Socio-cultural Attitudes Towards Appearance Scale-4 (SATAQ-4), Body Appreciation Scale (BAS-2), Acceptance of Cosmetic Surgery Scale (ACSS), Compulsive Buying Follow-up Scale (CBFS), proneness to avoid social interaction in retail contexts, and the intention to purchase a list of products and services as a compensation for body dissatisfaction. A structural equations model supported the hypotheses proposing the influence of BAS-2 and SATAQ-4 (the internalisation of thin/athletic body and the social comparison induced by family, peers and media) upon the outcomes of social-interaction avoidance, ACSS and CBFS. Nevertheless, BAS-2 only influences social-interaction avoidance. This paper provides several recommendations to brand managers highlighting the social responsibility role of brand advertising in enhancing positive body appreciation, mitigating the psychological damage caused by socio-cultural pressure and preventing the stigmatisation bias against obese people.

Direct and Indirect Roles of Men in Determining Women Decision to Use Laser Procedures for Skin Care

Laser procedures for skin care is becoming increasingly popular and used by the global community and affect many aspects of human life. However, there is very little research on the role of men in women's decision to follow this dermatological procedure. This study aimed to identify the role of men in motivating women to choose laser-based procedure. A systematic literature review research design was applied in this study. A total of 27 papers were obtained by searching PubMed Central for the 2013-2022 editions. The extraction of samples and the motivation of patients or research respondents in choosing laser procedures for cosmetic treatments were conducted to obtain clues about the role of men in making these decisions. Only six studies explicitly reveal the role of men as motivators of women to perform laser-based dermatological procedures. Four of these six studies were conducted in Asia in countries with a high degree of collectivism. The remaining two studies reveal a minor role for men in women's motivation to choose dermatological procedures. Other studies only indirectly implicate the role of men through intrasexual competition, increased self-esteem, and the needs of the world of work. Limitations of the study lies in the non-specificity of the study sample in the female population, laser-based treatments, and the role of men in motivating women. The role of men in motivating women to perform laser-based skin care procedures is stated explicitly in collectivist cultures while only implicitly in individualist cultures. These findings indicate that the strategy of utilizing the added value of men to laser treatment procedures should be directed at the relationship between men and women in real terms in collective cultured countries.

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.

"We should educate the public that cosmetic procedures are as safe as normal medicine": Understanding corporate social responsibility from the perspective of the cosmetic procedures industry

The cosmetic procedures industry is profitable and expanding. Through its premise and promotion, the industry contributes to unrealistic societal appearance pressures considered harmful to body image. In the context of limited regulation, there is an uneasy reliance on businesses in the sector to act in a socially responsible way. Corporate social responsibility (CSR) refers to voluntary business practices designed to benefit society, and engagement in CSR is shaped by extrinsic and intrinsic drivers. This study aimed to explore how senior UK industry professionals view CSR as it applies to their sector and to body image. Findings from 14 semi-structured interviews show that participants' understanding of CSR was limited to a myopic focus on patients. Little reflexivity was demonstrated in relation to the industry's responsibilities concerning negative body image in society. More broadly, the drivers of socially responsible practice were overwhelmingly extrinsic - oftentimes explicitly linked to bolstering or protecting company and/ or industry reputation. Participants, acknowledging a lack of intrinsic motivation for CSR across the sector, were largely in support of greater regulation. This research contributes to understandings of how the adoption of a CSR agenda might combine with regulatory efforts to curb the industry's impact on negative body image.

Men's Experiences and Psychological Outcomes of Nonsurgical Medical Penile Girth Augmentation: A Preliminary Prospective Study

BACKGROUND

The popularity of penile augmentation procedures is increasing, but investigation into men's experiences with these procedures and their impact on psychological well-being is lacking.

OBJECTIVES

The aim of this study was to investigate men's experiences with nonsurgical medical penile girth augmentation and assess, based on valid psychological measures, the impacts these procedures have on psychological well-being.

