Factor structure and correlates of the acceptance of cosmetic surgery scale among South Korean university students

Knowledge and Attitude Towards Botulinum Toxin Use in Cosmetic Injections Among the Arar Population in Saudi Arabia: A Cross-Sectional Study

Background The use of botulinum toxin (BT), commonly known as Botox, has become increasingly popular for cosmetic purposes, particularly in treating wrinkles and facial rejuvenation. While the efficacy of botulinum toxin in achieving desired aesthetic outcomes is well-established, it is also important to consider the level of public knowledge and awareness regarding this potent neurotoxin. This study investigates the knowledge and attitude towards botulinum toxin use in cosmetic injections in the Arar population. Methods This cross-sectional study utilized a self-report questionnaire distributed via social media platforms, employing randomized sampling from May to July 2024. The target population included adults aged 18 and older, regardless of gender, living in the city of Arar, Saudi Arabia. The data were collected through an online self-administered survey using a Google Forms questionnaire template, which was translated into the appropriate language. The collected data was analyzed using descriptive and inferential statistics. Results A total of four hundred and ten (410) participants responded to this study. The maximum number of participants, 149 (36.3%), were in the age group of 20-25 years, while the minimum number of participants, 6 (1.5%), was in the age group of 50-55 years. The results also showed that 341 (83.2%) of participants were females and 69 (16.8%) were males; 262 (63.9%) participants were aware of Botox treatment used in cosmetic clinics. Concerning the most prevalent non-surgical cosmetic treatments, 29 (7%) answered dental procedures, and 19 (4.6%) mentioned its use in pain. Conclusion This study found that 262 (63.9%) of the study population showed knowledge about botulinum toxins used in cosmetic injections. The majority of them were young individuals, females, or unmarried people. Only 83 (20%) were aware of the adverse effects of botulinum toxin. This low level of awareness about the potential risks associated with the use of botulinum toxins for cosmetic purposes is concerning and suggests the need for improved education and information dissemination.

Perception Toward Cosmetic Surgeries Among Adults in Saudi Arabia and Its Associated Factors: A Cross-Sectional Study

OBJECTIVE

This study assessed the acceptance of cosmetic surgery among the Saudi population and examined its relationship with body dysmorphic disorder and the participants' demographic characteristics.

METHODS

A cross-sectional study was conducted between June 2023 and February 2024. A sample of 1368 participants were recruited from hospitals, clinics, and public places such as malls, parks, and universities and were asked to complete a self-administered, pre-validated, and open-access questionnaire about the presence of body dysmorphic disorder using the BDD scale and the acceptance of cosmetic surgery using the ACSS scale, analyzed using IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.

RESULTS

More than half of the participants were female, single, and had a higher educational level. Only 3.0% of the participants had previously undergone cosmetic surgery (CS). Rhinoplasty was the most common cosmetic surgery performed by both genders. More than half of the participants indicated that they had concerns about their appearance, which caused them distress, torment, or pain. However, only one-third of the participants demonstrated acceptance toward CS. There was a significant positive correlation between body dysmorphic disorders (BDD) and acceptance of the cosmetic surgery scale (ACSS). Moreover, higher significant acceptance for CS (p-value is <0.001) was observed in females, south region, 32- to 40-year-olds, postgraduate degrees of education, married persons, and those undergoing previous cosmetic surgery.

CONCLUSION

Concerns about appearance causing distress were prevalent among participants, yet acceptance of cosmetic surgery was moderate. Individuals with higher levels of BDD symptoms are more inclined to view cosmetic surgery as a viable solution to their perceived concerns about their appearance. Moreover, being female, from the southern region, aged 32 to 40 years, with postgraduate education, married individuals, and having prior cosmetic surgery experience are motives to accept CS. These findings underscore the complex interplay between psychological factors and demographic characteristics in shaping the acceptance of cosmetic surgery.

Knowledge, Attitudes, and Practices With Regard to Cosmetic Procedures Among the General Population in the Western Region of Saudi Arabia: A Cross-Sectional Study

Background One of the most frequently carried out medical procedures is an aesthetic procedure. These procedures have become increasingly popular in our country due to various factors, such as body image dissatisfaction, the desire for perfection, and the expanding influence of social media. The aim of our study is to assess the knowledge, attitudes, and practices with regard to cosmetic procedures among the general population in the western region of Saudi Arabia. Methods This population-based cross-sectional study uses a self-report questionnaire distributed via social media platforms with randomized sampling between March and April 2023. The target population of this study is the general population in the western region of Saudi Arabia who are 18 years old and above from both genders. All participants who have congenital anomalies or mental disorders, are non-Arabic speakers, and refuse to participate in the study are excluded. Our data collected via an online self-administrated translated questionnaire survey was designed using a Google Forms questionnaire template. Results The study questionnaire was completed by 477 individuals in total. The mean age of the participants was 27.4±12.9 years, with ages ranging from 18 to over 60. A total of 190 individuals (39.8%) had prior knowledge of cosmetic procedures, and 338 (70.9%) were female. Of the non-surgical cosmetic treatments that people are most familiar with, 37.9% mentioned filler injections. Additionally, the most popular surgical cosmetic surgery was rhinoplasty (73.6%) and liposuction (22%). 85.7% of respondents said social media impacts people's decisions to undergo cosmetic treatments, while 86.8% of respondents said women do more cosmetic procedures than males. Of the participants, only 40 (8.4%) had previous cosmetic procedure done before. Rhinoplasty was the most common undergone surgical treatment (15.4%). In terms of non-surgical treatments, hair removal accounted for the majority (51.3%). Conclusion This study revealed that 39.4% of the study population, the majority of which are young individuals, females, and singles, have a good knowledge with regard to cosmetic procedures due to many factors such as culture diversity among generations, distribution of the social media, and interest differences. We conclude that the social media factor can significantly influence the practice of cosmetic procedures.

