Adolescent Desire for Cosmetic Surgery: Associations with Bullying and Psychological Functioning

"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.

Exploring the Prevalence and Etiological Factors of Body Dysmorphic Disorder in Cosmetic Surgery Populations: Implications for Enhanced Clinical Assessment

BACKGROUND

The prevalence of body dysmorphic disorder (BDD) varies across different clinical settings, with evidence indicating its notable presence not only in psychiatric environments but also in dermatology and plastic surgery. This article aims to investigate the etiological factors associated with the elevated incidence of BDD in plastic surgery outpatient settings, with the ultimate objective of enhancing the assessment process for potential cosmetic procedure candidates.

METHODS

We recruited 531 patients seeking consultations or surgeries at the Department of Plastic Surgery, Peking University Shenzhen Hospital, from October 2022 to February 2024. The Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) was utilized to diagnose BDD, and the Hospital Anxiety and Depression Scale (HADS) assessed psychological comorbidities. Statistical analyses included Spearman's correlation, Kruskal-Wallis, and chi-square tests.

RESULTS

BDD was diagnosed in 11.3% of the participants, with significant variations related to gender (p = 0.042) and marital status (p = 0.026). A significant correlation was also displayed between BDD-YBOCS and HADS (Spearman's rho = 0.266, p < 0.001). Notably, BDD prevalence was higher during the COVID-19 pandemic (13.6%) compared to post-pandemic period (3.4%) (p = 0.003).

CONCLUSION

This study elucidates the significant prevalence of body dysmorphic disorder (BDD) among patients seeking cosmetic surgery, highlighting critical demographic, psychological and environmental factors that contribute to its manifestation. Given the significant prevalence and the multifactorial nature of BDD, it is important to develop comprehensive assessment tools before cosmetic consultation that prioritize mental health alongside aesthetic considerations in the future.

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 .

Practices in Pediatric Cosmetic Dermatologic Procedures: A National Survey

BACKGROUND

Adult populations have traditionally been the primary recipients of cosmetic treatments, but a growing trend shows an increase in such procedures among pediatric patients.

OBJECTIVE

The objective of the authors' study was to investigate types of procedures currently being performed by pediatric and cosmetic dermatologists and factors that may influence their choice of treatments in a pediatric population.

METHODS

The authors conducted an anonymous online survey targeting healthcare practitioners who frequently use lasers for pediatric cutaneous conditions. The survey collected information on participants' primary scope of practice, pediatric cosmetic procedures they performed, counseling topics, and procedural details.

RESULTS

Of 85 survey respondents, 73 (86.00%) completed all questions. Most respondents identified as pediatric dermatologists (77.65%), followed by general dermatologists (18.82%), cosmetic dermatologists (8.24%), and dermatologic/Mohs surgeons (1.18%). Top pediatric cosmetic conditions treated included hypertrophic/traumatic scars (95.29%), acne (89.41%), axillary and facial hyperhidrosis (77.65%), hypertrichosis/hirsutism (67.06%), and pigmented lesion removal (64.71%). Commonly performed procedures were vascular lasers (77.65%), laser hair removal (50.59%), and pigmented lasers (28.24%), among others. Respondents prioritized understanding risks/benefits, clinically indicated treatment, and the natural course of the condition.

CONCLUSION

As the first multisociety, national survey, these results offer valuable insight into the current landscape of pediatric cosmetic treatments from the perspective of dermatologists.

Impact of Gender-Role Attitudes and Mental Health on Hostile Sexism and Acceptance of Cosmetic Surgery

BACKGROUND

Each year, tens of thousands of people worldwide choose to undergo cosmetic surgery in order to alter their appearance. In recent years, young people have gradually emerged to comprise the main driving force behind the increasing demand for cosmetic surgery. Previous studies have found that sexism may motivate young people to undergo such surgeries. However, few studies have been conducted to determine if this psychological mechanism influences the acceptance of cosmetic surgery among Chinese university students.

METHODS

A total of 579 Chinese university students (280 girls and 299 boys, 17-20 years) volunteered to participate in the online survey. They completed a questionnaire containing the Ambivalent Sexism Inventory, the 12-item General Health Questionnaire, the Gender-Role Attitudes Questionnaire and the Acceptance of Cosmetic Surgery Scale. We firstly evaluated the underlying factor structure of the Acceptance of Cosmetic Surgery Scale using exploratory and confirmatory factor analyses, and exploring pattern of associations between the constructs was analyzed via path analysis.