METHODS

Men seeking to undergo a girth augmentation (n = 19) completed an online questionnaire prior to their procedure and 6 months later that contained standardized measures assessing impacts of the procedure, penile size self-discrepancy, body dysmorphic disorder, psychological distress, self-esteem, and body image-related quality of life. Girth size was also measured preprocedure and 6 months postprocedure for a subsample of men.

RESULTS

Almost half of the men reported positive impacts of "increased self-confidence" and "increased sexual pleasure" after their procedure. Despite an average girth increase of 3.29 cm, the men still perceived that their penile girth and length was less than what they should be or less than the ideal size after their augmentation procedure. However, this perceived discrepancy was significantly smaller than before their procedures. Prior to the procedure, the men who met diagnostic criteria for body dysmorphic disorder according to self-reported questionnaire (11%, n = 2/19) and clinical interview (7%, n = 1/15) lost this diagnosis at 6 months. There were no changes in psychological distress, self-esteem, or body image-related quality of life from pre- to postprocedure.

CONCLUSIONS

Men report positive impacts on their lives after penile girth augmentation, but impacts on broader psychological well-being are mixed.

LEVEL OF EVIDENCE: 4

Motivations and Psychological Characteristics of Men Seeking Penile Girth Augmentation

BACKGROUND

The popularity of penile augmentation procedures is increasing, but little is known about the motivations and psychological characteristics of men who seek these procedures.

OBJECTIVES

Employing valid psychological measures, the authors sought to investigate the motivations and psychological characteristics of men seeking penile girth augmentation.

METHODS

Men seeking to undergo a penile girth augmentation (n = 37) completed an online questionnaire containing standardized measures assessing their motivations to undergo augmentation, penile size self-discrepancy, psychological distress, self-esteem, body image-related quality of life, body dysmorphic disorder (BDD), and cosmetic procedure screening scale-penile focused dysmorphic disorder.

RESULTS

Men's motivations for seeking penile girth augmentation were characterized as "improve self-confidence," "change penile size/appearance," "sexual function/pleasure," "feelings of insecurity," and "medical issues," with self-confidence being the most commonly reported motivation. The men perceived their actual penis size (girth, flaccid length, erect length) as significantly smaller than ideal size, the size they believed their penis should be, and their expected size postaugmentation. Compared with non-clinical norms, the men seeking penile augmentation had higher penile dysmorphic disorder symptoms, lower self-esteem and lower body image-related quality of life, but comparable psychological distress. In addition, 4 of the men met diagnostic criteria for BDD according to self-reported questionnaire (11%, n = 4/37) and clinical interview (14%, n = 4/29).

CONCLUSIONS

Men seek penile girth augmentation for a variety of reasons and perceive all their penile dimensions to be smaller than ideal sizes. They differ from non-clinical samples in some psychological characteristics, and a small but sizeable portion experience BDD.

Attitudes towards cosmetic surgery among women in China and the Netherlands

Around the world, an increasing number of people, predominantly women, are choosing to undergo cosmetic surgery-despite the associated health risks. This study aimed to promote a better cross-cultural understanding of the correlates and predictors of favorable attitudes toward cosmetic surgery among women in China (an Eastern country where cosmetic surgery is increasing most rapidly) and the Netherlands (a Western country). Questionnaire data were obtained from 763 adult women; 245 were Chinese women in China (Mage = 29.71), 265 were Chinese women in the Netherlands (Mage = 25.81), and 253 were Dutch women (Mage = 29.22). Facial appearance concerns and materialistic belief were significant predictors of favorable attitudes towards cosmetic surgery for all three cultural groups. Body appreciation was a significant positive predictor among Chinese women in both China and the Netherlands, whereas age and beauty-ideal internalization were significant positive predictors only among Chinese women in China. The findings and their implications are discussed with respect to the characteristics of Chinese culture that could explain the identified differences between Chinese and Dutch women.