The Effect of Beautification Strategies on Mating Popularity Judged by Men from the People's Republic of China

Contemporary women frequently employ beautification strategies. The impact of such strategies, such as plastic surgery, on mating popularity in different mate contexts remains unclear. To investigate this issue, the current study conducted two experiments. In Experiment 1, beautification strategies were manipulated using three images of the same female with different conditions (natural, makeup, and plastic surgery). The results indicated that when the beautification strategies were not informed, surgical-enhanced and makeup targets were perceived as significantly more attractive, loyal, and popular among potential mates than natural targets. However, when participants were informed of the beautification strategies, both natural and makeup targets showed a significant increase in perceived loyalty and mating popularity. In contrast, surgically enhanced targets saw a reduction in these dimensions. Experiment 2 aimed to reduce the confounding effect of facial attractiveness by using vignettes. The results indicated that the mating popularity of natural targets was significantly higher than that of makeup or surgically enhanced targets, with surgically enhanced targets being the least popular. Moreover, the results revealed the mediating role of perceived loyalty in the impact of beautification strategies on long-term mating popularity. This study sheds light on the potential stigmatization and negative bias toward beautification strategies in the mating market. Additionally, it provides guidance for women who intend to enhance their mate popularity through plastic surgery.

BodyThink program-based body image education improves Korean adolescents' attitudes toward cosmetic surgery: randomized controlled trial

BACKGROUND

The aims of this study were to modify the widely used BodyThink program to suit the circumstances of Korean schools and determine its effects on body esteem, body image, appearance stress, depression, and attitudes toward cosmetic surgery.

METHODS

Participants were 184 third-grade students from two middle schools in Korea, who were randomly assigned to a control or intervention group. Two of the participants dropped out; hence, data from 182 students were analyzed. The control group received the existing curriculum for 4 sessions, and the experimental group was provided with 4 sessions of the revised BodyThink program. Before and after the intervention, all participants completed questionnaires.

RESULTS

In the BodyThink group, improved body image, decreased depression, and positive improvements in attitudes toward cosmetic plastic surgery were observed after the intervention.

DISCUSSION

These results suggest that school health nurses can utilize interventions based on BodyThink program in their curricula to improve the physical and emotional health of adolescents.

TRIAL REGISTRATION

This study has been retrospectively registered with the Clinical Research information Service (CRIS) in Korea on October 5, 2023 (KCT0008839).

A guide to exploratory structural equation modeling (ESEM) and bifactor-ESEM in body image research

Traditionally, assessments of factor validity of body image instruments have relied on exploratory or confirmatory factor analysis. However, the emergence of exploratory structural equation modeling (ESEM), a resurgence of interest in bifactor models, and the ability to combine both models (bifactor-ESEM) is beginning to shape the future of body image research. For these analytic approaches to truly advance body image research, scholars will need to have a deep understanding of their use and application. To facilitate such understanding, we describe ESEM and bifactor-ESEM models for body image researchers and provide them with the tools they need to apply these methods in their own work. Specifically, we provide an overview of ESEM and bifactor-ESEM models, and describe their broad applicability to body image research. Next, we describe how ESEM and bifactor models can be used and, using an existing dataset of responses to the Acceptance of Cosmetic Surgery Scale, demonstrate how ESEM and bifactor-ESEM models can be deployed. To facilitate wider application of these ideas, we provide our Mplus syntax (inputs) in Supplementary Materials. Through this manuscript, we hope to assist researchers to better understand the strengths ESEM and bifactor models, and to use these approaches in their own work.

Psychometric properties of an Arabic translation of the body appreciation scale (BAS-2) and its short forms (BAS-2SF) in a community sample of Lebanese adults

OBJECTIVES

The present study sought to examine the factor structure, reliability, validity and gender invariance of the Arabic Body Appreciation Scale (BAS-2), and its two short forms (the 3-item and 2-item BAS-2SF) among community Lebanese Arabic-speaking adults.

METHODS

We carried-out an online cross-sectional survey. The 10-item BAS-2, the functionality appreciation scale and the Eating Attitudes Test-26 were completed by 826 Lebanese community adults (57.9% females, aged 25.42 ± 8.44 years).

RESULTS

The Arabic 10-item, 3-item and 2-item BAS-2 converged on a one-factor solution, and demonstrated high internal consistency (McDonald's ω value of .92, .88, and .86 respectively). All indices suggested that configural, metric, and scalar invariance was supported across gender. The 3-item and 2-item BAS-2SF were highly correlated with the original BAS-2 (r > 0.9). Higher 10-item, 3-item and 2-item BAS-2 scores correlated significantly and strongly with more positive eating attitudes and greater functionality appreciation, and higher 10-item BAS-2 scores correlated positively and weakly with BMI, supporting convergent validity.

CONCLUSION

The present work contributes to the literature by providing a psychometrically sound Arabic-translation of the BAS-2 and short-forms, benefitting both researchers and clinicians.