RESULTS

According to the findings, hostile sexism was associated with greater levels of acceptance toward cosmetic surgery. Moreover, gender-role attitudes mediated the link between hostile sexism and the acceptance of cosmetic surgery, and this mediation was positively influenced by general mental health.

CONCLUSION

Our study contributes to a deeper understanding of Chinese university students' attitudes toward cosmetic surgery, hostile sexism may contribute to normalizing traditional gender stereotypes and encourage cosmetic surgery acceptability among Chinese university students.

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 .

Appearance-related cyberbullying and its association with the desire to alter physical appearance among adolescent females

Cyberbullying is associated with various mental health concerns in adolescents, including body dissatisfaction and disordered eating behaviours. However, there is a significant research gap concerning the unique effects of appearance-related cyberbullying (ARC) on adolescent mental health. This study examined the prevalence and psychological consequences of ARC among middle to late adolescent females (aged 14-19 years, Mage = 15.98, N = 336). Participants completed an online survey regarding their experiences of ARC, body image variables, and eating disorder symptomology. Findings indicate the widespread occurrence of ARC among adolescent females, with body shape and size emerging as predominant targets. Experiences of ARC-victimisation positively correlated with increased concerns about body shape, body shame, and eating disorder symptomology. Conversely, experiences of ARC-victimisation were negatively correlated with body esteem and body appreciation. Finally, appearance-related cybervictimisation was significantly associated with adolescent females' desire to pursue appearance alterations through methods such as dieting and exercising, altering self-presentation, and undergoing cosmetic procedures due to perceived experiences of ARC. These findings highlight the urgent need for preventative measures, such as age-appropriate social media policies and health promotion programs that encourage positive online behaviour, and strategies to address the impacts of ARC to protect the mental well-being of adolescent females.

Body Dysmorphic Disorder in Aesthetic and Reconstructive Plastic Surgery-A Systematic Review and Meta-Analysis

(1) Background: Body dysmorphic disorder (BDD) presents significant challenges in aesthetic and reconstructive plastic surgery, impacting patient outcomes and well-being. Understanding its prevalence and associated factors is crucial for effective patient care. (2) Methods: A systematic review of national and international databases on body dysmorphic disorder, plastic surgery, cosmetic surgery, reconstructive surgery, and prevalence yielded 999 studies between 1878 and April 2024. Inclusion criteria focused on studies reporting prevalence while excluding those with small sample sizes (<20 participants), unclear diagnostic criteria for BDD, and non-English accessibility. (3) Results: A meta-analysis using a random effects model was conducted on 65 studies involving 17,107 patients to estimate the prevalence of BDD. The overall estimated prevalence of BDD was 18.6%; 10,776 (62.9%) were females, with a mean age of 35.5 ± 11.7 years. Subgroup meta-analysis found significant variability in effect sizes across countries and types of specialty, of which Brazil showed the highest proportion and dermatology exhibited the smallest. Meta-regression analysis found no significant relationship between the year of publication and prevalence rates. (4) Conclusions: Our findings update the current literature on BDD prevalence in aesthetic and reconstructive plastic surgery. We emphasize the importance of proactive screening and multidisciplinary care approaches to address the complex challenges posed by patients with BDD. Further research is needed to explore evolving trends in BDD prevalence and factors influencing its expression across different cultural contexts.

The Effects of Cosmetic Procedures on the Youth

Cosmetic procedures involve the maintenance, restoration, or enhancement of one's physical appearance through surgical or medical techniques. Restorative or reconstructive procedures, on the other hand, are essential procedures that restore normal function or appearance to abnormal structures caused by trauma or infection. Cosmetic procedures are generally elective and may either be surgical or nonsurgical. Nonsurgical or minimally invasive cosmetic procedures include laser hair or tattoo removal, chemical peeling, micro-dermabrasion, and soft tissue augmentation with injectables. These procedures are fast-growing with more than a 50% increase globally over the last 5 years.