The values you endorse set the body you see: The protective effect of intrinsic life goals on men's body dissatisfaction

The mass media portrayal of a muscular body type ideal has been increasingly tied to men's body image dissatisfaction. We examined the role of self-determination theory's intrinsic life goals within this body image ideal and its potential as a moderator of this dissatisfaction. We first tested the moderating effect of intrinsic life goals on the link between magazine consumption and body image dissatisfaction via an online questionnaire (Study 1; N = 826), then experimentally manipulated these goals and exposure to images of muscular male models (Study 2; N = 150). A robust protective effect of intrinsic goals on body image satisfaction was observed - the relationship between magazine consumption and body image dissatisfaction was only significant among individuals with a lower level of intrinsic life goal orientation. When participants' intrinsic goals were momentarily heightened, they reported significantly less body image dissatisfaction, compared to those not receiving a strengthening of these goals. The results are the first to find a protective effect of intrinsic life goals on men's body image, and have important implications for intervention.

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.

Body Dysmorphic and Narcissistic Personality Disorder in Cosmetic Rhinoplasty Candidates

BACKGROUND

Body dysmorphic disorder (BDD) and other psychological problems are more common in cosmetic surgery applicants.

OBJECTIVE

The aim of this study was to investigate the frequency of the symptoms of BDD and narcissistic personality disorder in rhinoplasty candidates.

MATERIALS AND METHODS

This descriptive cross-sectional study was performed on rhinoplasty applicants. All subjects were evaluated by BDD and narcissistic personality questionnaires (NPI-16).

RESULTS

A total of 380 patients were studied. Our findings showed that the prevalence of mild, moderate, and severe BDD symptoms was 31.6%, 43.4% and 25%, respectively. The mean BDD scores were not significantly different in variables such as gender, age, marital status, history of cosmetic surgery, education, place of residence, and income. 29.5% of the subjects had symptoms of narcissism. There was no significant relationship between the symptoms of narcissism and variables such as gender, age, marital status, history of cosmetic surgery, place of residence, and income. Higher education was associated with higher rates of narcissistic personality disorder (p-value = 0.021).

CONCLUSIONS

According to the results of the study, there was no statistically significant relationship between BDD score and demographic parameters. Also, association between narcissistic personality disorder and demographic characteristics was not significant except for education.

LEVEL OF EVIDENCE IV

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 .

Predictors of Acceptance of Cosmetic Surgery: Instagram Images-Based Activities, Appearance Comparison and Body Dissatisfaction Among Women

BACKGROUND

This study aimed to test a model in which Instagram images-based activities related to self, friends, and celebrities were associated with acceptance of cosmetic surgery via Instagram appearance comparison and body dissatisfaction. We predicted that Instagram use for images-related activities involving celebrities and self (but not friends) was associated with acceptance of cosmetic surgery both directly and indirectly.

METHODS

The study participants were 305 Italian women (mean age, 23 years). They completed a questionnaire containing the Instagram Image Activity Scale, the Instagram Appearance Comparison Scale, the Body Shape Questionnaire-14, the Acceptance of Cosmetic Surgery Scale. A path analysis was performed in which the Instagram images-based activities were posited as predictors of the Instagram appearance comparison, body dissatisfaction and acceptance of cosmetic surgery, respectively.

RESULTS

We found that only image-based activities related to celebrities and self were significantly related to acceptance of cosmetic surgery, whereas friends' Instagram-related activities were not significantly related to this criterion variable. Moreover, the indirect effect of both Instagram self- and celebrities-images activities on acceptance of cosmetic surgery through Instagram appearance comparison and body dissatisfaction was significant. Friends' Instagram images-related activities were not associated with acceptance of cosmetic surgery.

CONCLUSIONS

Overall, these findings provide information about the role that activities carried out on Instagram, appearance comparison and body dissatisfaction, play on the acceptance of surgery for aesthetic reasons among women. The study highlighted the importance for surgeons to consider some psychological aspects and the influence of sociocultural factors on the interest for cosmetic surgery.

LEVEL OF EVIDENCE IV

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 .