Cosmetic Surgery and the Diversity of Cultural and Ethnic Perceptions of Facial, Breast, and Gluteal Aesthetics in Women: A Comprehensive Review

An increasing number of people are opting for cosmetic surgeries. For many years, the physical and aesthetic appearance of Caucasians has been considered to be ideal. However, it is now commonly acknowledged that attractiveness and aesthetic standards vary among cultural backgrounds and ethnic groups and that Western attractiveness criteria no longer apply to all. Herein, we conducted a comprehensive review of studies that examined cultural and ethnic variations in preferences for facial, breast, and gluteal aesthetics, as well as reviewed studies that investigated ethnic disparities in attitudes and motivations for cosmetic surgery. A total of 4532 references were identified, 66 of which met the inclusion criteria. Several studies have reported that facial golden ratios are invalid for representing perceived attractiveness standards among different ethnicities. The majority of studies also indicated that facial aesthetic interventions should not aim to Westernize but to optimize ethnic traits. Significant ethnic differences in preferences for upper- and lower-pole breast proportions have been reported. The size of the buttocks and waist-to-hip ratio were identified as the main factors of buttock aesthetics, with buttock size preferences having a high ethnic diversity. Interest in cosmetic surgical procedures while maintaining ethnic identity continues to grow among young women worldwide. This comprehensive review strongly suggests that accommodating cultural and ethnic differences in aesthetic standards in cosmetic surgery planning can lead to more acceptable cosmetic outcomes.

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.

Local Community View of Aesthetic Surgery: Results of a Cross-Sectional Survey

Background Aesthetic surgery has increased in popularity, reflecting the increased consumer demand. However, the variation in patients' ethnic and cultural beliefs has led to many challenges. Therefore, those who manage aesthetics should always listen and recognize the variability of cultural identities, desires, attitudes, anxieties, and uncertainties of the patient. Emerging from a diversity of cultures and its transforming trends, the scope of cosmetic surgery and its practice reflect not only the individual's personality but also the culture as a whole. When counseling an individual, one has to recognize that even in groups of seemingly identical social or cultural standards, there are subtle differences in attitude. Aim To assess the perception of the local community about aesthetic procedures and to determine the possible factors influencing their level of acceptance through a randomized cross-sectional survey. Methodology A community-based, qualitative, cross-sectional study was performed through an anonymous questionnaire that was randomly distributed among the local population. Questions with regard to the sociodemographic data were implemented, as well as the core questions, to assess the perceptions that are based on the modified Acceptance of Cosmetic Surgery Scale (ACSS). Results A total of 857 participants responded to the study questionnaire. Their age ranged from 18 to more than 55 years, with a mean of 23.1 ± 12.9 years. Out of the total number, 630 (73.5%) were females while the remaining 227 (26.5%) were males. More than half of them were single (53.4%), and the remaining were married. Regarding perception, the highest score in percentage was for the interpersonal subscale (18.7 ± 7.9; 53.4%), followed by the consider subscale (18.2 7.2; 52%) and the social subscale (15.5 ± 7.9; 44.3%). The overall mean score was (52.4 ± 21.1; 49.9%). As for the procedure, the most intended was rhinoplasty (41.1%), followed by liposuction (32.9%), abdominoplasty (31.1%), face-lift (24.4%), reconstructive surgeries (24.4%), and lips filler (20.8%) while the least intended was gluteal flat grafting (8.7%). Conclusions Female patients are more eager to undergo cosmetic and aesthetic surgery compared to their male counterparts. Age did not have a major impact as a motive to look for cosmetic surgery.

The Effect of Acceptance of Cosmetic Surgery, Body Appreciation, and Nasal Obstruction on Patient Satisfaction After Rhinoplasty

Background: It is difficult to predict functional and aesthetic results and provide patient satisfaction after rhinoplasty. Objective: To investigate the effect of nasal obstruction, body appreciation, and acceptance of cosmetic surgery (ACS) in predicting patient satisfaction postrhinoplasty. Methods: We prospectively included 97 consecutive participants who underwent rhinoplasty. We recorded age, gender, marital status, education, and body mass index (BMI), and nasal obstruction symptom evaluation (NOSE) scale, body appreciation scale-2 (BAS-2), acceptance of cosmetic surgery scale (ACSS), and rhinoplasty outcome evaluation (ROE) scale were determined preoperatively and at the 3-month postoperative follow-up. Results: The preoperative and postoperative NOSE, BAS-2, ACSS, and ROE scores differed significantly. The mean ROE score improved from 36.8 preoperatively to 82.1 postoperatively. The ROEpostop score was not correlated significantly with age, BMI, ACSSpreop, BAS-2postop, or ACCSpostop. The BAS-2preop scores were correlated significantly with ACCSpreop and ACSSpostop scores. The NOSEpreop and BAS-2preop scores were significant predictors of the ROEpostop scores in the regression analysis. Conclusion: Preoperative nasal obstruction and body appreciation, but not ACS, are factors that might affect patient satisfaction after rhinoplasty.

Short forms of the Body Appreciation Scale-2 (BAS-2SF): Item selection and psychometric evaluation

The 10-item Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015) is a widely used contemporary measure of positive body image that assesses one's love for, acceptance and appreciation of, and respect for their body. Given the need for abbreviated measures to reduce participant burden and study cost, we aimed to generate a short form of the BAS-2 (BAS-2SF). Two versions of the BAS-2SF emerged: a 3-item version derived deductively from theory (items selected based on their unique contribution to the body appreciation construct), and a 2-item version generated empirically (items selected based on a genetic algorithm approach). Psychometric evidence was garnered across five studies, totaling 3114 participants. Both BAS-2SF versions correlated highly (rs = .93-.97) with the original 10-item BAS-2 and demonstrated internally consistent and stable scores. Factor analyses revealed high item-factor loadings, unidimensionality, and gender invariance of the 3-item BAS-2SF. Correlations with construct validity measures, as well as model pathways, were similar between both BAS-2SF versions and the 10-item BAS-2. BAS-2SF versions also evidenced incremental validity. Both BAS-2SF versions retain the psychometric integrity of the BAS-2 and are recommended for use; however, the 3-item BAS-2SF is an ideal option for researchers who wish to estimate a body appreciation latent factor.

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.