Very preterm birth and trajectories of domain-specific self-concept from childhood into adulthood

Self-concept refers to individuals' perceptions of themselves in specific domains and is closely related with their overall self-esteem. Lower self-esteem has been reported in those born preterm (<37 weeks gestation), but the development of self-concept has not been studied in this population. This study investigates whether differences in trajectories of domain-specific self-concepts are explained by premature birth or other risk factors, using the Bavarian Longitudinal Study (N = 460), a population-based study of very preterm (VP; <32 weeks gestation)/very low birth weight (VLBW; <1500 g) cohort and term-born controls. Trajectories of body and social self-concept from 6 to 26 years of age were estimated using latent class growth analysis. Regression models examined the effects of VP/VLBW and other individual, social, and family factors. Two trajectories - one stable and one decreasing - were identified for both self-concepts. VP/VLBW birth was associated with decreasing self-concept in both domains, although the effect of VP/VLBW on social self-concept was weakened in the adjusted analysis. Furthermore, mediated pathways were found from VP/VLBW to decreasing social self-concept via chronic bullying (β = 0.05, 95% CI [0.002, 0.12]) and motor impairments (β = 0.04, 95% CI [0.01, 0.07]), suggesting that negative self-concept in the VP/VLBW population is partially modifiable through improving peer relationships and motor impairments in childhood.

Teachers Can Make a Difference in Bullying: Effects of Teacher Interventions on Students' Adoption of Bully, Victim, Bully-Victim or Defender Roles across Time

School bullying is a serious problem worldwide, but little is known about how teacher interventions influence the adoption of bullying-related student roles. This study surveyed 750 early adolescents (50.5% female; average age: 12.9 years, SD = 0.4) from 39 classrooms in two waves, six months apart. Peer ratings of classmates were used to categorize students to five different bullying-related roles (criterion: >1 SD): bully, victim, bully-victim, defender, and non-participant. Student ratings of teachers were used to obtain class-level measures of teacher interventions: non-intervention, disciplinary sanctions, group discussion, and mediation/victim support. Controlling for student- and class-level background variables, two multilevel multinomial logistic regression analyses were computed to predict students’ bullying-related roles at wave 2. In the static model, predictors were teacher interventions at wave 1, and in the dynamic model, predictors were teacher intervention changes across time. The static model showed that disciplinary sanctions reduced the likelihood of being a bully or victim, and group discussion raised the likelihood of being a defender. Mediation/victim support raised the likelihood of being a bully. The dynamic model complemented these results by indicating that increases in group discussion across time raised the likelihood of being a defender, whereas increases in non-intervention across time raised the likelihood of being a victim and reduced the likelihood of being a defender. These results show that teacher interventions have distinct effects on students’ adoption of bullying-related roles and could help to better target intervention strategies. The findings carry practical implications for the professional training of prospective and current teachers.

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.

Childhood Predictors of Adolescent Joint Trajectories: A Multi-Informant Study on Bullying Perpetration and Hypercompetitiveness

Objective: Bullying perpetration has been proposed to be a strategic behavior used by adolescents to compete for social resources, yet the co-development of bullying perpetration and trait hypercompetitiveness is understudied. The joint developmental trajectories of self-rated bullying perpetration and parent-rated hypercompetitiveness were investigated in a sample of adolescents and childhood social, emotional, and physical predictors were explored.Method: In a sample of 607 adolescents (M_age = 13.02 years in Grade 7 [SD = 0.38]; 54.4% girls; 76.4% White) self-rated bullying perpetration and parent-rated hypercompetitiveness were assessed across six years of development (Grades 7 to 12). Childhood (i.e., Grades 5 and 6) social, emotional, and physical predictors of trajectory group membership were also examined.Results: Using latent class growth analyses, the three expected joint trajectory groups of primary interest were found: (1) a pattern of moderate stable bullying perpetration and high increasing hypercompetitiveness (high-risk group), (2) a pattern of low decreasing bullying and high increasing hypercompetitiveness (hypercompetitive only group), and (3) a pattern of low decreasing bullying and low stable hypercompetitiveness (low-risk group). Adolescents reflecting the high-risk joint trajectory pattern were differentiated from adolescents reflecting the other two trajectory patterns by having more adverse childhood social, emotional, and physical predictors.Conclusions: Findings indicate that bullying is a developmental and context-dependent behavior that can reflect trait hypercompetitiveness. Bullying prevention efforts should focus on reducing emphasis on outcompeting peers and instead facilitate a sense of self-acceptance, awareness, and accomplishment within prosocial school and family environments.

Development of a multiphasic, cryptic screening protocol for body dysmorphic disorder in cosmetic dermatology

Background

The incidence of body dysmorphic disorder in cosmetic dermatology is high. Even though treating patients with this disorder may worsen symptoms and is fraught with potential complications, screening is low, due in part to lack of knowledge of the disorder, as well as inadequate screening tools.

Objectives

To verify the probability of body dysmorphic disorder in a nonsurgical esthetic setting and determine the effect of a multiphasic screening protocol on mitigating poor outcomes in high‐risk patients.

