Physical appearance and cosmetic medical treatments: physiological and socio-cultural influences

Cross-cultural perspectives on patient expectations in cosmetic dermatology: A comparative analysis across countries and ethnicities

Patient expectations in cosmetic dermatology exhibit significant variations across countries, cultures, and ethnicities, thereby reflecting individual desires, concerns, and goals. While some individuals seek aesthetic enhancements, others prioritize addressing specific skin conditions within the context of beauty norms in their respective countries. The provision of personalized and culturally sensitive care plays a crucial role in meeting these diverse expectations. Skin characteristics and concerns differ among ethnicities, influencing treatment preferences. For instance, individuals with darker skin tones may prioritize the treatment of pigmentation disorders, whereas those with lighter skin tones may focus on achieving a fair complexion. Furthermore, differences in facial anatomy among various ethnicities necessitate tailored treatment approaches. This commentary aims to contribute to the effective understanding and management of patient expectations, ultimately leading to satisfactory outcomes. Additional research and regional studies are required to further deepen our understanding of patient expectations in cosmetic dermatology and enable the delivery of improved and culturally appropriate care on a global scale.

Understanding the Impact of Aging on Attractiveness Using a Machine Learning Model of Facial Age Progression

Background: Advances in machine learning age progression technology offer the unique opportunity to better understand the public's perception on the aging face. Objective: To compare how observers perceive attractiveness and traditional gender traits in faces created with a machine learning model. Methods: Eight surveys were developed, each with 10 sets of photographs that were progressively aged with a machine learning model. Respondents rated attractiveness and masculinity or femininity of each photograph using a sliding scale (range: 0-100). Mean attractiveness scores were calculated and compared between men and women as well as between age groups. Results: A total of 315 respondents (51% men, 49% women) completed the survey. Accuracy of the facial age progression model was 85%. Females were considered significantly less attractive (-10.43, p < 0.01) and less feminine (-7.59, p < 0.01) per decade with the greatest drop over age 40 years. Male attractiveness and masculinity were relatively preserved until age 50 years where attractiveness scores were significantly lower (-5.45, p = 0.39). Conclusions: In this study, observers were found to perceive attractiveness at older ages differently between men and women.

Do we enjoy what we sense and perceive? A dissociation between aesthetic appreciation and basic perception of environmental objects or events

This integrative review rearticulates the notion of human aesthetics by critically appraising the conventional definitions, offerring a new, more comprehensive definition, and identifying the fundamental components associated with it. It intends to advance holistic understanding of the notion by differentiating aesthetic perception from basic perceptual recognition, and by characterizing these concepts from the perspective of information processing in both visual and nonvisual modalities. To this end, we analyze the dissociative nature of information processing in the brain, introducing a novel local-global integrative model that differentiates aesthetic processing from basic perceptual processing. This model builds on the current state of the art in visual aesthetics as well as newer propositions about nonvisual aesthetics. This model comprises two analytic channels: aesthetics-only channel and perception-to-aesthetics channel. The aesthetics-only channel primarily involves restricted local processing for quality or richness (e.g., attractiveness, beauty/prettiness, elegance, sublimeness, catchiness, hedonic value) analysis, whereas the perception-to-aesthetics channel involves global/extended local processing for basic feature analysis, followed by restricted local processing for quality or richness analysis. We contend that aesthetic processing operates independently of basic perceptual processing, but not independently of cognitive processing. We further conjecture that there might be a common faculty, labeled as aesthetic cognition faculty, in the human brain for all sensory aesthetics albeit other parts of the brain can also be activated because of basic sensory processing prior to aesthetic processing, particularly during the operation of the second channel. This generalized model can account not only for simple and pure aesthetic experiences but for partial and complex aesthetic experiences as well.

The Role of Age and Gender on Perception of Women After Cosmetic Rhinoplasty

BACKGROUND

Rhinoplasty is known to increase attractiveness; however, the influence of observer age and gender are largely undetermined.

METHODS

This retrospective cross-sectional study included 20 women who underwent cosmetic rhinoplasty between January 1st, 2012, and December 31st, 2019. A total of 4 surveys were constructed with 10 sets of photographs each (5 preoperative and 5 postoperative). Surveys were designed such that photographs of the same patient were not placed in the same survey to avoid recall bias. Each of these surveys were then sent to at least 30 lay people via a web-based survey tool. Anonymous blinded respondents used a 7-point Likert scale to rate their perception of each patient's aggressiveness, likeability, sociability, trustworthiness, attractiveness, femininity, intelligence and confidence. A multivariate linear mixed effect model was applied to analyze the overall patient trait data as well as to assess age and gender differences.

