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Consumer Behavior

Why Undergo Cosmetic Surgery?

The psychology behind our willingness to go under the knife and needle

Melies the Bunny/Flickr
Source: Melies the Bunny/Flickr

Why do people undergo cosmetic surgery? It’s a simple question that’s unlikely to yield a simple answer.

A common refrain from those who have gone under the knife or needle is “I do it for myself.” But what does that really mean? Maybe that the patient decided on surgery because of the benefits it confers on the self, and not for any effects it might have on others, such as romantic partners or rivals. “I do it for myself” also emphasizes the free will of the patient: he or she doesn’t feel pressured into surgery by outside forces, such as peer pressure, the media, or advertisements.

But is this true? New research published recently has questioned the motives of those who opt for cosmetic procedures, and suggests that they may be more complex than many would care to admit.

Ubiquitous advertisements

The imagery of cosmetic interventions is everywhere. Strolling down a busy city street, flicking through a glossy magazine, or surfing cable TV, we’re inundated with advertisements or puff pieces for various beautifying procedures: Botox, fillers, cosmetic dentistry, breast augmentation; the list goes on. It’s sometimes difficult to recall, but only a few short years ago many of us were shocked by these emergence of these advertisements; now they are so integrated into our media landscape they often go unremarked upon. The stigma around cosmetic surgery has been eroded, and to contemplate a procedure is now perfectly normal.

Now, some of you will identify with the picture I’ve just painted. Others will think I’m developing a sideline in dystopian fiction. And that’s because the quantity of cosmetic surgery advertisements you encounter is dependent on where you live in the world.

Where I’m from — the UK — these adverts are quite common. Where I currently live, in Switzerland, I rarely see any. In Italy and France, advertising for cosmetic surgery is banned outright.

This is a difference that was noticed by Eleni-Marina Ashikali of the University of Sussex in Brighton, UK. She and her colleagues, who had previously conducted research into how cosmetic surgery advertising affects British women, decided to run a similar study in the French-speaking part of Switzerland. Their aim: To discover whether women’s attitudes to surgery are different in this land-locked “island” at the heart of Europe.

(By the way, it makes sense to begin by investigating women rather than men, because nine out of 10 cosmetic surgery patients are female.)

Risks, Rewards, and… Flowers?

Ashikali recruited 145 women at the University of Neuchâtel. These women were randomly allocated to four groups. Each group of women saw four advertising posters, but the posters they saw were subtly different.

The first group saw advertisements for cosmetic surgery clinics featuring attractive female models. The second group saw advertisements that were identical except for one detail: they featured a discount of “700 Swiss francs off your first procedure.” The third group’s advertisements featured no discount but instead a warning of the potential risks associated with surgery: “…bleeding, scarring, and infection.” The fourth and final group, as a control, saw advertisements not for cosmetic surgery but for a flower delivery company.

Afterwards, the women completed a couple of surveys. One was a body-image survey. Another was the Aspirations Index, which can be thought of as a measure of materialism: the extent to which a person seeks self-worth through money or popularity rather than community affiliation or other intrinsic factors.

The women also completed the Acceptance of Cosmetic Surgery Scale. This survey includes items such as:

  • “It makes sense to have minor cosmetic surgery rather than spending years feeling bad about the way you look.”
  • “I would seriously consider having cosmetic surgery if my partner thought it was a good idea.”
  • “If I knew there would be no negative side effects or pain, I would like to try cosmetic surgery.”

Respondents are tasked with rating how much they agreed or disagreed with each statement. Higher scores indicate a person thinks cosmetic surgery could improve their self-image, or that they would consider undergoing cosmetic surgery.

The results of the study showed that women exposed to cosmetic surgery advertisements were more likely to report a discrepancy between their ideal and actual body-image: 44% wished they were thinner and 68% wished their appearance was in some way more attractive. Among women who were shown the florists’ advertisements, only 21% reported a desire to look thinner while 24% wanted to change some other aspect of their appearance.

So, the adverts seemed to make women feel worse about themselves. But analysis of the results of the Acceptance of Cosmetic Surgery Scale suggested that this dissatisfaction didn’t directly translate into a desire to undergo surgery: women were just as likely to express an acceptance of cosmetic surgery whether or not they had just been exposed to a cosmetic surgery advertisement.

This is not what the researchers had previously found in the UK. In their paper, published in the Swiss Journal of Psychology, they speculate that:

Maybe the lower exposure to cosmetic surgery in Switzerland results in more stigma being attached to cosmetic surgery and Swiss women, therefore, being less likely to report having a positive attitude toward it.