Methods

A multiphasic screening protocol for body dysmorphic disorder was distributed to a total of eight esthetic clinics in the United States. Practitioners administered an anonymous, cryptic prescreening form to all new, incoming patients aged ≥ 18 to ≤ 65 years from June 1, 2019, through September 1, 2019, followed by a second, more extensive screening questionnaire. Patients with suspected or subclinical body dysmorphic disorder could be refused treatment.

Results

A total of 734 initial screenings were recorded over 16 weeks. Of these, 4.2% (31/734) proceeded to the secondary screening phase; 29% (9/31) subsequently screened positive for body dysmorphic disorder. Practitioners refused to treat 77.8% (7/9) of positive screenings. Two patients out of seven who tested positive underwent a third screening and were subsequently treated with positive outcomes.

Conclusions

Use of a cryptic screening protocol enables identification of individuals at risk for BDD and encourages open and continuous communication between patient and provider.

An ethics analysis of the rationale for publicly funded plastic surgery

Background

Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a well-considered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system.

Methods

This analysis uses a reflective equilibrium approach, according to which considered normative judgements in one area should be logically and argumentatively coherent with considered normative judgements and background theories at large within a system.

Results and conclusions

In exploring functional versus non-function conditions, we argue that it is difficult to find a principled reason for an absolute priority of functional conditions over non-functional conditions. Nevertheless, functional conditions are relatively easier to establish objectively, and surgical intervention has a clear causal effect on treating a functional condition.

Considering non-functional conditions that require plastic surgery [i.e., those related to appearance or symptomatic conditions (not affecting function)], we argue that the patient needs to experience some degree of suffering (and not only a preference for plastic surgery), which must be ‘validated’ in some form by the healthcare system.

This validation is required for both functional and non-functional conditions. Functional conditions are validated by distinguishing between statistically normal and abnormal functioning. Similarly, for non-functional conditions, statistical normality represents a potential method for distinguishing between what should and should not be publicly funded. However, we acknowledge that such a concept requires further development.

Role of Attitude, Body Image, Satisfaction and Socio-Demographic Variables in Cosmetic Surgeries of Iranian Students

BACKGROUND

Nowadays, cosmetic surgery is one of the most common types of surgeries all around the world including Iran and those demanding such surgeries are also growing in number. The present study is an attempt to determine the factors in the tendency towards cosmetic surgery in Iranian students.

METHODS

In a descriptive-analytical study, all students at Guilan University of Medical Sciences related to health issues were enrolled. The participants (n=314) were selected through census sampling. Data was garnered using a multi-section questionnaire including socio-demographic variables, body image, body satisfaction, and cosmetic surgery intention. The questionnaires were completed as self-statement.

RESULTS

The age range of the students was 18-55 years and the mean age was 25.07±7.41 years. Body mass index (BMI) of the participants was 23±3.82. Among socio-demographic variables, BMI, gender, family revenue, father’s job, marital status, mother’s job, and fathers’ literacy level were the predictors of intention for cosmetic surgery. In addition, among psychological variables, body satisfaction and image, and attitudes were predictors of intention for cosmetic surgery.

CONCLUSION

Educational and psychological interventions are recommended to create body satisfaction, to develop positive attitudes toward one’s body, and to develop negative attitudes toward cosmetic surgery and the side effects. Apparently, providing an environment for physical activity and exercise, especially for girls would help the students in losing weight, remaining in shape and attenuating the tendency toward cosmetic surgery.

Body dysmorphic disorder and facial aesthetic treatments in dental practice

There is a relatively high prevalence of body dysmorphic disorder (BDD) and it is known that this patient group regularly and frequently visit dental practitioners, especially those who advertise themselves as cosmetic or aesthetic practices. The market for facial aesthetics is hugely increasing both generally and within dental practices making it ever more likely that dentists will encounter this patient group frequently. Moreover, due to the nature of their concerns individuals within this group are likely to have contact with dentists (or other medical professionals in the physical health field) prior to any contact with mental health professionals. The aim of this paper is to give an overview of the presentation of BDD, to discuss the changing climate of facial aesthetic treatments and to highlight a care pathway for general dentists. Identification of patients with potential BDD is far more predictable with the use of a validated questionnaire, and the BDD Questionnaire and Dysmorphic Concern Questionnaire are described. A flowchart approach for the management of patients requesting aesthetic improvements is presented as the ideal method for identifying, referring and managing the aesthetic treatment desires of potential BDD patients.