The correlation of clinical and psychological characteristics of women seeking cosmetic help

Background. Patients seeking cosmetic help, most commonly, haven`t only defects in appearance, in particular, facial skin, but also experience certain psychological problems in this regard. On the other hand, the reaction to the performed cosmetic correction of the mentioned defects depends, including on the patients psychological characteristics. The study of the correlation between clinical and psychological characteristics should contribute to the individualization of the cosmetological correction process and optimization of the patient life quality. Aims. To establish the correlation between age, clinical and psychological characteristics of women with cosmetic problems of the facial skin. Materials and methods. Using the methods of psychological diagnostics, we examined 110 women who received cosmetic assistance. Semi-quantitative method was used to assess the cosmetic problem intensity, the duration of its existence and the effect of the correction performed. Clinical and psychological research was carried out using the author's structured interview, which questions were aimed at fixing both the formal social positions of the patients and the characteristics of the system of significant relationships. Psychometric research was carried out using standardized questionnaires in order to identify a wide range of personality characteristics. In the course of statistical processing of the results, a frequency analysis of the gradations of nominative and rank signs was carried out using Pearson's 2, as well as a correlation analysis of clinical and psychological characteristics using the Spearman -test. Results. The author traced the statistical correlation between the degree of manifestation of the cosmetic problem and its influence on the psychological state of patients, as well as between the degree of their satisfaction with its solution and a number of personal characteristics and attitudes. Conclusions. The assumption was confirmed that the effect of treatment is determined not only by clinical factors and the possibilities of modern cosmetology, but also by psychological factors, among which the motivational orientation and activity of the individual, which form the basis of patient compliance, are of decisive importance.

Normalization of the epidermal barrier as a method of pathogenetic therapy of Atopic Dermatitis in children

Background. A key link in the pathogenesis of atopic dermatitis is a violation of the barrier function of the skin. Artificial skin moisturizing with emollients is the basis of palliative therapy for the disease. Aims. The purpose of the study was to assess the effectiveness and tolerability of the cosmetic product Admera. Materials and methods. The article presents the results of an open non-comparative prospective observational study of the efficacy and safety of Admera cream in pediatric patients with mild to moderate atopic dermatitis, conducted at the Pierre Wolkenstein Clinic for Skin Diseases in June-August 2020. Results. The study included 35 patients aged 4 to 17 years. The study included 35 patients aged 4 to 17 years inclusive. The clinical study demonstrated a statistically significant decrease in the Severity scoring of atopic dermatitis (SCORAD) index total score. The average value of this indicator decreased by 33% from the value 36.2 12.3 at the screening visit to 24.2 11.4 at the visit 3 (p 0.001). Assessment of the dynamics of the Eczema area and severity index (EASI) index showed a significant decrease in the total score of the indicator after 14 and 28 days of therapy relative to the baseline (p 0.001). The cosmetic product studied was well tolerated by patients. During the present study, 3 adverse events were reported in 2 patients. According to expert opinion, the recorded undesirable phenomena were not associated with the application of the studied cosmetic product. Reported adverse events were gastrointestinal disorders and included cases of diarrhea, abdominal pain and at the end of the study completely Conclusions. Evaluation of the results of the study showed high efficacy and safety of the study drug as a moisturizing agent: four-week therapy leads to a decrease in the severity of Atopic dermatitis manifestations, a decrease in the intensity of pruritus, an increase in the level of skin hydration in the T-zone and on the patient's body.

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.

Examination of the factorial model of a scale developed to assess body satisfaction in the Brazilian context: a study with people 18 to 40 years old

PURPOSE

Confirmatory factor analysis was employed to investigate an instrument developed to assess body satisfaction of Brazilian women and men and to identify participants' body satisfaction level.

METHODS

Brazilian young adults completed the Body Satisfaction Situational Scale and a sociodemographic questionnaire. A total of 1481 individuals (female = 1035; male = 446) aged between 18 and 40 years old participated in the study. Factorial, convergent and discriminant validity and reliability were evaluated. An invariance test was performed across sexes using multi-group analysis. The prevalence of body satisfaction among participants was calculated using the final models of the instrument.

