Body image can be defined as ‘a person's perceptions, feelings and thoughts about his or her own body’ (Grogan, 2008). Body dissatisfaction, which can be defined as ‘a person's negative thoughts and feelings about his or her own body’ (Grogan, 2008), is common, particularly in Western populations, with high levels consistently reported (Tiggemann, 2004; Frederick et al, 2016). This is concerning because, in addition to the negative psychological impact, body dissatisfaction can have an impact on physical health by contributing to people engaging in behaviours that pose a risk to their health (Rumsey and Harcourt, 2012), including sunbed use (Stapleton et al, 2017), disordered eating (Stice, 2002) and negatively impacting on breastfeeding intention, initiation and duration (Morley-Hewitt and Owen, 2020).
Research has suggested that women working within the aesthetics sector may be an at-risk group for body dissatisfaction and symptoms of disordered eating, given the emphasis that the profession places on appearance. Wong (2003) revealed how Taiwanese beauticians were more dissatisfied with their weight and more likely to practice weight loss strategies compared to non-beauticians. As Wong (2003) highlighted, this is concerning given the association of these practices and beliefs with disordered eating. Similarly, Lukacs-Marton and Szabo (2012) indicated that those working within the aesthetics sector could be at an increased risk of developing eating disorders. Weight-reducing methods of dieting, exercise and the use of appetite suppressants and diuretics were significantly more prevalent amongst beauticians from Transylvania compared to a control group, as well as the prevalence of clinical and subclinical eating disorders. Therefore, women working within the medical aesthetics or beauty sectors may be vulnerable to engaging in behaviours that pose a risk to their health.
Although research indicates that those working within the aesthetics sector may be vulnerable in terms of body dissatisfaction and health risk behaviours, such as disordered eating, investigation within this specific population has been scarce, with no research, to the authors' knowledge, exploring the experiences of those working within the medical aesthetics or beauty sectors in the UK. Given an increasing preoccupation with appearance, especially in Western cultures, and the potentially negative health consequences of body dissatisfaction (Rumsey and Harcourt, 2012), it is vital to explore the body image experiences of those who may represent a vulnerable group. Qualitative research is needed to explore people's body image experiences in their own words (Hargreaves and Tiggemann, 2006). The current study sought to address the gaps in the literature by qualitatively exploring the body image experiences of those working within the medical aesthetics and beauty sectors in the UK. A combination of online surveys and semi-structured interviews were used to collect data.
All participants spoke about how working within the aesthetic sector necessitated them looking a certain way in terms of their physical appearance
Methods
Participants
Some 41 participants took part in the study (38 survey responses and three interviews). All were female, with an age range of 18 to 60 years (n=34). All self-identified as working in either the medical aesthetics or beauty sector; 28 were self-employed, and 13 worked in a salon setting. Participants were recruited online, with the online link for the survey being posted on social media alongside an explanation of the research aim and criteria for participation. Participants were required to be aged at least 18 years and working in the medical aesthetics or beauty sector at the time of taking part in the research. Salons were also contacted via email with the online link, which was accompanied by a short text description introducing the research. Participants were asked to contact the researchers if they preferred to take part in an interview.
Surveys
Online surveys are increasingly advocated as an excellent way of collecting qualitative insight, because of their ability to generate rich, detailed and varied data (Terry and Braun, 2017). Due to their anonymous nature, Terry and Braun (2017) suggested that online surveys are useful for collecting data on sensitive topics. As talking about appearance has been identified as a potentially sensitive topic for some (Grogan and Richards, 2002), the authors considered online qualitative surveys particularly appropriate for this study.
The survey was created using the software Qualtrics, and divided into two sections. Alongside demographic information, section one asked participants for information about their work in their sector (for example, whether they were self-employed or worked for a larger company/organisation). Section two consisted of four main questions asking participants how they felt about their appearance; whether they compared themselves to others in terms of appearance; whether they experienced any appearance-related pressure; and how working in the medical aesthetics/beauty sector made them feel about their appearance.
» Working with aesthetic nurses to develop training sessions for employers to disseminate to their employees about body image issues and concerns in the workplace, as well as promoting body positivity, could be useful in improving body image for those in these sectors «
Interviews
The reason for the combination of the different methods was pragmatic, as it gave participants a choice and helped to maximise recruitment. Two participated in a telephone interview and one face-to face. The same questions were adopted for use in the interviews. All interviews were recorded via a digital audio-recorder.
Ethical considerations
Ethical approval was obtained by the Staffordshire University Ethics Committee. All participants were provided with an information sheet and required to provide their written informed consent prior to participating. Consent was also obtained for using quotes from participant responses, and the contact details of a support organisation were provided, as the authors acknowledge that talking about and reflecting upon appearance could be a potentially sensitive topic.