Validation of a Korean Version of the Body-Appreciation Scale (K-BAS) in Young Women

Despite concerns regarding body image in young Korean women, no measurement tool has yet been developed or is available. This study examined the validity and reliability of the Korean version of the Body-Appreciation Scale (K-BAS) to assess body image positivity among young women. For this purpose, convenience sampling was conducted using social network services. The participants were 245 women (N = 245) aged 20 to 40 years. Validity and reliability were examined using item analysis, factor analysis, and correlation with body mass index, body dissatisfaction, and Cronbach’s alpha. Twelve items were selected for the study. Two factors were extracted through factor analysis, explaining 64.82% of the variance and showing a good model fit in the K-BAS. The K-BAS score was negatively correlated with body mass index (r = −0.33, p < 0.001) and body dissatisfaction (r = −0.41, p < 0.001). Reliability was high, as indicated by a Cronbach’s alpha of 0.91. These results indicate that the K-BAS may serve as an appropriate instrument for measuring body image positivity among young Korean women. It may also be useful for identifying women with abnormal body perceptions.

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.

Gender Differences in Body Appreciation and Its Associations With Psychiatric Symptoms Among Chinese College Students: A Nationwide Survey

BACKGROUND

Body appreciation (BA hereafter), which reflects approval, acceptance, and respect for one's body while also rejecting media-promoted appearance ideals as the only form of human beauty, is an important aspect of positive body image. Much of the BA literature has been conducted on samples from Western nations but less is known about BA or its correlates in Asian cultural contexts wherein concerns with body image are also common. Toward addressing this gap, we examined gender differences in BA and its associations with common psychiatric symptoms (i.e., depressive symptoms, anxiety symptoms, and suicidality) within a national college student sample from China.

METHOD

This cross-sectional, nationwide study was conducted between December 27, 2020, and January 18, 2021, based on snowball sampling. Aside from measures of demographics and background factors, Chinese versions of the Body Appreciation Scale-2 (BAS-2), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and a standard item on suicidal ideation and planning were administered to assess BA, depressive and anxiety symptoms, and suicidality, respectively.

RESULTS

In total, 2,058 college students (665 men, 1,393 women) in China were assessed. An analysis of covariance revealed that the men had a significantly higher average BA level than did women [F _(1,2058) = 13.244, P < 0.001, Cohen's d = 0.193]. Hierarchical multiple regression analyses revealed BA was negatively associated with symptoms of depression, anxiety, and suicidality within the entire sample (depressive symptoms, β = -0.129, P < 0.001; anxiety symptoms, β = -0.101, P < 0.001; suicidality, OR = 0.788 P = 0.020) and among women (depressive symptoms, β = -0.172, P < 0.001; anxiety symptoms, β = -0.131, P < 0.001; suicidality, OR = 0.639 P = 0.001) but not men.

CONCLUSION

Chinese college women reported lower BA than their male peers did. Furthermore, among women but not men, elevations in BA corresponded with protective mental health experiences including lower levels of depressive symptoms, anxiety symptoms and suicidality. Findings underscore the potential utility of including BA in mental health assessments of Chinese college students, especially women. Findings also provide foundations for continued research on interventions to increase BA among at-risk young women in China.

Acceptance of Cosmetic Surgery among Hungarian Women in a Global Context: the Hungarian Version of the Acceptance of Cosmetic Surgery Scale (ACSS)

In recent years, the popularity of surgical cosmetic procedures has dramatically increased in the Western world. The Acceptance of Cosmetic Surgery Scale (ACSS) provides a measure of psychological acceptance of cosmetic surgery. The original instrument (ACSS) contains three subscales (Interpersonal, Social, and Consider). Since its publication, the ACSS has been adapted for many languages. The primary objective of the present study was to develop the Hungarian version of the ACSS. Furthermore, focus was laid on whether the original factor structure could be replicated with a Hungarian sample despite expectable cultural differences from other national samples. To obtain cross-culturally comparable data, the same scales were used for psychometric analysis as those used in the development of the original ACSS and its various national versions. The Hungarian sample included 482 female participants aged between 18 and 68 years (M = 29.02, SD = 10.71), who completed a questionnaire battery. Validity of the Hungarian version was tested with the following measures: the Rosenberg Self-Esteem Scale (RSES), the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3), the Satisfaction with Life Scale (SWLS), the Body Appreciation Scale (BAS), and the Photographic Figure Rating Scale (PFRS) developed for women. The results show that the obtained Hungarian version of the ACSS is a reliable and valid measure, which enables researchers in the field to study Hungarian samples. Furthermore, the factor structure of the Hungarian scale is identical with that of the original ACSS, which enables reliable cross-cultural comparisons. For these reasons, the authors expect that the Hungarian ACSS will stimulate more in-depth quantitative research on attitudes towards cosmetic surgery within the Hungarian context, and it will also contribute to a better understanding of acceptance of cosmetic surgery from a cross-cultural perspective.