RESULTS

The complete model of the scale (23 items and four factors) was invariant across sexes, but it did not fit the samples even after refinement. Therefore, a theoretical investigation of the scale content was performed based on literature. Thus, a reduced model composed of two factors and ten items was found for each sex. These models showed good validity and reliability to independent samples. About prevalence, most of the women were not at all satisfied with body fat and most of the men were slightly satisfied with body musculature. Further, women and men were moderately satisfied with their face, hair, and skin.

CONCLUSION

A reduced model of the instrument for women and another for men showed adequate indices of construct validity and reliability to samples. The most participants were not very satisfied with their bodies. The results can be useful to develop protocols aiming to promote body satisfaction.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Is the needle as risky as the knife? The prevalence and risks of body dysmorphic disorder in women undertaking minor cosmetic procedures

OBJECTIVES

Body dysmorphic disorder is commonly considered a contraindication for major cosmetic surgery, but whether body dysmorphic disorder relates to poorer outcomes from minor cosmetic treatment remains unknown. This study aimed to explore the prevalence of body dysmorphic disorder in clients seeking non-surgical cosmetic procedures and to examine whether body dysmorphic disorder clients are vulnerable in minor cosmetic settings. Vulnerability was explored in terms of psychological distress, unrealistic expectations and motivations for treatment outcome, and reduced satisfaction with past cosmetic procedures.

METHOD

A cross-sectional online survey was completed by 154 women seeking minor cosmetic procedures which included the Body Dysmorphic Disorder Questionnaire - Dermatology Version to screen for body dysmorphic disorder, and measures of cosmetic treatment motivation, expectations and satisfaction.

RESULTS

Roughly 25% of women in the current sample screened positive for a potential body dysmorphic disorder diagnosis. Participants with suspected body dysmorphic disorder demonstrated higher levels of psychological distress and more unrealistic expectations and motivations for cosmetic treatment, such as improving social or romantic relationships. However, body dysmorphic disorder participants reported similar levels of satisfaction with past minor cosmetic treatments to the non-body dysmorphic disorder group.

CONCLUSION

While the relationship between body dysmorphic disorder and treatment outcome warrants further investigation in prospective research tracking satisfaction and adverse reactions over time, this preliminary evidence suggests clients with suspected body dysmorphic disorder display several vulnerabilities in non-surgical cosmetic settings. Given the rapidly increasing accessibility of minor cosmetic procedures, further research is needed to determine their safety for clients with body dysmorphic disorder. Detection of body dysmorphic disorder in non-surgical cosmetic settings could facilitate earlier psychological intervention, promoting superior long-term outcomes.

The Zoom Effect: Exploring the Impact of Video Calling on Appearance Dissatisfaction and Interest in Aesthetic Treatment During the COVID-19 Pandemic

BACKGROUND

The popularity of videoconferencing platforms has skyrocketed during the COVID-19 pandemic; however, concerns have been expressed regarding the potential for video calls to promote appearance dissatisfaction because individuals are exposed to an image of themselves on camera for extended periods.

OBJECTIVES

The aim of the current study was to characterize current video usage behaviors and their relation to appearance dissatisfaction and interest in aesthetic procedures in the general population.

METHODS

An online survey was completed by 335 adults currently living in Australia. Multiple aspects of video usage were assessed, including engagement in video-manipulation techniques to enhance appearance and the focus of visual attention (ie, on self or others) while on video calls. The Dysmorphic Concern Questionnaire was administered to determine if video-use behaviors were associated with greater body image disturbance.

RESULTS

Over one-third of participants had identified new appearance concerns while on video. Dysmorphic concern was associated with self-focused attention, greater engagement in video-manipulation behaviors, and increasing appearance concerns due to their time on video calls. Individuals who identified new video-based appearance concerns reported greater interest in obtaining future beauty treatments (eg, waxing) and aesthetic procedures (eg, nonsurgical procedures such as antiwrinkle injections).