Data analysis
The audio-recorded interviews were transcribed verbatim and collated with the survey responses, to form our overall dataset. The data was then analysed using the thematic analysis procedure outlined by Braun and Clarke (2006). The authors chose thematic analysis, as we were interested in identifying and reporting common patterns in body image experiences, rather than identifying patterns at a more idiographic level. An inductive approach was adopted and led by the first author. Following data familiarisation, line-by-line, semantic coding was carried out, and codes reflected the explicit, surface level of the data (for example, ‘accepting of appearance’ and ‘an advertisement for your work’). Similar codes were then clustered using a colour-coding system to form overarching patterns that captured the body image experiences of the participants. Both authors then spent time reviewing and refining the themes, checking their coherence and ensuring they were the best fit for the dataset.
Results
Three themes captured the body image experiences of the women who took part in this study: looking ‘good’ as a necessity for working in the aesthetic sector; the ubiquitous and inevitable nature of appearance comparisons; and dichotomy in terms of appearance satisfaction. The themes are presented under sub-headings, with illustrative quotes, accompanied by pseudonyms and other contextual information in parentheses.
Looking ‘good’ as a necessity for working in the aesthetics sector
All participants spoke about how working within the aesthetics sector necessitated them looking a certain way in terms of their physical appearance. The main reason for this was described as a ‘need’ to promote their business/company/treatments to patients and clients. They could only do this by looking a certain way to ‘advertise’ and promote what they offer:
‘… you need to look good for clients to come in, so they want to have those things done’
(Katie, age 25, telephone interview)
Looking ‘good’ was defined by many as the need to look presentable at work:
‘I think, when I'm in work, I like to wear makeup and make sure my hair and nails look neat. I think, if you don't look presentable, people won't book with you’
(Sofia, age 43, survey)
Looking presentable was frequently described as being necessary to reflect their own professionalism and business:
‘I've got to be presentable, you have to have good skin … you're not going to get somebody booking a facial unless your skin is in great shape, if you're not groomed you know that's not going to be, it's not actually going to be a professional image’
(Alice, age 57, telephone interview)
While some participants spoke about feeling ‘pressurised to have makeup on’ (Ella, age 40, survey), many talked about looking presentable more in the sense of appearing ‘professional, clean and tidy’ (Aisha, age 59, survey). Looking presentable and professional was considered essential for gaining the trust and respect of patients and clients, as well as meeting their expectations:
‘You're on show. People look at you like an advert for your own work. You wouldn't trust a doctor who was very unhealthy’
(Jade, age 25, survey)
The ubiquitous and inevitable nature of appearance comparisons
Many of the participants spoke about the ubiquitous nature of appearance comparisons, with some describing them as inevitable. When asked, for example, whether she ever compared herself to other people, Freya replied: ‘Yes, all the time, but I think that's perfectly natural’ (age 36, survey). For some, these comparisons were positive:
‘It usually makes me feel good because I take good care of myself’ (Varsha, age 55, survey). However, for most participants, the comparisons led to feelings of negativity, for example: ‘Always. Everyone, all the time. [It] makes me feel self-conscious and inadequate’ (Jade). Appearance comparisons with friends, celebrities, work colleagues and even patients and clients were described:
‘Colleagues, yes, if they look great, I think: “why I don't look that good?” Clients, when they come in looking glamorous. Friends on nights out always think they look better than me’
(Isla, age 25, survey)
The inevitability of these negative appearance comparisons was mainly attributed to the growing influence and accessibility of social media. In particular, Instagram was described as being especially influential:
‘… last year, before I went on holiday, I felt very like down because I didn't look like these girls on Instagram’
(Katie)
‘Scrolling through Instagram, and seeing girls looking incredible, really does get you down’
(Isla)
Several participants spoke about how such appearance comparisons were unavoidable due to the accessibility of social media. As a result, the importance of reminding themselves about the unrealistic nature of some of these photos was highlighted, for example: ‘No one looks like that on holiday’ (Katie).
A dichotomy in terms of appearance satisfaction
The women appeared to be almost dichotomous in terms of either feeling confident with how they looked or being dissatisfied with their appearance:
‘I feel confident about my look, which is very simple with minimal makeup’
(Ella)
‘I am never happy with how I look or part of my personality, I have always been this way’.
(Collette, age 32, survey)
For several of those who felt confident and satisfied, this appeared to stem from an acceptance of their appearance:
‘I am who I am … I feel good about myself’.
(Maxine, age 42, survey)
For some, this acceptance had developed with age:
‘I think that I look good for my age. I'm not perfect, but as I have got older, I accept this and recognise that good health and happiness is more important’.
