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Table of Contents
Year : 2021  |  Volume : 29  |  Issue : 2  |  Page : 116-120

Investigation of the relationship between university students social appearance anxiety and their attitudes towards aesthetic surgery

1 Karabuk University Vocational School of Health Services, Karabük, Turkey
2 University of Health Sciences, Gulhane Faculty of Nursing, Ankara, Turkey

Date of Submission09-Jun-2020
Date of Acceptance27-Aug-2020
Date of Web Publication26-Mar-2021

Correspondence Address:
Emine Onalan
Department of Surgical Nursing, University of Health Sciences Turkey, Gulhane Faculty of Nursing
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjps.tjps_62_20

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Introduction and Purpose: The aim of this study is to investigate the factors affecting University students' attitudes toward aesthetic surgery. Materials and Methods: This descriptive study was carried out in the spring semester of the 2018-2019 academic year with the students of the nursing Karabuk University. A form determining the sociodemographic characteristics of the students, the Cosmetic Surgery Acceptance Scale, and the Social Appearance Anxiety Scale were used to collect the study data. Results: The mean age of the students participating in the study was 21 ± 1.9 years, the mean body mass index was 22.54 ± 3.8, 72.5% were female, and 97.2% were single. The mean scores of the students obtained from the Cosmetic Surgery Acceptance Scale and Social Appearance Anxiety Scale were 45.73 ± 17.68, 34.85 ± 10.05, respectively. A significant relationship was determined between the mean of the Cosmetic Surgery Acceptance Scale and the ages of the students (P < 0.0001). In addition, there was a positive and strong relationship between the mean scores of the sub-dimensions of the Cosmetic Surgery Acceptance Scale (personal, social, and intellectual levels) and the mean score of the Social Appearance Anxiety Scale (P < 0.0001). Conclusion: In this study, it was determined that age and social appearance anxiety among university students are the factors that increase the possibility of opting for aesthetic surgery. Before aesthetic surgery interventions, determining psychological factors such as aging anxiety and social appearance anxiety that affect attitude toward aesthetic surgery in psychosocial evaluations and integrating the necessary interventions into nursing care will be beneficial in evaluating the suitability of patients for surgical intervention more accurately, applying more qualified nursing care, and increasing patient satisfaction.

Keywords: Aesthetic surgery, nursing, psychosocial, social view

How to cite this article:
Onalan E, Sahin SY, Iyigun E. Investigation of the relationship between university students social appearance anxiety and their attitudes towards aesthetic surgery. Turk J Plast Surg 2021;29:116-20

How to cite this URL:
Onalan E, Sahin SY, Iyigun E. Investigation of the relationship between university students social appearance anxiety and their attitudes towards aesthetic surgery. Turk J Plast Surg [serial online] 2021 [cited 2023 Jan 30];29:116-20. Available from: http://www.turkjplastsurg.org/text.asp?2021/29/2/116/312188

  Introduction Top

While surgical interventions are usually performed with curative or palliative intent because of a disease, in some cases they can be performed electively to alter the physical appearance of the individual. Aesthetic surgery is a specialized field that deals with maintaining, reconstructing, or improving the physical appearance of the individual and thereby contributes to improving their quality of life.[1],[2] The main objective in aesthetic surgical interventions is to transform a functionally normal body part into a form that is perceived as pleasant by both the individual and the society to enhance their perception of their bodily appearance.[3] A 98% increase has been reported between 2000 and 2012 in the number of different types of aesthetic surgical procedures performed for the purposes of changing personal appearance.[4] According to the American Society of Plastic Surgeons, 17.5 million aesthetic surgeries and minimally invasive treatments were performed in 2017 alone.[5] While there are no epidemiological studies published in this field in Turkey, the country ranks 9th among the member countries of the International Society of aesthetic plastic surgery in terms of aesthetic surgery rates.[6]

Reports in the literature indicate dissatisfaction with body image as the main factor affecting the tendency to undergo aesthetic procedures.[7],[8] Individuals who are concerned about their social appearance due to poor body image resort to aesthetic surgical methods to alter their physical appearance.[7] The success measure of the surgical procedure in such patients is reported to be the satisfaction level of the patient.[9] According to the reports, patients' dissatisfaction with aesthetic surgeries do not usually arise from technical errors, but from failures in communication before surgical intervention and patient selection criteria, and postoperative physical complications are rarer than psychological complications.[4],[10]

