Cosmetic procedures are arguably a highly gendered activity. Men's interest in appearance-related cosmetic procedures is rising, yet women continue to account for the majority of the cosmetic-surgery patient population, accounting for 92% in 2017 (American Society of Plastic Surgeons, 2017). The increasing popularity of cosmetic procedures is postulated to be the result of a number of factors. These may include, but are not limited to: the increasing availability and financial accessibility of many cosmetic procedures; the increase in the numbers of less invasive procedures, such as botulinum toxin A injections; and the increasingly pervasive presence of cosmetic procedures in advertising, particularly on social media (Wen et al, 2017). Moreover, evidence highlights the important role of psychological factors, as there also exists a wide range of research examining the relationships between body dissatisfaction and media exposure as potentially motivating factors for surgical and/or non-surgical cosmetic procedures (Henderson-King and Brooks, 2009; Yin et al, 2016; Sarwer, 2019).
The influence of social media upon individuals' body image and levels of body dissatisfaction is well documented in the literature. A substantial body of correlational literature indicates that exposure to social media is significantly associated with lower self-perceptions of appearance, resulting in greater body dissatisfaction (Grabe et al, 2008). Motivations to undergo surgical procedures typically include to increase self-confidence, increase self-esteem and reduce dissatisfaction with appearance (von Soest et al, 2009). Acknowledging the pervasive nature of social media and its impact on body image, the role of body image in relation to one's motivations for, and expectations of, surgical and non-surgical procedures requires consideration.
Body dissatisfaction and cosmetic procedures
Body image may be best understood as a multidimensional mental process focused on one's physical appearance (Cash and Henry, 1995). Body dissatisfaction—a discrepancy between one's appearance ‘ideal’ (what people wish to look like) versus their actual appearance (Grogan, 2008)—is well documented within Western societies. In the UK, 80% of women in the UK report feeling dissatisfied with the way they look, and 85% of women and 79% of girls opt out of important life activities due to body image concerns (Dove Self Esteem Project, 2017).
In Western societies, the female ‘appearance ideal’ is arguably tall, toned with a curvy figure, big eyes and lips, no wrinkles and moderately-sized, perky breasts. Sociocultural theories propose that societal standards of beauty convey an ever-present, ever-changing, increasingly unattainable goal for the average person (Thompson and Heinberg, 1999), resulting in greater body dissatisfaction upon failure to meet such standards (Robinson et al, 2017). This rise in body dissatisfaction may partially explain the parallel increase and popularity of appearance-related cosmetic procedures. As Sarwer (2019) suggests, individuals who typically present for cosmetic procedures have increased levels of body dissatisfaction. This is in line with previous findings by Crandall Sharp (2018), which indicated that body dissatisfaction is a key motivational factor for cosmetic procedures.
Social media and cosmetic procedures
Body dissatisfaction is largely attributed to sociocultural factors, with media being the most powerful and pervasive (Holland and Tiggemann, 2016). The rise in social media use is evident, particularly among 18–29-year-olds. In 2005, 12% of this age group reported active social media use, while 90% reported it in 2015 (Pew Research Center, 2015). In line with this trend in social media use, there are also increasing numbers of young people undergoing cosmetic procedures. The American Academy of Facial Plastic and Reconstructive Surgery (2013) reported a rise in cosmetic procedure requests (the most popular being for rhinoplasty, botulinum toxin A injections and facelifts) as a result of the amount of photo sharing on social media. The importance of body dissatisfaction, social media use and its apparent role in motivating individuals to consider/undergo cosmetic procedures is further supported by recent findings by Walker et al (2019) whereby 118 young females aged 18–29 were exposed to facial cosmetic enhancements on social media. Results found that viewing images of females undergoing cosmetic procedures increased the young women's desire for such procedures, exacerbated by their time spent on social media and their existing degree of body dissatisfaction (Walker et al, 2019).
Psychological factors and implications for surgical expectations/outcomes
While research indicates that the majority of patients undergoing cosmetic procedures are satisfied, there is a substantial subgroup that derives minimal, if any, benefit following cosmetic procedures (Paraskeva et al, 2014). This may be for a number of reasons, including unrealistic surgical expectations—which can result in postoperative dissatisfaction and poorer psychological outcomes—and the presence of body dysmorphic disorder (BDD). BDD is characterised by a preoccupation with an imagined defect in appearance and/or a distorted perception of one's body image (Franca et al, 2017). In a survey by Bouman et al (2017) including 173 members of the Dutch professional association for aesthetic plastic surgery, dermatology and medicine, findings revealed that the surgeons surveyed argued BDD to be a body-image problem whereby affected individuals are likely to yield little to no beneficial effects from cosmetic procedures.
This is in line with other findings in this area showing that individuals with BDD often hold unrealistic expectations of surgical outcomes and, as a result, are dissatisfied regardless of the surgical outcome (Naraghi and Atari, 2016). Therefore, validated pre-procedure assessment tools are required in order to assess an individual's overall suitability for cosmetic procedures; however, at present, the availability of such pre-surgery screening tools is limited (Morselli et al, 2016).
Conclusion
From the evidence available, it is apparent that body image, particularly levels of body dissatisfaction, may play a crucial role in one's motivations and decisions to undergo appearance-related cosmetic procedures. Social media also seems to be a significant contributing factor that may be acting to exacerbate individuals' (particularly young women's) levels of body dissatisfaction and appearance-related concerns. Subsequently, this impact on body image increases the desire for appearance-related cosmetic procedures.
While this article has reviewed some of the literature surrounding body image and appearance-related procedures, it is important to consider that it has drawn upon literature mainly focusing on young, Western women. Thus, these conclusions may not reliably reflect the experiences of men in Western societies, or men and women in other cultures. Furthermore, it is crucial to note that appearance-related cosmetic procedures can also have extremely positive effects and outcomes for individuals' body image and wellbeing.