The number of people cosmetic surgery has increased significantly in the past ten years. This trend is mainly seen due to the concept of physical attractiveness and its role in society today (Furnham & Levitas 2012, pp.47-50). The latest trend towards going for cosmetic surgery for physical attractiveness might also be because of the development of less invasive procedures other than invasive procedures. The expense in cosmetic surgery has increased and based on the figures obtained from invasive and surgical cosmetic procedures done in US in 2014, it can be said that it resulted in a expense of about $12.9 billion (Milothridis et al. 2016, p. 397). This figure clearly reflects changes in attitude of people to achieve satisfaction in life. Today, cosmetic surgery is mostly concern with self-esteem concept particularly for youth. Seeing this interest in cosmetic surgery, it is evident that psychological factors have a great impact choice for cosmetic surgery as well as outcome associated with it. There is a need to explore in-depth regarding the roles of these two factors behind the rise in surgery. Although past research literature focused on identifying role of media behind higher preference for cosmetic surgery, however the psychology behind such interest is left to be explored.
Research question and aim
The main aim of this literature review is to analyze recent development in the field of cosmetic surgery and find out the psychological factors surrounding cosmetic surgery. The main research question for the literature review is as follows:
- What are the current developments in the field of cosmetic surgery?
- What are the psychological factors surrounding cosmetic surgery?
As the main aim of the literature review is to investigate about recent advancement in the field of cosmetic surgery and psychological factors related to cosmetic surgery, relevant and recent research article related to the topic has been taken from databases like Medline, Cochrane Library, Google Scholar and Pubmed The key search terms used for the search included ‘advancement in cosmetic surgery methods’, ‘psychology behind cosmetic surgery’ and ‘factors influencing motivation for cosmetic surgery’. The main inclusion criteria for taking articles were as follows:
- Articles must be published within 2010 to 2017
- The articles must be published in English
- It should cover details only on cosmetic surgery and no other types of surgery.
The final articles obtained for literature review was analyzed on the basis of thematic analysis to get answer to the research question.
Current development in the field of cosmetic surgery:
The review of research literature reveals that although many non-invasive procedures like botox and filler options are available to patient, however high rate of satisfaction and distress after surgery has also become a common phenomenon. This has been found to be highly linked with psychological factors and traits of an individual. For instance, Di Mattei et al., (2015) showed that in case of patient having body image and its related disorder before the operations are most likely to be dissatisfied with the outcome of operation. Hence, this study gave the implication that careful assessment of patients regarding psychological health disorder might help to plan treatment and care for patients and improve their outcome. Wimalawansa, Fox & Johnson, (2014, pp. 306-316) also supported the fact that mental health diagnoses also increase the outpatient cosmetic surgery burden due to complications in patient. By review of inpatient databases, the study was successful in proving that mental health conditions increases the stay in hospital, hence pre-operative assessment may help to address mental health issues before proceeding with the procedure. However, the limitation found in this evidence is that it gives idea about the role of mental health problem on cosmetic surgery outcomes. However, there are many psychosocial factors too that motivate people to go for such surgeries. Hence, investigating about the psychological factors surrounding cosmetic surgery is crucial to understand the reason for high rate of cosmetic surgery.
Social norm and personality trait as a factor behind interest in cosmetic surgery
The research by Milothridis et al. (2016, p. 397) gave the insight regarding the psychosocial perspective of people who wish to have a cosmetic surgery done. The researcher used systematic review method to find out psychosocial reasons for people deciding to modify their physical appearance through cosmetic surgery. Firstly, epidemiological factor particularly influence of gender was found as more number of women were found to favor cosmetic surgery compared to men. In addition, alcohol consumption and education were found as predictor for interest in plastic surgery (Slevec & Tiggemann 2010, pp.65-74).
Review of many studies also gave idea about the impact of social network on youth’s favor for cosmetic surgery. It showed that preference for cosmetic surgery was higher for unmarried women and being connected with someone who have already undergone cosmetic surgery. These results did not discussed about psychological factors predicting interest for cosmetic surgery. However, the section on body image and self-esteem clearly gave idea about psychological traits behind choosing plastic surgery. The discussion revealed that people who are highly conscious about their body image are more likely to go for cosmetic surgery. In addition, level of self-esteem, inner attitude, emotions and disposition affected the decision to go for cosmetic surgery. This is also consistent with the research by Furnham & Levitas (2012, pp.47-50) as it explained the people with low self-esteem will to have cosmetic alterations to boost their self-confidence. The strength of Milothridis et al. (2016, p. 397)) work is that it established links between social norms and cosmetic surgery. However, it has not explored in-depth regarding the psychosocial characteristics of people going for cosmetic surgery which is the main objective of the literature review. Hence, extensive research on psychological characteristics is needed.