But this isn’t the whole story. When Ashikali compared women who were high or low on materialistic values she happened upon some interesting results.

Materialistic and non-materialistic women were no different in their judgments of the benefits that would accrue to them if they underwent cosmetic surgery, if they had just been exposed to a cosmetic surgery advertisement. Among women who had instead been exposed to a florists’ advertisement, materialistic women were more likely to see benefits in surgery than were non-materialistic women.

Advertisements appear to make materialistic women less enthusiastic about surgery, and non-materialistic women more enthusiastic.

What’s more, materialistic and non-materialistic women were no different in their judgments of the benefits of surgery when they had been shown advertisements highlighting the risks of surgery. But materialistic women were more positive about surgery than were non-materialistic women after being shown adverts touting monetary discounts.

The researchers suggest that these results:

Could be related to materialistic women’s sensitivity to financial information and the offer of a discount making surgery more appealing.

In the UK, exposure to cosmetic surgery advertisements lessens a woman’s perceptions of the benefits of surgery, but in Switzerland the effect is more nuanced. Whether this can really be explained by the different media environments between the two countries, we can’t say for sure. Further cross-cultural research would seem to be warranted. Looks like a field trip to France or Italy is in order…

Moving on Up in the Mating Market

One of the clearest benefits of cosmetic surgery is that is improves appearance. If it didn’t, nobody would spend the money or go through the pain associated with these procedures.

Most of us would rather be more than less attractive than our peers because attractiveness confers all kinds of benefits, including the ability to compete for higher-value partners.

But we don’t cease efforts to improve our appearance as soon as we secure a partner. As regular readers of this blog will know, humans are motivated to keep a partner just as much — if not more so — than they are motivated to acquire a partner.

This realization led a team of researchers from the US and Iran to test a controversial question. The results of their inquiry were recently published in the journal Frontiers in Psychology.

Mohammad Atari of the University of Tehran, the lead author of the study, wondered whether women might undergo cosmetic procedures as a way of retaining their mates. He theorized that men would not be similarly motivated because men’s appeal as a partner is less dependent on their physical appearance than is women’s.

Cosmetic Surgery for the Partner’s Benefit?

Atari and his colleagues approached men and women on the streets of Tehran. Two hundred men and women who had a partner agreed to participate. They each completed the Acceptance of Cosmetic Surgery Scale and the Mate Retention Inventory. The latter is a measure of the frequency with which a person deploys various tactics that may keep their relationship intact. These tactics include so-called benefit-provisioning behaviors, such as giving the partner gifts, and cost-inflicting behaviors, such as insulting or assaulting the partner.

Atari found that women were more likely to consider undergoing cosmetic surgery if they also frequently performed benefit-provisioning mate retention behaviors. However, contrary to expectations, he did not find a link between cost-inflicting mate-retention behaviors and attitudes to surgery. So, women who perform nice but not nasty behaviors to keep their relationships strong are also more likely to consider undergoing surgery, perhaps in the hope that their improved appearance might attract their partner more strongly.

As predicted, there was no link between attitudes to cosmetic surgery and mate retention in men.

The researchers state that:

These findings indicate that women more generally consider cosmetic surgery as a means of retaining their long-term mates by improving their physical attractiveness.

At first glance, this may seem true. But, as Atari and colleagues concede:

It is possible that the direction of causality may be reversed such that the proclivity to improve physical appearance may influence report of different mate retention behaviors.

That is, we don’t know whether attitudes to cosmetic surgery cause a woman to perform more mate-retention behaviors, or if performing more mate-retention behaviors causes a woman to improve her attitudes toward cosmetic surgery.

It’s also possible that a willingness to undergo cosmetic surgery has nothing to do with mate-retention, and that both traits are related to some other characteristic: how about, for the sake of argument, materialism?

Perhaps it would be useful to run a study in which women are primed to feel more positively or negatively about plastic surgery and then measure their mate-retention behavior. This experimental study would provide clearer evidence of causation, if it exists.

A combination of the methods used in these two studies by Ashikali and by Atari might go some way to answering that deceptively simple question: why do people undergo cosmetic surgery?


Ashikali, E.-M., Dittmar, H., & Ayers, S. (2017). The impact of cosmetic surgery advertising on Swiss women’s body image and attitudes toward cosmetic surgery. Swiss Journal of Psychology, 76(1), 13–21. doi:10.1024/1421–0185/a000187

Atari, M., Barbaro, N., Sela, Y., Shackelford, T. K., & Chegeni, R. (in press). Consideration of cosmetic surgery as part of women’s benefit-provisioning mate retention strategy. Frontiers in Psychology.

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