Physical attractiveness is documented to influence almost every aspect of an individual's life, including one's self-esteem, body image, interpersonal relationships and employment opportunities (Johnson et al, 2010; Berry, 2016; Sanlier et al, 2018). The term ‘appearance ideal’ refers to a set of sociocultural standards of beauty one must meet to be considered conventionally ‘beautiful’ by society. When individuals do not meet these beauty standards, they are more likely to experience teasing, stigmatisation and discrimination and become more vulnerable to experience body dissatisfaction (Schmidt and Martin, 2019).
The prevalence of the ‘ideal’ feminine and masculine appearance in Western societies may reinforce potential discrepancies that individuals experience between their ideal self and physical self, exacerbating dissatisfaction with one's appearance (Jacobi and Cash, 1994; Dittmar et al, 2009). Thus, the steady rise of aesthetic surgeries and minimally invasive cosmetic procedures (MICPs) is unsurprising (British Association of Aesthetic Plastic Surgeons (BAAPs), 2019). Aided by the increasing exposure to a range of cosmetic procedures from the media, there has been a rise in public awareness and acceptance of such procedures, further adding to their popularity (Wen et al, 2017; Walker et al, 2019). Alongside the growing availability, accessibility and affordability of cosmetic procedures, this is likely to have contributed to the rapid rise in these procedures among young men and women over the past decade (Cook and Dwyer, 2017).
Body dissatisfaction in men and women
Body dissatisfaction—a discrepancy between one's appearance ideal (what they wish to look like to meet sociocultural standards of beauty) and actual appearance—is well documented in Western societies (Grogan, 2017). In a 2017 study, among a UK female sample, 80% of women reported feeling dissatisfied with their appearance, and 85% of women and 79% of girls reported reducing or ceasing their involvement in important life activities due to body image concerns (Dove, 2017). There is a vast body of experimental and correlational literature that has been identified and continues to demonstrate the negative associations between exposure to appearance ideals, social comparison and body dissatisfaction among women (Fardouly and Vartanian, 2015; Betz et al, 2019; Casale et al, 2019). Despite limitations associated with all forms of research, these correlational and experimental findings continue to reflect a large volume of past and present literature demonstrating the negative impact of engaging in upward-appearance comparisons to others on body dissatisfaction and desire to alter appearance (Sharp, 2018).
Equally, there is an increasing body of evidence demonstrating the rising experience of body dissatisfaction among the male population (Garner, 1997; Adams et al, 2005). It is reported that 10%–30% of men show body dissatisfaction (Frederick et al, 2012), with 69% of male adolescents being dissatisfied with their bodies in terms of their weight (Furnham and Calnan, 1998). Looking at a US sample, Frederick et al (2007) found that 90% of male students reported being dissatisfied with their bodies, particularly regarding their level of muscularity. According to recent evidence, the drive for muscularity (the desire to appear muscular, defined and toned) appears to be a repetitive concern raised by the male population in regard to their body image (McCreary and Sassee, 2000; Cafri et al, 2005; Cordes, 2017; Hoffmann and Warschburger, 2017). Sociocultural models of body image (Thompson et al, 1999) and theories of social appearance comparison (Festinger, 1954) are among the most widely used and accepted theoretical frameworks that attempt to conceptualise the associations between body dissatisfaction and a desire to alter appearance (e.g. Slater et al, 2017; Fardouly et al, 2018).
A 2017 study reported that 80% of women were dissatisfied with their appearance, and 85% of women and 79% of girls reported reducing or ceasing their involvement in important life activities due to body image concerns
Tripartite model of influence and body dissatisfaction
The Tripartite model of influence indicates sociocultural standards of beauty as an ever-present, ever-changing and increasingly inaccessible goal for the average person (Thompson et al, 1999), resulting in greater body dissatisfaction upon failure to meet these standards (Robinson et al, 2017). The Tripartite model of influence (Thompson et al, 1999) identifies three main sources of influence: peers, parents and the media. These influences are said to impact body image via two mediational mechanisms: physical appearance comparisons with others (see Groesz et al, 2002 for meta-analysis) and internalisation—the extent to which an individual is affected by sociocultural standards of beauty and the behaviours they are willing to engage in to get closer to this ‘ideal’ (Thompson and Stice, 2001). Of these influences, experimental and correlational evidence continues to suggest the media, specifically social media, as the most powerful and pervasive (Tiggemann et al, 2017; Cohen et al, 2018, Betz et al, 2019).