CONCLUSIONS

This is one of first empirical studies to report the potential consequences of video-call usage for increasing appearance dissatisfaction and dysmorphic concern, and to demonstrate a link between the use of video calls and interest in cosmetic procedures.

Effect of clinical photography on postprocedure patient satisfaction in female patients who underwent nonsurgical rhinoplasty

STUDY DESIGN

A prospective clinical study.

BACKGROUND

To the best of our knowledge, there is no study in the literature that addresses the effect of showing comparative photographs in the follow-up period to patients who had undergone nonsurgical rhinoplasty on patient satisfaction.

OBJECTIVES

To examine the effect of showing preprocedure and postprocedure photographs to patients in the follow-up period on patient satisfaction.

METHODS

It was a nonsimultaneous prospective study that included patients suitable for nonsurgical rhinoplasty. Photographs were taken during routine follow-up after 1 month of the procedure, and patients were asked to fill the Derriford Appearance Scale 24 (DAS24) and Rhinoplasty Outcome Evaluation (ROE) questionnaires. Next, after the preprocedure and postprocedure photographs were shown to the patients, they were asked to complete the DAS24 and ROE questionnaires again.

RESULTS

The study included 265 female patients. The mean age of the patients was 35.11 ± 8 (18-61 years). Before the preprocedure and postprocedure photographs were shown, the DAS24 score was 52.2 ± 14.26 and the ROE score was 75.91 ± 11.91. After the photographs were shown, the DAS24 score was found to be 40.80 ± 13.25 and the ROE score as 87.722 ± 8.56. Therefore, significant improvement in DAS24 and ROE scores and an increase in patient satisfaction were observed after the preprocedure and postprocedure photographs were shown (p = 0.01, p < 0.05).

CONCLUSION

Showing preprocedure and postprocedure photographs in the follow-up period to patients who underwent nonsurgical rhinoplasty leads to greater patient satisfaction with the surgery and their self-image.

Validation of the Cosmetic Procedure Screening (COPS) Questionnaire in the Greek language

Practitioners in cosmetic and aesthetic treatment practices are likely to unknowingly work with patients with Body Dysmorphic Disorder (BDD). Screening questionnaires to identify the disorder in Greece are lacking. The purpose of this study was to validate a Greek version of the Cosmetic Procedure Screening (COPS) questionnaire, a self-report measure of how the respondents feel about their appearance, before an aesthetic intervention. The COPS was translated into Greek and was completed by 216 adult females from several areas of Attica (four private beauty centers, three dermatology clinics, five plastic surgery clinics, and Thriasio General Hospital of Elefsina) who pursued a cosmetic procedure. Participants also completed the Perceived Stress Scale (PSS-14). The Greek version of the COPS questionnaire demonstrated high internal consistency (Cronbach's α of 0.856) with corrected item's total range 0.468 to 0.687. Two of the factors explained 58.98% of total variance. Twenty (9.26%) women had a possible diagnosis of BDD (80% were unmarried, 95% had no children, 80% had university education). An increase in perceived stress levels was associated with an increase in the likelihood of being diagnosed with BDD (Pearson's r=0.726). The Greek version of the COPS questionnaire is a valid instrument that can be used by professionals to screen adult women for BDD.

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.

A review of the psychosocial aspects of clinically severe obesity and bariatric surgery