Involvement in bullying as a psychological predictor of cosmetic surgery
In response to the topic of psychological factors influencing interest in cosmetic surgery, the research literature by Lee et al. (2017, pp. 1109-1118) is considered a useful piece of evidence as it investigated about the role of adolescent bullying as a key factor predicting people’s interest in cosmetic surgery. Adolescent who were bullied in schools and colleges have poor psychological functioning and they regard cosmetic surgery as a source to reduce their psychological distress and modify perceived flaws that resulted in past history of bullying. The researcher used two-stage study design to first screen participants for bullying experience and then, collect data related to their preference for cosmetic surgery. The psychological functions that were assessed in the subjects included self-esteem and emotional problem in the first stage of research and body-esteem score in the second stage. The result convincingly proved that youths involves in bullying were significantly interested in cosmetic surgery compared to other adolescents. The study finding is also consistent with another study which showed that bullies have increased desire to increase their attractiveness and social status. Hence, going for cosmetic surgery is high in such group (Lee et al. 2017, p. 38). The strength of the study is that it clearly stated the reason behind increased rate of cosmetic surgery by the argument of poor psychological functioning in victimized adults. This evidence is useful to screen candidates coming for cosmetic surgery and identify psychological vulnerability in people.
Impact of psychosocial factor on cosmetic surgery consideration:
The study by Nerini, Matera & Stefanile (2014, pp. 461-466) was based on the background evidence that percentage of people undergoing cosmetic procedure has increased from 2000 to 2012 resulting in an increased in rate by 98% in US. This influenced the establish links between attitude towards cosmetic surgery and impact of socio-cultural influences. The importance of this research article was that apart from media influence, it also explored peer and family influence on choosing cosmetic surgery. The results of the study proved that social comparisons in society often mediate women’s desire to go for cosmetic surgery. Women internalized the idea of physical attractiveness by being involved in regular conversation with friends about appearance (Nerini, Matera & Stefanile 2014, pp. 461-466). Hence, peer influence and their importance of weight and shape for success resulted in interest for cosmetic surgery. Hence, this study gave a useful insight that friends can also influence the psychology of women going as their conversations related to appearance evoke the interest in cosmetic surgery. The strength of the evidence for the literature review is that it clearly explains attitude towards cosmetic surgery by means of socio-cultural influence and psychological process surrounding it. However, some limitation of this study is that it has not considered those factors that might have influenced study outcome. Hence, in future, researchers must also collect details about personality and social anxiety in participants and analyze the impact of these factors on attitude towards cosmetic surgery.
The limitations found in above research was addressed by Pavan et al. (2017, pp. 90-97) as it investigated about both psychological traits in post-bariatric patient asking for body contouring surgery. Many patients go for bariatric surgery as they are not satisfied with their physical appearance and this affects their social and work life too. Hence, investigating about psychological traits in patient is critical to prevents unsatisfactory result in surgery. Pavan et al. (2017, pp. 90-97) used survey questionnaire to identify and categorize patients on the basis of diagnosis. The study showed presence of several psychological traits in patient such anxiety disorder, previous history of depression, impulsivity and binging disorder. With this result, the study was successful in explaining about reasons for poor outcome in patient post surgery. The strength of this study is that through the result finding it gave idea about the need for professional collaboration between surgeon and psychologist to reduce negative outcome post surgery.
Influence of psychological factors on cosmetic surgery journey:
The main aim of this literature review to find out psychological links surrounding cosmetic surgery. Paraskeva, N Clarke, A & Rumsey (2014, pp. 28-32) mainly discussed about the need for routine psychological screening of cosmetic surgery patients and with this discussion, it gave idea about not just psychological factors influencing choice for cosmetic surgery but also on its journey. The researcher emphasized that pre-operative psychological screening is important for surgeons and psychologist as it will help to identify patients with poor post-operative outcome. Apart from the influence of psychological factors on choice for cosmetic surgery, the research gave information regarding the role of psychological factors on entire cosmetic surgery. It may have an impact on patient’s satisfaction with the surgery. Hence, it can be said that psychological factor is one of the reason behind increased risk of poor outcome in client. Unrealistic expectations associated with surgery results in post-operative distress and distraction in many patients (Klassen et al., 2016, pp. 1068-1078). In addition, inappropriate motivation and underlying psychological disorder also increased the likelihood of poor outcome post surgery. The strength of the evidence is understood as it clarified regarding the impact of psychological factors on poor outcome of patient. There is a need to explore in-depth regarding psychological vulnerability of patient as this research did not conducted the research on vulnerable group.