RESULTS

This survey study included photographs of 20 women (mean age, 28.2 years) before and after cosmetic rhinoplasty. A total of 174 respondents (mean age range, 25-34 years [41%]; 108 [62%] were female) completed the survey. Overall, postoperative photographs were perceived as significantly more sociable (0.13; 95% CI, 0.01-0.25), attractive (0.21; 95% CI, 0.09-0.34), feminine (0.18; 95% CI, 0.05-0.30), and confident (0.15; 95% CI, 0.02-0.27). When analyzed by sex, men rated women as less aggressive (-0.42, 95% CI, -0.65,-0.17) and more likeable (+0.45, 95% CI, 0.21-0.69), sociable (+0.38, 95% CI, 0.14-0.62), trustworthy (+0.37, 95% CI, 0.13-0.61), attractive (+0.60, 95% CI, 0.35-0.84), feminine (+0.23, 95% CI, 0.07-0.41) and intelligent (+0.29, 95% CI, 0.04-0.53). In contrast, female respondents indicated an increase in perceived attractiveness (+0.16, 95% CI, 0.06-0.22) and femininity (+0.18, 95% CI, 0.03-0.32) for women after rhinoplasty. Raters aged 25-34 indicated improvements across all traits analyzed. Almost all age ranges rated post-operative photographs as more attractive (18-24: +0.32, 95% CI, 0.19-0.46; 25-34: +0.52, 95% CI, 0.33-0.72; 35-44: +0.29, 95% CI, 0.12-0.51; 45-54: +0.50, 95% CI, 0.11-0.89) while individuals over age 55 only indicated increased trustworthiness (+0.51, 95% CI, 0.03-0.99).

CONCLUSIONS

These findings suggest that cosmetic rhinoplasty improves perceptions of personality and physical traits of women with males and individuals aged 25-34 indicating the greatest benefit.

LEVEL OF EVIDENCE

Level IV.

Non-surgical rhinoplasty using hyaluronic acid dermal fillers: A systematic review

BACKGROUND

Non-surgical rhinoplasty using hyaluronic acid dermal fillers is a cosmetic procedure that has been becoming increasingly popular among patients wanting to correct nasal deformities or nasal irregularities, in the recent years.

AIM

This systematic review aims to provide quality evidence about the success of non-surgical rhinoplasty procedures in terms of patient satisfaction and complications.

METHODS

A systematic electronic literature search using keywords and MESH search terms over the PubMed/Medline, Cochrane Central, Scopus, and EBSCO online databases was conducted from November 2005 to February 2021. Additionally, the reference lists of included systematic reviews were hand searched. Data collected included patient satisfaction and complications from prospective and experimental studies providing highest level of evidence. Articles were critically appraised, and MINORS scale was used to assess the risk of bias.

RESULTS

Based on the search criteria, 2896 citations were found. After removing duplicates and screening for relevance, 23 citations were finalized for full-text review, of which 12 articles were excluded and 11 articles were included in the study. The average satisfaction of patients amongst the studies was found to be >90%. In all the studies, transient edema and erythema, post-injection pain, and bruising were some temporary complications. Rare complications that were reported were vascular impairments and hematoma.

CONCLUSIONS

Non-surgical rhinoplasty is a good, minimally invasive alternative over conventional rhinoplasty. There is however a paucity of quality data in the form of experimental and prospective studies regarding the accuracy, effectiveness, and complications of non-surgical rhinoplasty.

Patient satisfaction after breast cancer surgery : A prospective clinical trial

BACKGROUND

This study investigated the impact of curative breast cancer surgery on patient satisfaction concerning cosmetic results and quality of life (QoL).

METHODS

In this study 61 participants completed questionnaires to evaluate their QoL and patient satisfaction with cosmetic results following breast cancer surgery. Cosmetic outcomes were evaluated by the breast surgeon and an independent breast specialist using the Harris scale and the breast analyzing tool (BAT).

RESULTS

Of the participants 71% completed all 4 follow-up visits, 38 (62%) patients received breast-conserving therapy (BCT) and 23 (38%) received a mastectomy. Surgery-associated complications arose in 2.6% of the patients who received BCT and 17.4% of patients who received a mastectomy. No significant differences in QoL between BCT patients and mastectomy patients were observed immediately after surgery, or after 6 and 12 months. Breast asymmetry, measured using the BAT score, and QoL scores were worst immediately after surgery. The surgeon rated the cosmetic results as better compared to the independent breast expert (p = 0.001). Furthermore, patients aged over 60 years old were less satisfied with the cosmetic outcome compared to younger patients at the time of discharge (p = 0.024). Patients who received a mastectomy were less satisfied when the resected volume was higher.