Body dissatisfaction, social media and cosmetic procedure interest
With over 90% of young adults accessing social media on a daily basis (Perrin, 2015), social media sites, specifically those of a photo-sharing nature such as Instagram—a social media site with over one billion active users and over 50 billion images shared (Omnicore, 2020)—provide an overabundance of images to which young people compare their physical appearance to. Festinger's (1954) social comparison theory proposes that people have an innate drive to compare themselves with others to evaluate their positioning in various aspects of their lives. Social comparisons may be upward—comparing one's self to another that is perceived to be ‘better’ (e.g. more attractive)—or downward—comparing one's self to another that is perceived to be ‘worse off’ (e.g. less attractive) in nature (Festinger, 1954). Relatively recent evidence from an Australian sample including 184 men and women suggested that photo manipulation/editing and investment were associated with greater body dissatisfaction in both men and women (Lonergan et al, 2019). Moreover, recent findings exploring the impact of social media sites, particularly Instagram, on body dissatisfaction in males (348 participants aged 18–50 years) suggested that Instagram use was positively associated with appearance comparisons, and thus, positively associated with body dissatisfaction (Modica, 2020).
» There is a sub-group of individuals who, despite undergoing a cosmetic procedure, derives minimal, if any benefit. This highlights the need for an appropriate and effective screening tool that can be used at the pre-assessment stage to determine an individual's suitability for cosmetic procedures «
Therefore, body dissatisfaction, social media and social comparisons may reflect one avenue of attempting to understand the rise in appearance-related aesthetic procedures. This is supported by recent evidence from Walker et al (2019), whose findings suggested that viewing images of women who had undergone cosmetic enhancements on social media affected young women's desire for cosmetic surgery, exacerbated by the number of accounts followed, time on social media and existing dissatisfaction with their appearance.
Body dissatisfaction and cosmetic procedures
Body dissatisfaction is associated with a number of maladaptive behaviours and outcomes, such as eating problems aimed at controlling body shape and weight (Neumark-Sztainer et al, 2006). However, body dissatisfaction is also associated with other forms of body modification/alteration, which may include body art, physical activity and/or cosmetic surgery (Cegolon et al, 2010; Henderson-King and Henderson-King, 2005; Karupiah, 2013). Looking particularly at young people, the evidence suggests that adolescents are aware and are becoming increasingly accepting of altering their appearance via cosmetic surgery—with cosmetic surgeries being viewed as a way to reduce an individual's suffering associated with body dissatisfaction (Lunde, 2013). This is supported by more recent findings exploring predictors of cosmetic surgery consideration among young Chinese men and women, whereby body surveillance and facial appearance concerns were highlighted as the strongest unique predictors of cosmetic surgery consideration (Jackson and Chen, 2015). However, although there is evidence to suggest that undergoing cosmetic procedures to alter one's physical appearance can result in improved body satisfaction/reduced levels of body dissatisfaction (Asimakopoulou et al, 2020), there is a substantial sub-group that derives minimal, if any, benefit following cosmetic procedures (Paraskeva et al, 2014). Therefore, it is important for health professionals to consider the appropriateness of each individual expressing a desire for cosmetic surgery and for assessment/screening tools to be developed to aid professional judgement on a patient's appropriateness for such procedures, which are currently limited (Morselli et al, 2016).
Conclusion
Drawing upon the available evidence throughout this article, it is somewhat clear that body dissatisfaction is likely to play a significant role in young men and women's desire to undergo cosmetic procedures to alter their physical appearance. Equally, the role of social media should not only be considered in terms of its potential impact on young people's body image and levels of body dissatisfaction but also consideringthe role it plays in increasing young people's exposure to cosmetic procedures via posts and advertisements. Although body modification through cosmetic procedures is documented within the literature to yield positive outcomes, including improvement in body satisfaction, there is a sub-group of individuals who, despite undergoing a cosmetic procedure, derives minimal, if any benefit. This highlights the need for an appropriate and effective screening tool that can be used at the pre-assessment stage to determine an individual's suitability for cosmetic procedures. Finally, it is important to acknowledge that the evidence drawn upon in this article is focused specifically on young men and women from Westernised populations. Therefore, these conclusions should not be generalised cross-culturally, nor be reliably applied to explain trends of this nature in groups that fall outside of this specific demographic and cultural sample.
Social media plays a key role in the way that young people perceive their bodies
Key points
- Body image and one's degree of dissatisfaction with one's physical appearance are important motivational factors associated with an interest in cosmetic procedures
- Social media, particularly those of a photo-sharing nature, arguably play a noteworthy role in increasing exposure to and acceptance of cosmetic procedures
- Cosmetic procedures can yield favourable outcomes in terms of body satisfaction, but a sub-set of individuals do not reap much benefit, if any at all
- There is a need for pre-assessment tools to be developed and used to aid clinical judgement regarding a patient's suitability for appearance-related cosmetic procedures.
CPD reflective questions
- Based on the information in this article, what questions may be most useful to incorporate into a screening assessment tool and why?
- What are the limitations and benefits of using qualitative versus quantitative screening tool?
- Thinking about your own use of social media, have you been exposed to any content related to cosmetic procedures, and how they were advertised to you (e.g. were they glorified, minimised, informative)? Think how this may impact younger generations who use social media at a potentially significantly higher level and how consistent exposure may impact their beliefs/motives.