Why Cosmetic Surgery Is on the Rise in the U.S.

August 28th 2015

More than 15.6 million cosmetic procedures were performed in 2014, a 3 percent increase from the previous year, according to the American Society of Plastic Surgeons.

Of these 15.6 million procedures, 1.7 million were surgical and 13.9 million were minimally-invasive procedures. The most performed cosmetic surgical procedures in 2014 were breast augmentation, nose reshaping, liposuction, eyelid surgery, and facelifts. Botulinum toxin type A was the most popular minimally-invasive procedure, followed by soft tissue fillers, chemical peel, laser hair removal, and microdermabrasion.

The number of cosmetic surgeries performed increased across all demographics and among both men and women from 2013 to 2014. And these procedures aren’t cheap: Americans spent $12.9 billion on cosmetic procedures in 2014, an increase of 2 percent from 2013.

Why cosmetic surgery is on the rise in the U.S.

RealSelf, a website that provides cosmetic surgery information and reviews, surveyed 700 people who had contacted a doctor to discuss cosmetic surgery. Respondents were asked to pick one adjective from a list to describe how they hoped to feel after the procedure, and 76 percent of those surveyed picked “confident.” In the age of 24/7 social media bombardment, confidence isn’t necessarily easy to come by—especially among those who hope to emulate the look of a particular celebrity. In one extreme case, a man spent $100,000 to look more like Justin Bieber. (He was found dead on August 27.)

The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) reported that in 2014, 13 percent of facial plastic surgeons surveyed reported an increase in requests for procedures designed to make patients look like celebrities. In 2014, according to the AAFPRS press release, these were the top five most-wanted celebrity facial features: 

1. Angelina Jolie’s lips and cheekbones

2. Beyoncé’s facial structure

3. Kim Kardashian’s eyes and jaw line

4. Brad Pitt’s nose

Brad PittDepartment of Defense - wikimedia.org5. Natalie Portman’s nose

Natalie PortmanGeorges Biard - 

“Some people are attracted to the power, fame and attention that being a celebrity brings,” said Stephen S. Park, president of the AAFPRS, in the press release. “It’s important to remember that simply changing your appearance will not give you the same level of recognition. Celebrity photos are so often re-touched that their images are distorted which can result in unrealistic expectations that propel consumers to seek excessive or extreme surgeries.”

What selfies are doing to plastic surgery.

The rising prevalence of selfies is also a factor that has contributed to increased image consciousness. Preoccupation with the look of a particular celebrity, or constantly comparing oneself with others on social media, can lead to an unhealthy body image. In its most serious form, poor body image manifests as body dysmorphic disorder (BDD).

According to the Anxiety and Depression Association of America (ADAA), people suffering from BDD are fixated on their perceived physical flaws to an extremely unhealthy extent. People with BDD “…can't control their negative thoughts and don't believe people who tell them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may even undergo unnecessary plastic surgeries to correct perceived imperfections, never finding satisfaction with the results.”

What are the risks?

A study that analyzed hospital readmission rates for cosmetic and reconstructive surgery reported that in 2011, only 4.5 percent of patients were readmitted within 30 days. Readmission rates for elective surgeries were lower than those for reconstructive surgeries. Certain risk factors made readmission more likely, for example, readmission rates increased for obese patients by 20 percent, and for anemic patients by 80 percent.

Individuals struggling with BDD may not be good candidates for cosmetic surgery, as 82 percent of surgeons whose patients had BDD reported that their patients had poor postoperative outcomes. Unfortunately, symptoms of BDD often remain undetected until after patients receive cosmetic surgery; however, it may be possible for doctors to screen patients for BDD symptoms. Research published in 2013 in the International Journal of Medical Informatics provides a “fuzzy linguistic model” intended to measure the distress of patients seeking cosmetic surgery.

Researchers continue to explore the psychological impacts of cosmetic surgery on patients who don’t suffer from BDD. A study published in 2013 reviewed existing scientific research to attempt to determine whether such procedures benefit patients psychologically. The researchers found that, “Most studies reported modest improvement in psychosocial functioning, which included quality of life, self-esteem, and body image. Unfortunately, the overall quality of evidence is limited owing to an absence of control groups, short follow-up periods, or loss to follow-up.”

Sexual objectification and cosmetic surgery.

In 2013, a study conducted in the U.K. and published in the Psychology of Women Quarterly found that undergraduate women exposed to words associated with sexual objectification demonstrated increased body shame and a greater desire to have cosmetic surgery. ATTN: asked lead researcher and University of Kent psychologist Rachel Calogero if she was surprised by any particular aspect of these findings.

Calogero said that while she wasn’t surprised by the general pattern of the findings, “it was disturbing that such a subtle prompt to focus on appearance (reading appearance-focused words) was sufficient to activate beliefs about body shame and the desire for cosmetic surgery. When you think about how frequently women are exposed to these messages within so many areas of their daily life—it is troubling.”

The idea that social media may be detrimental to cultivating a healthy body image is well documented, as is the phenomenon of women fielding anonymous, often sexually explicit, hateful messages online. I asked Calogero if she thinks that social media has exacerbated the sexual objectification of women.

“The most prevalent sources today are the same sources of sexual objectification that women have always encountered: leering and catcalls, street harassment, media portrayals, interpersonal commentary, workplace harassment, sexual violence, and rape,” Calogero said. “Social media is simply the latest delivery system for sexist ideology and dehumanizing treatment of women, although the anonymity and lack of accountability make it even more insidious.”

Those who seek elective cosmetic surgery because of sexual objectification at the hands of others, or because of self-objectification, may not find what they’re looking for in an operating room. To foster a health body image, Calogero says, young women need to challenge self-objectification.

“When we change the focus from 'what do I look like' to 'what can I do', we change our self-orientation and the direction of our pursuits," she said. "We take care of ourselves from the inside out. Young women need to focus on and appreciate more what their bodies can do than what they look like to others. The value placed on women's physical competence and strength and endurance, as well as their intellectual prowess and ability, is low—this needs to change.”

Part of challenging objectification means not only placing less focus on physical appearance, but also adopting a broader and less homogenous idea of beauty.

“Young women also need to expand their views on what constitutes beauty and appreciate (and understand) the diversity of bodies that women inhabit—and that it's a good thing,” Calogero said. “Size acceptance is a critical component of self-acceptance, and protective against self-objectification and the pressure to surgically alter one's body and appearance. Finally, we have to stop trivializing and normalizing the sexual objectification of women and instead call it out for what it is: sexism. Young women need to understand that when they feel bad about their bodies, and feel valued only when they perform as sex objects, their opportunities for achievement and true self-determination become more limited.”

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