For the past 2 decades, clinically severe obesity (operationalized as a body mass index ≥40 kg/m2) has increased at a more pronounced rate that less severe obesity. As a result, the surgical treatment of obesity (bariatric surgery) has become a more widely accepted, yet still underutilized, treatment for persons with severe obesity and significant weight-related health problems. Psychologists play a central role on the multidisciplinary team involved in the preoperative assessment and postoperative management of patients. They also have played a central role in clinical research which has enhanced understanding of the psychosocial and behavioral factors that contribute to the development of severe obesity as well as how those factors and others contribute to postoperative outcomes. This article, written specifically for psychologists and other mental health professionals who currently work with these patients or are considering the opportunity to do so in the future, reviews these contributions over the past 20 years. The article highlights how this work has become a fundamental part of international clinical care guidelines, which primarily focus on preoperative psychosocial screening. The article also outlines avenues for future research in the field, with a specific focus on the need for additional behavioral and psychosocial interventions to promote lifelong success after bariatric surgery. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Psychosocial Differences Between Transgender Individuals With and Without History of Nonsurgical Facial Injectables

BACKGROUND

Considerable research has explored psychosocial characteristics of individuals who seek aesthetic procedures as well as psychological changes experienced after successful treatment. Little research, however, has explored the experiences of transgender individuals who have undergone nonsurgical injectable procedures (NSIPs).

OBJECTIVES

This study examined theoretically relevant psychosocial characteristics of transgender individuals who have and have not undergone NSIPs.

METHODS

An online survey of demographic and psychosocial constructs was disseminated through transgender-specific support groups and Facebook groups from December 2019 to February 2020. Psychosocial measures included self-esteem (Rosenberg Self-Esteem Inventory), anticipated discrimination (Intersectional-Anticipated Discrimination), gender identity and physicality congruence (Transgender Congruence Scale), body image (Body Image Quality of Life Inventory), and overall satisfaction with facial appearance (FACE-Q Face Overall). The Mann-Whitney U test assessed differences by history of NSIPs, and the Kruskal-Wallis test assessed gender and racial differences. A P-value of <0.05 was considered significant.

RESULTS

Participants (N = 101) were transfeminine (n = 58), transmasculine (n = 31), gender-diverse (n = 12), and mostly (71%) white. Almost two-thirds of respondents (62%) reported using NSIPs; 6 participants reported undergoing NSIPs from non-licensed providers. History of NSIPs was associated with greater self-esteem (P < 0.01), less anticipated discrimination (P < 0.01), greater physicality and gender identity congruence(P < 0.001), greater body image quality of life (P < 0.001), and greater satisfaction with overall facial appearance (P < 0.01).

CONCLUSIONS

Use of NSIPs was associated with more positive psychosocial symptoms. Experiences with NSIPs may play an important role in psychosocial functioning for transgender individuals.

LEVEL OF EVIDENCE 3

Do Genital Cosmetic Procedures Improve Women's Self-Esteem? A Systematic Review and Meta-Analysis

BACKGROUND

The popularity of genital cosmetic procedures in women is increasing. These procedures are often assumed and promoted as having a positive effect on women's psychological well-being, particularly their self-esteem. Empirical support for these claims is lacking.

OBJECTIVES

The aim of this study was to conduct a systematic review and meta-analysis of the impact of genital cosmetic procedures on self-esteem in women.

METHODS

The authors performed a systematic literature review of MEDLINE, PreMEDLINE, Ebase, EMBASE, OVID, CINAHL, Cochrane, PsycINFO, and PubMed to identify articles that measured self-esteem in women after a genital cosmetic procedure. A meta-analysis was conducted to assess the pooled effect of these procedures on self-esteem.

RESULTS

The authors identified 5 eligible studies for the meta-analysis, comprising 2 prospective and 3 retrospective studies. Labia minora reduction was the most commonly studied procedure. All 5 studies used different measures of self-esteem, with only 1 study employing a validated psychometric measure at both preoperative and postoperative time points. The meta-analysis results showed a pooled logit rate estimate of 1.230, indicating a positive effect of surgery on self-esteem. However, there was substantial heterogeneity across studies.

CONCLUSIONS

Female genital cosmetic procedures, particularly labiaplasty, appear to have a positive effect on women's self-esteem. However, inconsistencies in study measures and methods limit our conclusions. Future research should involve the development of standardized outcome measures to more accurately assess the impact of these procedures on self-esteem, and on psychological well-being more generally.

LEVEL OF EVIDENCE: 3