Impact of Self-Esteem and Self-Perceived Body Image on the Acceptance of Cosmetic Surgery

Backboard Cosmetic surgery is the preservation, rebuilding, or improvement of the physical appearance of an individual through surgical and non-surgical methods. In the last few years, an increase in the number of cosmetic procedures was noticed worldwide. This increase suggests due to multifactorial changes in people's attitudes towards cosmetic surgery and concern about their physical appearance. This study aims to assess the impact of self-esteem and self-perceived body image on the acceptance of cosmetic surgery and other related factors in the Eastern province of Saudi Arabia. Material and methods This was a cross-sectional study carried out in the Eastern region of Saudi Arabia. The study was conducted between May and August 2021. A self-administrated questionnaire was distributed to all the participants who are attending plastic surgery clinics and online through social media. Three valid and reliable scales were used [Acceptance of Cosmetic Surgery Scale (ACSS), Body Appreciation Scale (BAS), Rosenberg Self-Esteem Scale (RSE)] to assess the relationship between these variables and other factors. The data were analyzed by using two-tailed tests. P-value less than 0.05 was statistically significant. Correlation analysis was done by using the Pearson correlation coefficient (r). Results A total of 1008 participants were included in the study with a response rate of 67%. Participant's ages ranged from 18 to 54 years with a mean age of 34.7 ± 11.2 years old. The study participants showed an average level of acceptance with a mean score % of 55.4% comparing to body appreciation; it was 74.2% higher with a more than average level of self-esteem, 24.7 out of 40 points for self-esteem with a mean score of 61.8%. Participants with a history of cosmetic surgery had significantly higher acceptance score than who did not (mean score of 72.6 compared to 57.1; P=0.001). Male participants had better body appreciation than females (mean score of 50.2 vs. 47.6, respectively; P=0.013). A weak positive correlation with no significance was found between participants' self-esteem and their acceptance of cosmetic surgery. Conclusion A better understanding of the acceptance of cosmetic surgery from a different cultural perspective and other related factors including social, psychological, and self-esteem are crucial for the plastic surgeon to ensure patient satisfaction.

The cosmetic surgery paradox: Toward a contemporary understanding of cosmetic surgery popularisation and attitudes

Modern women feel compelled to meet near-impossible standards of beauty. For many, this pursuit ultimately culminates in cosmetic surgery - a radical form of beautification that is rapidly becoming popular worldwide. Paradoxically, while prevalent, artificial beauty remains widely unaccepted in contemporary society. This narrative review synthesizes feminist dialogue, recent research, and real-world case studies to argue that female beauty standards account for both the growing popularity of cosmetic surgery and its lack of mainstream acceptance. First, we implicate unrealistic beauty standards and the medicalization of appearance in popularizing cosmetic surgery. Second, we analyze how negative attitudes toward cosmetic surgery are also motivated by unrealistic beauty standards. Finally, we generate a synthesized model of the processes outlined in this review and provide testable predictions for future studies based on this model. Our review is the first to integrate theoretical and empirical evidence into a cohesive narrative that explains the cosmetic surgery paradox; that is, how cosmetic surgery remains secretive, stigmatized, and moralized despite its surging popularity.

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

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

METHODS

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

RESULTS

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

CONCLUSION

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

Factors Affecting the Desire to Undergo Cosmetic Procedures Among the Nurses of Kermanshah, Iran: A Cross-Sectional Study

The number of people undergoing cosmetic procedures (CP) has been growing around the world in recent years. The aim of this study was to determine factors involved in the desire of nurses to undergo CP. A total of 360 nurses were recruited in this cross-sectional study. Stratified random sampling was used to select the samples. The data were collected using the Social Appearance Anxiety Scale and a questionnaire addressing social factors affecting the desire to undergo CP. More than half of the nurses (56.7%) were willing. Gender, social factors, and social appearance anxiety (SAA) were associated with undergoing CP. The results of logistic regression indicated that women were four times more willing to undergo CP than men, and for each unit increase in SAA score, the odds of desiring to undergo CP increased by 1.04. The Hosmer-Lemeshow test confirmed the goodness-of-fit of the regression model. Moreover, 3 independent variables of gender, SAA, and social factors were powerful predictors of the desire to undergo CP that could explain 39.9%-53.6% of changes in the desire to undergo CP. Further studies are needed to investigate the amount of CP and motivations to undergo CP in nurses.

Cross-cultural measurement invariance of the Body Appreciation Scale-2 across five countries

The Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015a, 2015b) is a widely used measure of positive body image within many cultures and countries; yet, cross-cultural examinations are few. The present study aimed to investigate the measurement invariance of the BAS-2 across adults from five countries: Iran, Japan, Poland, Serbia, and the U.S. The sample included 2944 participants ranging in age from 18 to 82 years. The findings provided evidence that the BAS-2's one-dimensional structure is the same in these countries. Partial metric invariance (when some but not all items contribute to a latent construct equally for groups) indicated that nine out of 10 items contributed to the latent body appreciation construct to a similar degree across the countries. When a Multiple Indicators Multiple Causes (MIMIC) model was applied with participants' age and gender as covariates, evidence of differential item functioning was found. Results suggest that both age and gender influenced body appreciation, indicating that the body appreciation factor means are different at different levels of the covariates. In conclusion, cross-culturally body appreciation may be shaped by country, language, age, and gender correlates to different degrees. In future research, measurement invariance analyses should be conducted prior to cultural group comparisons on the BAS-2.

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

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

Meta-analysis of gender differences in body appreciation

There are a number of studies that have conducted comparisons of body appreciation between males and females. However, findings are largely inconsistent, making it unclear whether there are actual gender differences in body appreciation. With a meta-analytic approach, the current study quantitatively reviewed and synthesized previous findings, published up to May 2019, on gender differences in body appreciation. After searching and screening potential studies in four databases (i.e., PubMed, PsycINFO, Web of Science, and ProQuest Dissertations & Theses Global), we identified 40 relevant articles published from 2008 to 2019. A random-effects model reveals an overall estimate of gender difference in body appreciation of d = 0.27 (95 % CI: 0.21, 0.33; p <  .001); that is, males generally have a higher level of body appreciation than females, with a small effect size. Survey method, type of sample (cohorts), and age were identified as significant moderators that have contributed to the variability in previous findings. Future research and interventions in body appreciation may consider gender differences in their designs.