CONCLUSION

Patient satisfaction was lowest immediately after surgery but improved during the following months, despite continued breast asymmetry. For mastectomy patients, a lower resected volume led to a higher satisfaction with cosmetic results. Satisfaction is subjective and cannot be determined from the esthetic satisfaction of the surgeon or using an objective tool measuring breast asymmetry.

Own Attractiveness and Dissatisfaction With Physical Appearance Independently Predict the Salience of Facial Cues to Size When Women Judge Other Women's Attractiveness

While facial cues to body size are a valid guide to health and attractiveness, it is unclear whether the observer's own condition predicts the salience of (low) size as a cue to female attractiveness. The current study examines whether measures related to women's own attractiveness/appearance predict the extent to which they use facial cues to size to differentiate other women on the attractiveness dimension. Women completed a body mass index (BMI) preference task, where they indicated their preference for high- versus low-BMI versions of the same woman, provided data to calculate their BMI and completed various psychometric measures (self-rated attractiveness/health, dissatisfaction with physical appearance). Here, attractive women and women who were dissatisfied with their own appearance were more likely to associate facial cues to low body size with high attractiveness. These data suggest that psychological factors related to women's appearance shape their evaluations of other women based on cues to size. Such variation in attractiveness judgements may function to reduce the costs of female competition for resources, for example, by identifying "quality" rivals or excluding others based on cues to size.

Gender differences found in a qualitative study of a disordered eating prevention programme: What do boys have to say?

Qualitative studies examining gender differences of eating disorder prevention programmes are scarce. We aimed to evaluate gender differences in adolescents who participated in a larger study on effectiveness of a disordered eating prevention programme. Perceptions of eating, female and male aesthetic models, media influences, prevention programmes and emerging topics from 12 school-going boys who received a media-literacy programme (n = 4), media-literacy plus nutrition-awareness programme (n = 4) or neither (n = 4) were explored using Interpretative Phenomenological Analysis and compared with previous results in girls. Findings suggest that the prevention programme is effective for both genders. Gender differences and consumer-culture influences may be considered in future interventions.

Beyond Sociocultural Influence: Self-monitoring and Self-awareness as Predictors of Women's Interest in Breast Cosmetic Surgery

BACKGROUND

The aim of the present research was to analyze the role of self-awareness, self-monitoring, perceived media pressures, and peer attributions on the consideration of breast cosmetic surgery among women. The internalization of thin ideals was taken into account as a key moderating variable.

METHODS

Participants were 132 Italian women (mean age = 33.62), who completed a questionnaire aimed at measuring the variables of interest. Path analysis was used to test our hypotheses.

RESULTS

The results indicated that perceived media pressure, self-monitoring, and peer attributions influenced participants' interest in breast modification procedures through the internalization of thin ideals. Self-awareness (both private and public) had a direct effect on women's consideration of breast cosmetic surgery.

CONCLUSIONS

This research is one of few analyzing how specific aspects of the self could influence women's interest in cosmetic surgery. These findings contribute to the understanding of the reasons that trigger women's interest in cosmetic surgery. Not only sociocultural influences contribute to the development of favorable attitudes toward cosmetic surgery, but also specific aspects of the self have a relevant role.

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 .

Painless, safe, and efficacious noninvasive skin tightening, body contouring, and cellulite reduction using multisource 3DEEP radiofrequency

In the last decade, Radiofrequency (RF) energy has proven to be safe and highly efficacious for face and neck skin tightening, body contouring, and cellulite reduction. In contrast to first-generation Monopolar/Bipolar and "X -Polar" RF systems which use one RF generator connected to one or more skin electrodes, multisource radiofrequency devices use six independent RF generators allowing efficient dermal heating to 52-55°C, with no pain or risk of other side effects. In this review, the basic science and clinical results of body contouring and cellulite treatment using multisource radiofrequency system (Endymed PRO, Endymed, Cesarea, Israel) will be discussed and analyzed.

Factors that motivate people to undergo cosmetic surgery

A sample of 204 British participants completed a questionnaire that assessed their attitude toward cosmetic surgery as well as measures of self-esteem, life satisfaction, self-rated physical attractiveness, religiosity and media consumption. Two factors emerged from a factor analysis of their attitudes toward surgery: likelihood to undergo, and benefits of undergoing, cosmetic surgery. Females with low self-esteem, low life satisfaction, low self-rated attractiveness and little religious beliefs who were heavy television watchers reported a greater likelihood of undergoing cosmetic surgery. Stepwise regression analysis with the two attitude factors as criterion variables showed two major predictors for likelihood: religiousness and low self-esteem, and four major predictors for benefit: religousness, media consumption, life satisfaction and sex. The role of religion is considered in this context.