A Four-Year Prospective Study of Bullying, Anxiety, and Disordered Eating Behavior Across Early Adolescence

We investigated the developmental pathways by which bullying perpetration and victimization, anxiety, and disordered eating behavior were related. Participants were drawn from the Canadian McMaster Teen Study. From Grade 5-8 (age 10-14), students (n = 657) were assessed on bullying involvement and symptoms of anxiety, and in Grade 7 and 8, students additionally completed a measure of clinically significant disordered eating behavior. Bullying victimization initiated a cascading effect on bullying perpetration, which subsequently led to disordered eating behavior. Anxiety had direct effects on disordered eating behavior at multiple time points and initiated a cascading effect on bullying victimization, and subsequently, perpetration. There was no evidence of moderation by sex. Bullying perpetration and anxiety may serve as early signals of eating pathology. Bullying prevention programs may attenuate the risk of disordered eating in both sexes, and the high continuity of disordered eating behavior suggests that early intervention is critical.

Healing Childhood Psychological Trauma and Improving Body Image Through Cosmetic Surgery

Cosmetic surgery is an interdisciplinary field involving cosmetics and medicine that stems from the early modern obsession with disfigurement. The "correcting" of facial features and body parts was very likely because beauty was at the heart of most reconstructive desires. Cosmetic surgery patients typically experience improvements in body image, and some are very satisfied with the impact of cosmetic surgery in changing their behaviors and improving self-esteem. The doctrine of mind-body connection supports the concept of healing the heart through the body. However, some people feel disgraced after revealing their experiences of cosmetic surgery. It is known that people who experience childhood psychological trauma, such as abuse and school bullying, may opt for cosmetic surgery later in life. The present study aimed to explore the relationship between childhood psychological trauma, cosmetic surgery, and body image. Three female adults who had undergone different types of cosmetic surgery completed the Acceptance of Cosmetic Surgery Scale (ACSS), the Fear of Negative Appearance Evaluation Scale (FNAES), and the Multidimensional Body-Self Relations Questionnaire (MBSRQ), followed by semistructured face-to-face interviews. According to the results, 1) undergoing cosmetic surgery can enhance self-confidence, reduce body dissatisfaction, resolve inner conflicts, and somewhat relieve psychological distress; 2) self-esteem and body image obtained from cosmetic surgery can resolve the distressing aftereffects of childhood trauma that occur later in life; and 3) the perceived sense of beauty achieved from cosmetic surgery contributes to a certain degree of self-confidence in the short term and promotes appearance-enhancing behaviors while increasing the distress of others discovering their cosmetic surgery experiences. The implications of this study are that undergoing cosmetic surgery can have healing effects on childhood trauma; however, there are certain drawbacks that can occur, such as distress and an insatiable desire for or an "addiction" to surgery.

When Is Teenage Plastic Surgery versus Cosmetic Surgery Okay? Reality versus Hype: A Systematic Review

Plastic surgery in teenagers has become popular in past decades because of an increase in self-awareness and desire to "fit in" with their peers. In 2016, over 229,551 cosmetic procedures were performed in patients who are younger than 19 years. The trend of plastic surgery in adolescents is increasing, and it is important for plastic surgeons to perform safe and appropriate procedures in this group. To this date, there is a myriad of literature on the psychological and ethical issues concerning plastic surgery in teenagers. However, studies regarding the safety of performing plastic surgery in this population are scarce. The rationale for this article is to study this issue in depth by means of a systematic review. The authors discuss the current indications, safety, patient satisfaction, and ethical considerations of teenage plastic surgery and make recommendations for future studies on this important area.

A Brief Comparative History Analysis

With the advent of gene-editing tools, changes to sequences encoding genes or regulatory elements can be made with relative ease compared to prior technologies. The development and anticipated commercialization of new applications using gene-editing technologies may span the gamut from therapeutic interventions to agricultural applications to cosmetic or enhancement procedures. Although objections have been raised about the purpose and on whom gene editing should be performed, limiting its uses in the absence of demonstrated harm may be difficult and unwise at this time, even at this early stage of development. The fledgling field may benefit from a review of the history of plastic and cosmetic surgery that underwent a similarly rocky start and continues to evolve to this day. From this brief comparative historical analysis, we may gain some insight about the path forward regarding the use of gene-editing tools for cosmetic purposes.