(Varsha, age 55, survey)
Here, Varsha reports acceptance, despite indicating there being aspects of her appearance that she might like to change.
For those who reported feeling unhappy with their appearance, this was either indicated as a constant feeling of dissatisfaction: ‘I always want to look better than I do’ (Belle, age 35, in-person), or dependent on personal circumstances or situation, such as recently having a baby:
‘Not great, but that's more to do with the fact I'm a mother now, as my appearance has changed a lot’
(Holly, age 27, survey)
Discussion
This exploratory study drew upon qualitative online surveys and semi-structured interviews to explore the body image experiences of women working within the medical aesthetics sector or beauty industry. The main theme was that the majority of women felt that looking ‘good’ was necessitated by the nature of their work. While many described this as an additional pressure in terms of, for example, making them more conscious of their appearance, a few felt that working in the medical aesthetics sector or beauty industry had no impact on their body image experiences. One participant described it as a positive experience.
Self-objectification (Fredrickson and Roberts, 1997), which many of the women in this study described as an inevitable aspect of their work, has been linked to negative health consequences, including low self-esteem (Mercurio and Landry, 2008) and disordered eating (Tiggemann and Williams, 2012). Therefore, the experience expressed by many of feeling an unavoidable need to maintain a certain appearance is of concern. Most participants spoke about the ubiqutious nature of negative appearance comparisons. In addition to comparisons to friends, women and celebrities on social media, the participants felt vulnerable to additional comparisons to colleagues, patients and clients. Many talked about these comparisons in an upward manner (whereby women talked about their appearance negatively in comparison to others), and research has found that these appearance comparisons are related to greater body image disturbance (Myers et al, 2012). Research indicating that women who are dissatisfied with their bodies engage in more upward comparisons (Lesley et al, 2007) is also particularly concerning, considering that several of the women in the authors' study described feeling dissatisfied and unhappy with their appearance.
Participants' responses were mixed in how satisfied they felt with their appearance. The main reason appearing to underpin satisfaction was a self-acceptance in terms of appearance. The potentially negative psychological and physical health implications of body disatisfaction (Grogan, 2006) is of concern for the women reporting feeling unhappy with their appearance, especially given the additional pressure that may be inevitable when working in the medical aesthetics sector or beauty industry. The appearance satisfaction expressed by some is reassuring, given evidence indicating the potentially protective role of a positive body image (Andrew et al, 2015; Becker et al, 2019).
Strengths and limitations
This study was the first to qualitatively explore the body image experiences of women working within the aesthetics sector; however, the authors recognise that the insight gained is preliminary, and further exploration is needed. While the online survey provided a useful way of exploring experiences, the inability to be able to prompt and encourage participants to expand upon their responses was something the authors felt limited the depth of the survey data.
Future research
While online surveys were a valuable tool for reaching women of varying ages across the UK, responses to many of the questions were brief and would have benefitted from some additional unpacking. Semi-structured interviews, as was the case in this research, would enable further prompting to explore experiences in more depth. Research needs to be conducted to try and counteract some of the additional body image pressures that people working in these sectors experience. For example, working with aesthetic nurses to develop training sessions for employers to disseminate to their employees about body image issues and concerns in the workplace, as well as promoting body positivity, could be useful in improving body image for those in these sectors. The specific finding that appearance satisfaction was underpinned, for some, by an acceptance that developed with age warrants further exploration, especially given research that has indicated the positive impact that ageing can have upon women's body image experiences (Jankowski et al, 2016).
Conclusion
The body image experiences of women working in the medical aesthetics sector and beauty industry are mixed and can be complex. Although some reported feeling satisfied with their appearance, others reported feeling very dissatisfied. While it is not clear if this disatisfaction is directly linked to working in this sector, findings indicate that some women working in these sectors are vulnerable to additional pressures and comparisons, which could potentially have negative implications for their health. A positive body image could be useful in terms of its protective qualities, and future research is needed to explore these ideas further.
Key points
- This exploratory study drew upon qualitative online surveys and semi-structured interviews to explore the body image experiences of women working within the aesthetics sector
- All participants spoke about how working within this sector necessitated them looking a certain way in terms of their physical appearance
- The study showed that some women working in the aesthetics sector reported feeling satisfied with their appearance, while others reported feeling very dissatisfied
- While it is not clear if this disatisfaction is directly linked to working in this sector, findings indicate that some women working in the aesthetics sector are vulnerable to additional pressures and comparisons.
CPD questions
- How do you feel about your own body image?
- Do you feel that your own feelings about your body have an impact on how you communicate with patients?
- What could you do in your workplace to help your colleagues maintain a positive body image?