Weight information labels on media models reduce body dissatisfaction in adolescent girls

PURPOSE

To examine how weight information labels on variously sized media models affect (pre)adolescent girls' body perceptions and how they compare themselves with media models.

METHODS

We used a three (body shape: extremely thin vs. thin vs. normal weight) × three (information label: 6-kg underweight vs. 3-kg underweight vs. normal weight) experimental design in three age-groups (9-10 years, 12-13 years, and 15-16 years; n = 184). The girls completed questionnaires after exposure to media models.

RESULTS

Weight information labels affected girls' body dissatisfaction, social comparison with media figures, and objectified body consciousness. Respondents exposed to an extremely thin body shape labeled to be of "normal weight" were most dissatisfied with their own bodies and showed highest levels of objectified body consciousness and comparison with media figures. An extremely thin body shape combined with a corresponding label (i.e., 6-kg underweight), however, induced less body dissatisfaction and less comparison with the media model. Age differences were also found to affect body perceptions: adolescent girls showed more negative body perceptions than preadolescents.

CONCLUSIONS

Weight information labels may counteract the generally media-induced thin-body ideal. That is, when the weight labels appropriately informed the respondents about the actual thinness of the media model's body shape, girls were less affected. Weight information labels also instigated a normalization effect when a "normal-weight" label was attached to underweight-sized media models. Presenting underweight as a normal body shape, clearly increased body dissatisfaction in girls. Results also suggest age between preadolescence and adolescence as a critical criterion in responding to media models' body shape.

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

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

Cosmetic medical treatments: why are we so obsessed with beauty-is it nature or nurture?

Cosmetic medical treatments have become mainstream, and images of beauty surround us on television, in magazines, and in advertising. It is no wonder that the quest for beauty has become so prevalent. This paper explores why individuals choose to undergo cosmetic procedures, and looks at the nature versus nurture debate surrounding this phenomenon. It is important for nurses, physicians, nurse practitioners, or other healthcare professionals involved in the cosmetic surgery field to understand the underlying motivations for choosing to undergo elective cosmetic procedures in order to make appropriate choices about their patients' care. The first theory in this article is rooted in the "nature" school-of-thought and explores the evolutionary basis behind the quest for beauty. It shows that we may be 'hardwired' to think that our appearance signals our reproductive capability (D. B. Sarwer, L. Magee, & V. Clark, 2004) and that human physical attractiveness is merely a collection of physical traits that signal fecundity and health (V. Swami, C. Greven, & A. Furnham, 2007). The "nurture" concept focuses on the second theory, the sociocultural theory, which implies that people who choose to use cosmetic medical treatments to enhance their appearance may be attempting to increase their self-image or self-perception, improve their social relationships, and increase their probability of success across a variety of social situations. Other minor theories such as the estrogen theory and the psychological theory are discussed, along with implications for practice. All of these theories are valuable to the healthcare professional and allow a deeper understanding of the psyche of their patients.

Commentary on cellulite: skin mechanobiology and the waist-to-hip ratio

Cellulite is a gender-related condition which is the clinical expression of conformational changes taking place in the fibrous strands partitioning the hypodermis. The affected skin areas are those where fat deposition is under the influence of estrogens. Some hypodermal fibrous strands become enlarged and others become loose and look similar to striae distensae. Cellulite is not a result of increased body mass, but its aspect may be influenced by the waist-to-hip ratio.

Motivating factors for seeking cosmetic surgery: a synthesis of the literature

The fascination in physical beauty is becoming more and more prevalent in today's society. Beauty in American culture is defined by the media through magazines, television, and music. The perfect career, the perfect family, social status, and high self-esteem all revolve around having an impeccable figure. Research shows that 94% of the covers of women's magazines showcase a woman with a thin physique (A. R., Malkin, K., Wornian, & J. C. Chrisler, 1999). Therefore, it is not surprising that year after year, millions of people elect for cosmetic surgery. According to the , approximately 11.7 million cosmetic surgical and nonsurgical procedures were performed and Americans spent $13.2 billion on these procedures. This is a 457% increase since 1997. As the demand for elective cosmetic surgery continues to rise, it is important for healthcare employees to recognize the motive behind the decision to seek cosmetic surgery. The purpose of this literature review project was to ascertain those factors that influence or motivate patients to seek cosmetic surgery. This project investigated physical, psychiatric, and psychosocial factors associated with individuals who undergo elective cosmetic surgery. It has been shown that the motivation for cosmetic surgery is based on a combination of psychological and emotional factors. Researchers surmise that body image, teasing history, and self-esteem were associated with motivational factors for those patients who elected to seek cosmetic surgery (T. Soest, I. L. Kvalem, K. C. Skolleborg, & H. E. Roald, 2006). In addition, the researchers concluded that body dysmorphic disorder, education, and culture are also predicting factors in the decision to have cosmetic surgery.