From Oldboy to Burning: Han in South Korean films

Korean culture has been shaped by the traumatic colonial past (1910–1945), which in part facilitated the rise of the historical-cultural han concept in the 1920s onward, often interpreted as rancor, grief, or resentment due to a real or alleged undeserved experience of the Korean people but also beautiful artistic expressions. Scholars have applied han to, for example, Korean music genres like pansori and even Korean American popular culture. The current article critically examines expressions of implicit han in relation to four contemporary South Korean films. The analysis suggests that han is expressed in a plethora of ways, depending on for instance the main characters’ constitution and the specific cultural-ideological framework presented in each text, and must always be understood in relation to such macro variables rather than as an isolated expression of a particular concept.

Craniofacial Anthropometric Profile of East Asians

Facial anthropometric data has significant ethnic variation. East Asia, comprised of fourteen countries, represents a significant proportion of the global population. This systematic review presents the facial anthropometric data collected from these countries. The systematic review was conducted in accordance with PRISMA guidelines. An electronic search of the MEDLINE database returned 3054 articles. Twenty articles were considered eligible for inclusion. Nine studies were conducted in China, 1 in Indonesia, 2 in Japan,3 in Korea, 4 in Malaysia, and 1 was a multicentre study conducted in China, Japan, Thailand, and Vietnam. Qualitative and quantitative parameters were extracted from the20 studies. No data was found for the other East Asian countries. There is a paucity of facial anthropometric data for East Asian countries despite their high burden of craniofacial anomalies and a strong demand for cosmetic facial surgery, both of which would benefit from the collection of robust craniofacial norms. It is in the interest of both the craniofacial surgeon and the East Asian patient to collect baseline facial anthropometric data for this population.

Attitudes and acceptance of the Saudi population toward cosmetic surgeries in Riyadh, Saudi Arabia

Context:

Public awareness regarding cosmetic surgery.

Aims:

To assess the attitudes and acceptance of cosmetic surgery among patients in a tertiary care hospital in Riyadh, Saudi Arabia.

Settings and Design:

Single-center, cross-sectional study in the family medicine department at our institution.

Methods and Material:

Data were collected from 389 patients (age 15-50, 29.37 ± 9.25 years, male: female = 139:250) using the Acceptance of Cosmetic Surgery Scale (ACSS) modified for Arabic speakers.

Statistical Analysis Used:

SPSS 22 statistical package.

Results:

One hundred eighty-five (47.6%) patients were willing to undergo minor cosmetic surgery, whereas 144 (37.1%) were not. Additionally, 237 (60.9%) patients agreed that cosmetic surgery is good because it can help people feel better about themselves, whereas104 (26.8%) patients disagreed. Robust Cronbach α values were observed among all ACSS scales. Mean significant (P = 0.002) differences were observed between gender and the intrapersonal scale scores. The average intrapersonal scale score was greater among female patients (22.48 vs. 19.29). Similarly, the mean consider scale scores among female patients (20.92 vs. 17.45; P = 0.001). Mean significant (P = 0.001) differences were also observed between education and the intrapersonal scale.

Conclusions:

The results reveal important information regarding the acceptance of and attitudes toward cosmetic surgery in Saudi Arabia. There is an urgent need for regulatory intervention to ensure patient safety and satisfaction.

Iranians' Perspective to Cosmetic Surgery: A Thematic Content Analysis for the Reasons

BACKGROUND

Currently, becoming beautiful is a value among Iranian society, although experts have suggested several complications of cosmetic surgery, but decision to have these surgeries has been dramatically increased in recent years. This increase has imposed high workload and costs on the health care system of the country. This study was conducted to explore the reasons why people perform cosmetic surgery in an Iranian context.

METHODS

Twenty-one subjects from both sexes who were 22-52 year-old and had undergone face plastic surgery between 1-5 years ago were enrolled and semi-structured data was collected via open interviews, while qualitative content were analyzed utilizing conventional analysis methods. Data analysis considered the theme “my face, my destiny” which contained 2 subcategories of “obtaining a chance for a better life “and” obtaining acceptance in society”.

RESULTS

The participants considered cosmetic surgery as a blessing from God that played a major role in their future, so they accepted the risks of the surgery.

CONCLUSION

Understanding experiences of these individuals may help health care team particularly nurses to consult them and other individuals who might think about doing cosmetic surgery through education to help them make a better decision for to do cosmetic surgery.

The South Asian facial anthropometric profile: A systematic review

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Body appreciation in British men: Correlates and variation across sexual orientation

Investigations of positive body image among men and across various social identities are lacking, and could contribute to a more complete understanding of the construct, including how positive body image can be improved. This study addressed this gap by investigating correlates of body appreciation - a key facet of positive body image - in men, and testing whether levels of body appreciation vary across sexual orientation. Data from a British community sample of 439 men (M_age = 39.13) showed that body appreciation inversely correlated with conformity to masculine norms and upward appearance-based social comparisons, and positively correlated with physical activity. Body appreciation was lower among sexual minority compared to heterosexual men, and athletic appearance-ideal internalisation and upward appearance-based social comparisons mediated this relationship. Replicating prior research among men, body appreciation positively correlated with body satisfaction, and inversely correlated with perceived appearance pressures from media and eating pathology. These findings have implications for interventions addressing body image among men.

