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The Cosmetic Surgery Paradox

A new review explains why people may both love and hate cosmetic surgery.

Key points

  • Cosmetic surgery is becoming increasingly popular worldwide.
  • The "cosmetic surgery paradox" describes the phenomenon whereby women are both encouraged to undergo cosmetic surgery and condemned for doing so.
  • Cosmetic surgery advertisements, media, and government policy contribute to the rise in cosmetic surgery.
  • Negative attitudes to cosmetic surgery are caused by concerns for well-being, and by the belief that cosmetic surgery is unnatural and unjust.
Photo by Joeyy Lee on Unsplash
Source: Photo by Joeyy Lee on Unsplash

Cosmetic surgery involves surgical procedures (e.g., liposuction) and non-surgical procedures (e.g., Botox) that aim to improve one’s appearance. Plastic surgery, in contrast, aims to restore the appearance and functioning of the body, for example after illness or injury.

Despite the potential health risks of cosmetic surgery, its popularity is rapidly increasing. For example, rates of cosmetic surgery increased by 20 percent worldwide between 2015 and 2019. In the U.S., 18 million procedures are performed each year, and in South Korea, 20 percent of the population undergoes cosmetic surgery each year. In all countries, most cosmetic surgery patients are women, and in many countries, cosmetic surgery patients are very young. In China, for instance, 96 percent of cosmetic surgery patients are under 35.

In a new review of the scientific literature, researchers at the University of Melbourne and the University of Queensland (Australia) sought to understand more about what they coined the cosmetic surgery paradox: “the phenomenon by which modern women are both encouraged to undergo cosmetic surgery and condemned for doing so” (p. 231). Below, I summarize the key points from their review.

Why We Like and Think We “Need” Cosmetic Surgery

Beauty ideals are at the core of the cosmetic surgery paradox. Current beauty ideals are unrealistic and often unachievable for most women. For example, to have muscle tone and no body fat, but with “curves in the right places.” Importantly, while beauty ideals have always existed, nowadays women are constantly exposed to them via technology (social media), and are taught to view their body as a “problem” that “needs to be fixed.”

Three main factors play a role in doing so:

1. Cosmetic surgery advertising.

Historically, many cosmetic surgeries aimed to reduce stereotypically racialized features. This ties into the fact that beauty ideals often idolized a more “Western” appearance. Nowadays, however, there are cosmetic surgeries for all areas of the body. Cosmetic surgery companies advertise their procedures as a tool to achieve a “better” appearance and to “fix” that particular body part.

Importantly, cosmetic surgery companies both promote existing beauty ideals and shape those beauty ideals as well. The authors give an example of cosmetic surgery for female genitalia. Cosmetic surgery companies created the term “labia hypertrophy” to describe when the labia minora extend beyond the labia majora and are “larger than normal.” Despite the fact that over half of all women have vulvas that are naturally formed in this way, cosmetic surgery advertisements frame “labia hypertrophy” as a “problem” with an “easy fix.” The increasing popularity of labiaplasty can be attributed to beauty ideals that idolize only one type of vulva, and to cosmetic surgery advertisements that frame other vulvas as "abnormal" and in need of fixing.

2. Media.

Reality TV like “Keeping Up With the Kardashians” is popular across cultures, and promotes beauty ideals and cosmetic surgery. The reach of these shows is magnified via the celebrities’ social media.

Interestingly, on many “makeover” shows, contestants describe wanting to undergo cosmetic surgery to look “normal.” These shows reinforce the idea that deviations from the beauty ideal are abnormal (e.g., larger nose, smaller breasts) and cosmetic surgery is a suitable “treatment.” The research shows that women who watch reality TV that promotes beauty ideals and cosmetic surgery are more likely to undergo cosmetic surgery.

3. Government policy.

Interestingly, governments often promote cosmetic surgery as well. The authors give an example from Brazil, where people can undergo free or low-cost cosmetic surgery. The initiative began in the 1960s as an attempt to help people overcome lower socioeconomic status, as many people who had migrated to urban centers in search of work were stigmatized based on their appearance (e.g., discernibly aged faces from working in the sun). Cosmetic surgery was promoted as a solution to help people break through classist barriers by altering their appearance. In other countries, cosmetic surgery is promoted in government tourist publications (e.g., Hungary) and is government-subsidized (e.g., South Korea).

Why We Dislike Cosmetic Surgery and Those Who Receive It

As much as cosmetic surgery is becoming increasingly popular, at the same time, there are widespread negative attitudes towards cosmetic surgery and those who receive it. Why is that? The authors provide the following reasons.

1. Concerns about well-being.

Even though rates of complications are typically low, cosmetic surgery does carry health risks. Unlike other medical procedures, cosmetic surgery is not considered necessary.

Further, even though cosmetic surgery can improve satisfaction with certain body parts, there is not much evidence to suggest that cosmetic surgery makes people significantly happier with their body, and any improvements to self-esteem are short-lived. People may therefore view cosmetic surgery negatively because they believe it is not justified. Indeed, research shows that people who are against cosmetic surgery justify their beliefs based on concerns about the harm done to people who undergo it.

2. Cosmetic surgery as unnatural.

The authors describe the naturalistic fallacy that underpins negative attitudes to cosmetic surgery—namely, the ingrained belief that that which is natural (vs. unnatural) is good and should be revered.

The naturalistic fallacy is reflected in current beauty ideals, where “natural beauty” is seen as good. For example, beauty companies and fashion magazines promote products and regimes to achieve a “natural” look, and studies show that men prefer women who are beautiful without using makeup, effort, or artifice. Further, although beauty ideals often idolize youthfulness, women who use treatments to mask or “reverse” the signs of aging are viewed negatively.

Numerous studies indeed show that people view cosmetic surgery in a negative light, precisely because they view it to be unnatural. For example, in South Korea, a country where cosmetic surgery is common, cosmetic surgery is only considered acceptable when the outcome looks “natural.” In contrast, in cases where the outcome does not look natural, people describe facing condemnation and stigmatization. Other studies show that people who view cosmetic surgery as wrong justify their beliefs based on the fact that cosmetic surgery “violated the body’s sanctity” (p. 235).

3. Cosmetic surgery as unjust. Last, there is evidence to suggest that cosmetic surgery is viewed negatively because it is perceived to give people an unfair advantage over others—for example, when it comes to dating or job success. Relatedly, people may view cosmetic surgery as unjust because they believe it to be a “lazy way out” (e.g., liposuction vs. dieting and exercise).

Putting It All Together

To summarize, current beauty ideals paint an unrealistic and often unattainable picture of beauty. Moreover, this beauty must be obtained “naturally” and must be “justly acquired.”

These beauty ideals contribute to the medicalization of appearance and to the popularization of cosmetic surgery, for example via cosmetic surgery advertisements, reality TV, and social media. At the same time, these beauty ideals also contribute to widespread negative attitudes towards cosmetic surgery, and those who undergo it, as unnecessarily risking their health, as an “unnatural” form of beauty, and as unjust.

Therefore, many women may find themselves in a Catch 22, where "you're damned if you do, damned if you don't." The authors conclude their review with valuable directions for future research, such as conducting more experiments across genders and across different cultures around the world.


Bonell, S., Barlow, F. K., & Griffiths, S. (2021). The cosmetic surgery paradox: Toward a contemporary understanding of cosmetic surgery popularisation and attitudes. Body Image, 38, 230-240.

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