Wildgoose et al. (2013, pp. 152-159) also supported the above evidence by stating that pre-operative psychological assessment is necessary to improve outcome of patients related to expectation and motivation. The study mainly reviewed performance of several pre-operative assessment tool and showed that there are very tools available that has validity and utility in the screening of patients. This may lead to inappropriate elucidation of patient expectation before surgery and their satisfaction and quality of life post surgery. Hence, this research pointed to the need for improving existing screening tools by addressing validity related issue.
The main purpose of the literature review was to explore about the psychological factors associated with cosmetic surgery. The main intention for this research objective was to understand the need for screening of cosmetic surgery patient and identify the implication of psychological factors on outcome of patient. The review of research on the topic gave rise to several themes like role of social norm, personality trait, bullying experience, education, peer influence, body image conversation and body image ideology behind the reason for such surgery. The evidences were found effective in clear understanding about the psychological factors influencing the decision to go for cosmetic surgery. However, another important strength of this literature is that it explored the impact of psychological factors both in pre-operation motivation as well as post-operation outcome. The data from this literature review will have great implication on the work of surgeons and psychiatrist as they can collaborate in the future to reduce the cost burden associated with complications post surgery.
American Society of Plastic Surgeon 2017, New Statistics Reflect the Changing Face of Plastic Surgery, viewed 18 December 2017, <
Di Mattei, VE Bagliacca, EP Ambrosi, A Lanfranchi, L Preis, FB & Sarno, L 2015, ‘The Impact of Cosmetic Plastic Surgery on Body Image and Psychological Well-Being: A Preliminary Study’, International Journal of Psychology & Behavior Analysis, 2015.
Furnham, A & Levitas, J 2012, ‘Factors that motivate people to undergo cosmetic surgery’, Canadian Journal of Plastic Surgery, 20(4), pp.47-50.
Klassen, AF Cano, SJ Alderman, A East, C Badia, L Baker, SB ... & Pusic, AL 2016, ‘Self-report Scales to measure expectations and appearance-related psychosocial distress in patients seeking cosmetic treatments’, Aesthetic surgery journal, 36(9), 1068-1078.
Lee, K Guy, A Dale, J & Wolke, D 2017, ‘Adolescent desire for cosmetic surgery: associations with bullying and psychological functioning’, Plastic and reconstructive surgery, 139(5), 1109-1118.
Lee, K Guy, A Dale, J & Wolke, D 2017, ‘Does psychological functioning mediate the relationship between bullying involvement and weight loss preoccupation in adolescents? A two-stage cross-sectional study’, International journal of behavioral nutrition and physical activity, 14(1), 38.
Milothridis, P Pavlidis, L Haidich, AB & Panagopoulou, E 2016, ‘A systematic review of the factors predicting the interest in cosmetic plastic surgery’, Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India, 49(3), 397.
Nerini, A Matera, C & Stefanile, C 2014, ‘Psychosocial predictors in consideration of cosmetic surgery among women’ Aesthetic plastic surgery, 38(2), 461-466.
Paraskeva, N Clarke, A & Rumsey, N 2014, ‘The routine psychological screening of cosmetic surgery patients’, Aesthetics, 28-32.
Pavan, C Marini, M De Antoni, E Scarpa, C Brambullo, T Bassetto, F ... & Vindigni, V. 2017, ‘Psychological and Psychiatric Traits in Post-bariatric Patients Asking for Body-Contouring Surgery’ Aesthetic plastic surgery, 41(1), 90-97.
Slevec, J & Tiggemann, M 2010, ‘Attitudes toward cosmetic surgery in middle-aged women: Body image, aging anxiety, and the media’, Psychology of women quarterly, 34(1), pp.65-74.
Wildgoose, P Scott, A Pusic, AL Cano, S & Klassen, AF 2013, ‘Psychological screening measures for cosmetic plastic surgery patients: a systematic review’, Aesthetic surgery journal, 33(1), 152-159.
Wimalawansa, SM Fox, JP & Johnson, RM 2014, ‘The measurable cost of complications for outpatient cosmetic surgery in patients with mental health diagnoses’, Aesthetic surgery journal, 34(2), 306-316