Brazilian Version of the Body Appreciation Scale (BAS) for Young Adolescents

The present study developed a Brazilian adaptation of the BAS for young adolescents, testing its factor structure by the Confirmatory Factor Analysis (CFA), concurrent and criterion validity, and its internal consistency. Participants were 347 adolescents (171 male and 176 female, aged between 10 and 13 years old). Three psychologists experts in psychological evaluation and three teachers of Portuguese of elementary school also participated for the adaptation stage of the items in order to be properly understood by the sample age group. There were few changes from the version culturally adapted for the Brazilian adult population. Cronbach's alpha coefficients were satisfactory for the general population and both sexes (.804; female =.851; male =.752). The one-factor model of the BAS was confirmed by the confirmatory factor analysis with good indicators for the measurements of adjustment to the model, χ2 = 77.9; GFI = 0.967; NFI = 0.940, CFI = 0.979; TLI = 0.968; RMSEA;.038). The convergent validity analyzes revealed significant correlations between BAS scores and BMI (r = -.230; p < .001) and between the first and body image satisfaction (r = .309; p < .001). The BAS version for Brazilian young adolescents had adequate levels of validity and reliability, keeping the one-dimensional structure which indicates its use in Brazilian adolescent's samples.

Factor structure and psychometric properties of a Romanian translation of the Body Appreciation Scale-2

We examined the psychometric properties of a Romanian translation of the 10-item Body Appreciation Scale-2 (BAS-2). A total of 453 university students from Romania completed the BAS-2, along with measures of disordered eating, self-esteem, satisfaction with life, and subjective happiness. In addition, a separate sample of university students (N=109) completed only the BAS-2 at two time-points three weeks apart. Principal-axis factor analysis indicated that BAS-2 scores had a one-dimensional factor structure in both women and men. Confirmatory factor analysis indicated that this factor structure had adequate fit, but invariance across sex was not supported. Further analyses indicated that BAS-2 scores evidenced internal consistency, convergent validity, and test-retest reliability in both women and men. These results suggest that BAS-2 scores reduce to one dimension in Romanian adults, but the lack of sex invariance may indicate that the same latent construct is not being measured in women and men.

Safety of Cosmetic Surgery in Adolescent Patients

Background

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Level of Evidence

2.

Body appreciation, interest in cosmetic enhancements, and need for uniqueness among U.S. college students

The aim of the current study was to examine associations between body appreciation and putative correlates that focus on self-enhancement and self-expression. Students (N=261; mean age=20.16years, SD=3.68; 60.9% female) from a non-residential college in the northeastern United States completed a questionnaire measuring body appreciation, interest in cosmetic enhancements, and need for uniqueness. Individuals with higher body appreciation and African Americans/Blacks reported significantly higher self-attributed need for uniqueness and significantly higher investment in a distinctive appearance. The association between body appreciation and interest in cosmetic enhancements (e.g., hair coloring) was not significant. Results suggest that body appreciation may be linked to a desire to express one's own unique qualities.

Body mass index and self-rated health in East Asian countries: Comparison among South Korea, China, Japan, and Taiwan

There have been conflicting findings regarding the relationship between body mass index (BMI) and self-rated health (SRH) worldwide. The purpose of this study was to examine the association between BMI and SRH by comparing its relationship in four East Asian countries: South Korea, China, Japan, and Taiwan. Using data from the East Asian Social Survey, the relationship between weight status and SRH status was investigated and compared between four countries, China, Japan, South Korea, and Taiwan. An ordinal logit regression model was estimated for each country, and the results were compared. We found that the relationship between weight status and SRH status differed across the four countries. In China, people who were overweight reported better SRH scores than those of normal weight, whereas in Japan, obese and severely obese people reported poor scores. In contrast, South Koreans who were underweight, obese, or severely obese reported poor ratings of health status than those of normal weight. In Taiwan, however, no differences in respondents' weight status were found across SRH scores. There were notable differences in the relationship between BMI and SRH status in four East Asian countries. Individual countries should consider these relationships when designing and implementing obesity intervention programs.

Weight, gender, and depressive symptoms in South Korea

Objectives

Obesity consistently predicts depression risk, but the underlying mechanisms are poorly understood. Body concerns are proposed as key. South Korean society is characterized by extremely high levels of explicit weight stigma, possibly the highest globally. Using cross‐sectional Korean 2014 National Health Examination Survey (KNHANES) data, we test this proposition in a nationally representative sample of South Korean adults (N = 5,632).

Methods

Depressive symptoms (outcome variable), was based on the PHQ‐9. Weight status (predictor variable), was based on direct measures of height and weight converted to BMI. Weight concern was self‐reported. Mediation analyses tested how weight concern mediated the influence of weight status on depressive symptoms for women and men.

Results

Current weight status influenced depressive symptoms in Korean adults, but not always directly. Concerns of being “fat” mediated that relationship. The effect increased significantly as BMI increased within “normal” and overweight/obese categories for women, and in overweight/obese categories for men. Even though women classified as underweight were significantly more depressed than those in other weight categories, there was no similar mediation effect related to weight concerns.

Conclusion

For South Koreans, the stress of adhering to social norms and avoiding stigma related to body weight seems to explain the relationship between higher body weight and more depressive symptoms. Women are more vulnerable overall, but men are not immune. This study demonstrates that body concerns help explain why weight predicts depression, and more broadly supports the proposition that widespread weight‐related stigma is a potentially major, if unrecognized, driver of population‐level health disparities.

Predictive factors for cosmetic surgery: a hospital-based investigation

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

LEVEL OF EVIDENCE

Cohort study, Level III.

Factor structure and psychometric properties of the Body Appreciation Scale-2 in Iran

Tylka and Wood-Barcalow (2015b) developed the Body Appreciation Scale-2 (BAS-2) as a psychometrically robust measure that is conceptually consistent with recent findings on positive body image. The present study aimed to examine the factor structure and psychometric properties of the BAS-2 in Iran. Participants were 568 men and 525 women from seven universities in Tehran, Iran. Two exploratory factor analyses were performed on data from women and men separately. Similar to the original English version, the Persian BAS-2 had a one-factor solution. Persian BAS-2 scores had satisfactory convergent validity (indexed by significantly correlations with self-esteem and life satisfaction) and internal consistency. Men had significantly higher scores on BAS-2 compared to women. The present study suggests that the Persian BAS-2 has adequate psychometric properties to assess body appreciation.