Acne vulgar e bem-estar em acadêmicos de medicina

FUNDAMENTOS - Observa-se comorbidade psiquiátrica em 40% dos pacientes dermatológicos adultos, sendo a acne vulgar de interesse da psicodermatologia por ter entre suas complicações seqüelas psicossociais. OBJETIVOS - Estabelecer a relação entre acne e o status de bem-estar. MÉTODOS - Estudo de caso-controle com dados coletados a partir do Índice de Bem-Estar da Organização Mundial da Saúde, por meio de entrevistas com dois grupos de 50 acadêmicos de medicina, sendo um com acne e outro sem acne. RESULTADOS - Foi verificado que 26% dos acadêmicos do grupo de casos e 24% do grupo controle apresentaram de 0 a 4 pontos em pelo menos um dos itens questionados. CONCLUSÕES - Apesar de a maioria dos pacientes apresentar atitudes e sentimentos desencadeados pela acne, não se demonstrou associação estatisticamente significativa entre essa dermatose e baixo nível de bem-estar.

Nasal shape and gender of the observer: implications for rhinoplasty

BACKGROUND

In a previous study we focused on gender specific nasal shapes. The aim of this study was to evaluate if preferences in nasal shape are also dependent on the gender of the observer.

METHODS

Stratified on the basis of each photographed subject's (n=311) own evaluation, female and male composite pictures of "average" (n=128, each), "optimal" (n=16, each) and "most unpleasant" (n=8, each) noses were created in a previous study. These composites were assessed by 308 independent female and male judges using a visual analogue scale.

RESULTS

On average, female judges were found to accord significantly higher ratings of attractiveness as compared to male judges for the composite images independent of the gender of the person shown (p=0.020). The difference was greatest when assessing most unpleasant male composites (p<0.003) but was not apparent when assessing "optimal" female and "optimal" male noses. Despite this, women displayed the same preferences for "optimal" and "average" noses as compared to the "most unpleasant" noses. In assessing their own noses, women were significantly less satisfied with their appearance in general (p=0.001) as compared to men.

CONCLUSIONS

In comparison to men, women are more critical in assessing the appearance of their own nose as opposed to the noses of other people. The implications of this for rhinoplasty, so far as considering the degree of influence of the gender of a person assessing a prospective patient's nose remains a matter of conjecture.

Facial Attractiveness

Symmetry is thought to be a major prerequisite for an attractive face. Many faces are not symmetric, yet are still regarded as beautiful. What role, then, does asymmetry play in the perception of beauty? We studied the assessment of computer-manipulated images by independent judges (n = 200-250): part A: nevi located at different positions; part B: standardized changes of the orbital region. The results showed that slight lateral orbital and facial asymmetry does not impair attractiveness at all and that asymmetries close to the midline are significantly less attractive than those affecting the lateral aspect of the face (P < 0.001). A single nevus which is located laterally on the face is significantly more attractive than a nevus close to the midline (P < 0.001). Faces with a completely symmetric bilateral pair of nevi in the same lateral positions (perceived as attractive when alone), received the worst ratings (P < 0.001). Symmetry is a characteristic of the attractive face, but there are exceptions to the rule. Under certain conditions symmetry can be completely unattractive. The visual impact of symmetry on the perception of beauty increases significantly when approaching the midline.

Body image and cosmetic medical treatments

Cosmetic medical treatments have become increasingly popular over the past decade. The explosion in popularity can be attributed to several factors-the evolution of safer, minimally invasive procedures, increased mass media attention, and the greater willingness of individuals to undergo cosmetic procedures as a means to enhance physical appearance. Medical and mental health professionals have long been interested in understanding both the motivations for seeking a change in physical appearance as well as the psychological outcomes of these treatments. Body image has been thought to play a key role in the decision to seek cosmetic procedures, however, only recently have studies investigated the pre- and postoperative body image concerns of patients. While body image dissatisfaction may motivate the pursuit of cosmetic medical treatments, psychiatric disorders characterized by body image disturbances, such as body dysmorphic disorder and eating disorders, may be relatively common among these patients. Subsequent research on persons who alter their physical appearance through cosmetic medical treatments are likely provide important information on the nature of body image.