Predicting dating behavior from aggression and self-perceived social status in adolescence

We investigated the longitudinal associations between self-reported aggression, self-perceived social status, and dating in adolescence using an intrasexual competition theoretical framework. Participants consisted of 536 students in Grade 9 (age 15), recruited from a community sample, who were assessed on a yearly basis until they were in Grade 11 (age 17). Adolescents self-reported their use of direct and indirect aggression, social status, and number of dating partners. A cross-lagged panel model that controlled for within-time covariance and across-time stability while examining cross-lagged pathways was used to analyze the data. The findings revealed that direct aggression did not predict dating behavior and was negatively associated with self-perceived social status in Grade 10. Self-perceived social status in Grade 9 was positively associated with greater use of indirect aggression in Grade 10. Regarding dating, in Grade 9, self-perceived social status positively predicted more dating partners the following year, while in Grade 10, it was higher levels of indirect aggression that predicted greater dating activity the following year. Overall, there were no significant sex differences in the model. The study supports the utility of evolutionary psychological theory in explaining peer aggression, and suggests that although social status can increase dating opportunities, as adolescents mature, indirect aggression becomes the most successful and strategic means of competing intrasexually and gaining mating advantages.

Cyber Victimization Is Associated With Eating Disorder Psychopathology in Adolescents

Introduction: Technology is constantly evolving in a vast number of fields. In this way, cyber victimization is associated with psychopathology, and body appearance is a primary target of cyberbullies. Thus, the literature demonstrates a clear association between bullying and unhealthy eating behaviors in adolescents. However, studies that have examined the association between cyber victimization and eating disorder psychopathology are scarce. Objective: (1) To analyze whether there are differences in the cyber victimization scores depending on the gender, controlling for age; (2) to analyze whether cyber victimization is negatively associated with eating disorder psychopathology; (3) to analyze whether this association is moderated by the level of Appearance Evaluation. Method: Participants in the present study included 676 adolescents, 367 girls and 309 boys from several cities of Spain. The mean age for the overall sample was 14.28 years (SD = 1.65), ranging from 12 to 19. The participants filled out the questionnaires ECIPQ, MBSRQ, and EAT. Results: Cyber victimization was associated with eating disorders psychopathology, Appearance Evaluation, and Overweight Preoccupation. Appearance Evaluation moderated the association between Cyber victimization and the eating disorder psychopathology. Conclusion: It is necessary to assess vulnerability to eating disorders in adolescents who have been victims of cyberbullying.

Bullying and negative appearance feedback among adolescents: Is it objective or misperceived weight that matters?

This study investigated (1) whether involvement in bullying as a bully, victim or bully-victim was associated with objectively measured overweight or underweight, or whether it was related to weight misperception (i.e., inaccurate perceptions), and (2) whether appearance-specific feedback mediated the relationship between bullying and weight misperception. In Stage 1, 2782 adolescents aged 11-16 years from British secondary schools were screened for peer bullying and victimisation. In Stage 2, 411 adolescents with weight and height data (objective n = 319, self-report n = 92) also self-reported on their weight perception and appearance-specific feedback. Neither bullying nor victimisation were related to objective underweight or overweight. Victims were at increased odds of overweight misperception, while bully-victims were at increased odds of underweight misperception. Additionally, there was an indirect effect of appearance feedback on overweight misperception in bully-victims. Both victims and bully-victims are at increased risk of weight misperception, posing further detrimental effects to their health and wellbeing.

Cosmetic Adolescent Filler: An Innovative Treatment of the "Selfie" Complex

PURPOSE

"Selfie" photography is increasing among teenagers, accentuates congenital anomalies, and impacts self-confidence. Tear trough deformity is most commonly due to aging, but also occurs as a congenital anomaly and can be a major source of insecurity and embarrassment.

OBJECTIVE

The purpose of this study is to show the efficacy and safety of hyaluronic acid gel filler in a teenage patient with congenital tear trough deformity.

MATERIAL AND METHOD

We describe the case of a teenager who underwent hyaluronic acid gel filling to the tear trough deformity at age 14 years. Prospective follow up was assessed for 5 years.

RESULTS

The patient improved clinical appearance and self confidence. Her satisfaction level was high, and no complication occurred during entire follow up.

CONCLUSION

In this case, hyaluronic gel acid filler was safe and effective for augmentation of congenital tear trough. The patient was satisfied and experienced increased self-esteem.

Cosmetic Surgery and Body Dysmorphic Disorder - An Update

With the increasing volume and popularity of cosmetic procedures and surgeries, physicians in related specialties are increasingly likely to encounter patients with body dysmorphic disorder. Given the ethical, safety, and legal considerations involved in aesthetic procedures in these patients, accurate identification and appropriate selection for procedures is crucial.