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

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

Factor structure and psychometric properties of the Body Appreciation Scale-2 in university students in Hong Kong

Previous studies have suggested that there may not be cross-cultural equivalence in the factor structure of body appreciation. Here, we examine the conceptual equivalence of a Chinese (Cantonese) translation of the Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015b), a newly-developed measure of body appreciation. Participants were 457 women and 417 men from a university in Hong Kong. The results of exploratory factor analyses showed that, like its English version, the Chinese BAS-2 had a one-dimensional structure. Body appreciation scores had good internal consistency and were also significantly associated with respondent body mass index, self-esteem, life satisfaction, and (in women) actual-ideal weight discrepancy. Men had significantly higher scores than women, while comparisons with data from Tylka and Wood-Barcalow (2015b) suggest that cross-cultural differences are small-to-moderate at best. The present findings suggest that the BAS-2 may prove to be a useful tool for the assessment of body appreciation across cultures.

Assessing positive body image: Contemporary approaches and future directions

Empirical and clinical interest in positive body image has burgeoned in recent years. This focused attention is generating various measures and methods for researchers and psychotherapists to assess an array of positive body image constructs in populations of interest. No resource to date has integrated the available measures and methods for easy accessibility and comparison. Therefore, this article reviews contemporary scales for the following positive body image constructs: body appreciation, positive rational acceptance, body image flexibility, body functionality, attunement (body responsiveness, mindful self-care), positive/self-accepting body talk, body pride, body sanctification, broad conceptualization of beauty, and self-perceived body acceptance by others. Guidelines for the qualitative assessment of positive body image and recommendations for integrating positive body image assessment within psychotherapy and applied research settings are also offered. The article concludes with articulating broad future directions for positive body image assessment, including ideas for expanding its available measures, methods, and dynamic expressions.

Factor structure and psychometric properties of the Body Appreciation Scale among adults in Hong Kong

Previous research has suggested that the factor structure of Body Appreciation Scale (BAS), a widely-used measure of positive body image, may not be cross-culturally equivalent. Here, we used confirmatory factor analysis to evaluate the conceptual equivalence of a Chinese (Cantonese) translation of the BAS among women (n=1319) and men (n=1084) in Hong Kong. Results showed that neither the one-dimensional nor proposed two-dimensional factor structures had adequate fit. Instead, a modified two-dimensional structure, which retained 9 of the 13 BAS items in two factors, had the best fit. However, only one of these factors, reflective of General Body Appreciation, had adequate internal consistency. This factor also had good patterns of construct validity, as indicated through significant correlations with participant body mass index, self-esteem, and (among women) actual-ideal weight discrepancy. The present results suggest that there may be cultural differences in the concept and experience of body appreciation.

The Body Appreciation Scale-2: item refinement and psychometric evaluation

Considered a positive body image measure, the 13-item Body Appreciation Scale (BAS; Avalos, Tylka, & Wood-Barcalow, 2005) assesses individuals' acceptance of, favorable opinions toward, and respect for their bodies. While the BAS has accrued psychometric support, we improved it by rewording certain BAS items (to eliminate sex-specific versions and body dissatisfaction-based language) and developing additional items based on positive body image research. In three studies, we examined the reworded, newly developed, and retained items to determine their psychometric properties among college and online community (Amazon Mechanical Turk) samples of 820 women and 767 men. After exploratory factor analysis, we retained 10 items (five original BAS items). Confirmatory factor analysis upheld the BAS-2's unidimensionality and invariance across sex and sample type. Its internal consistency, test-retest reliability, and construct (convergent, incremental, and discriminant) validity were supported. The BAS-2 is a psychometrically sound positive body image measure applicable for research and clinical settings.

The factor structure and psychometric properties of the Italian version of the Acceptance of Cosmetic Surgery Scale

The current study examined the validity of the Italian version of the Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King & Henderson-King, 2005) in a sample of 378 Italian adult women. A series of confirmatory factor analyses were conducted. A three-factor solution provided the best fit to the data and confirmed the Intrapersonal, Social, and Consider dimensions. The three factors were strongly inter-correlated. Cronbach's alphas were high (all alphas>.86). The scale showed good convergent and discriminant validity (estimated by Composite Reliability and the Average Variance Extracted). The nomological validity of the Italian version of the ACSS was confirmed by its significant correlations with participants' body dissatisfaction and sociocultural influences (internalization of thin ideals and perceived media pressure). The ACSS seems to be a useful measure of acceptance of cosmetic surgery in the Italian context. This instrument can be used with Italian speakers for research, health promotion, and preventive interventions.

Factor structure of the body appreciation scale among Indonesian women and men: further evidence of a two-factor solution in a non-Western population

While the body appreciation scale (BAS) reduces to a single dimension among Western samples, a two-factor solution has been found among non-Western populations. The present study examined the factor structure of the BAS among Indonesian women and men, a previously neglected population. A total of 262 women and 278 men in Jakarta, Indonesia, completed an Indonesian version of the BAS. Factor analyses revealed the existence of two factors that were only moderately correlated: a dominant 10-item factor representing general body appreciation and a second 3-item factor representing adaptive body image investment. However, only general body appreciation met criteria for acceptable internal consistency; thus, additional analyses were conducted with this factor alone. There were no significant ethnic differences in general body appreciation, but men had significantly higher body appreciation than women. Suggestions for future research, particularly in terms of uncovering culture-specific factors that contribute to positive body image, are discussed.