The prevalence of aesthetic surgeries in the general population is increasing due to the increasing interest, especially of young individuals, in aesthetic surgeries to alter physical appearance. Therefore, now nurses encounter more patients who present to the hospital for surgical procedures. Knowledge about how patients approach aesthetic surgery, and how their approach tends to change over time, as well as the factors associated with this tendency, are estimated to be useful to nurses in planning qualified nursing care for this special group of patients.[3],[10],[11],[12],[13] Studies aimed at investigating the prevalence of psychosocial pathologies of cosmetic surgeries will help to guide nurses in the psychological preparation before the surgical procedure, improve nursing processes, patient satisfaction, increase ethics, effectiveness, and safety of surgical procedures.[4]

There are few studies in the literature that investigate the psychological factors such as self-esteem, body image, and social appearance anxiety that affect the tendency to undergo aesthetic surgery. This study evaluates the influence of social appearance anxiety on the aesthetic surgical preferences of university students with tools that have been tested for validity and reliability and aims to contribute to the literature, as well as to developing evidence-based nursing practices, and to enhance the quality of care and patient satisfaction.


The purpose of this study is to identify the influence of sociodemographic characteristics and social appearance concerns of university students on their aesthetic surgery preferences.


  1. Do the sociodemographic characteristics of university students influence their tendency to undergo aesthetic surgery?
  2. What is the level of social appearance anxiety of university students?
  3. What is the attitude of university students toward aesthetic surgery?
  4. Is there a relationship between university students' social appearance anxiety and their attitudes toward aesthetic surgery?

  Materials and Methods Top

Type of study

This study is descriptive and prospective.

Place of study

This single-center study was conducted in the nursing department of a university in Karabuk.

Population and sample of the study

The study population consisted of 418 students studying at the nursing department of a university in Karabuk in the spring semester of the 2018-2019 academic year. Instead of sampling, the study is aimed to reach the entire universe. The sample of the study consisted of 316 (76%) students who volunteered to participate.

Data collection tools

A personal information form prepared by the researchers, the Acceptance of Cosmetic Surgery Scale (ACSS) and the Social Appearance Anxiety Scale (SAAS) were used in the study. The questionnaires were distributed in the classroom and asked to be completed on voluntary basis. It took approximately 15 min to complete one questionnaire.

Personal information form

The Personal Information Form, developed by the researchers, defines the sociodemographic characteristics (such as age, gender, marital status, and year of education) and the aesthetic surgery history of the students.

Acceptance of Cosmetic Surgery Scale

The ACSS, developed by Henderson-King and Henderson-King in the USA and the Cronbach's alpha coefficient for the scale was reported between 0.91 and 0.93.[14] The validity and reliability of the Turkish version of the ACSS were studied by Karaca et al. Karaca et al., report the Cronbach's alpha coefficient for the Turkish version as 0.92. The ACSS uses a 7-point Likert scale (ranging from 1 = strongly disagree to 7 = strongly agree) and can be evaluated based on three sub-scales as well as the total score. The score range is 15–105. Increase in sub-scale scores and scale total scores indicate a positive attitude toward aesthetic surgery. The sub-scales are interpersonal (items 1, 2, 4, 5, 14), social (items 9, 11, 12, 13, 15), and consider (items 3, 6, 7, 8, 10). The Interpersonal sub-scale measures the individual's personal evaluation of their own appearance that nurtures their motivation for aesthetic surgery. The Social Sub-Scale identifies the attitudes that affirm having an aesthetic surgery to make them feel better in their social relations and social circles. The consider sub-scale addresses the individual's views on aesthetic surgery. The results of the ACSS are calculated based on both the sub-scale scores and the total score. Higher scores indicate a higher likelihood of accepting aesthetic surgery.[3] In this study, Cronbach's alpha value for the ACSS was found 0.92.

Social Appearance Anxiety Scale

The SAAS was used to identify the social appearance anxiety levels of university students. The SAAS is a self-report type scale developed by Hart et al. (2008) to measure the behavioral, cognitive, and emotional anxieties experienced by individuals because of their appearance. The Turkish adaptation of the scale was made and tested for validity and reliability by Doğan et al. The Cronbach's alpha internal consistency coefficient for SAAS was found 0.93, the test–retest reliability coefficient 0.85, and the reliability coefficient obtained using the split-half method 0.88.[14] The SAAS consists of 16 items that are rated on a 5-point Likert-type scale, ranging from 1 to 5, namely, 1 = strongly disagree, 2 = disagree, 3 = slightly agree, 4 = agree, 5 = strongly agree. The first item of the scale is reverse-coded. As SAAS measures social appearance anxiety as single factor, the high scores indicate high appearance anxiety. In this study, Cronbach's alpha value for SAAS was found 0.90.

Ethical aspect of the study

Written approval was obtained from the Rectorate of the Karabuk University for conducting the study and from the proprietors of the measurement tools used in the study. Written informed consent was obtained from the students who participated in the study. Approval was also obtained from the Ethics Committee for Non-Interventional Clinical Research of the Karabuk University for Rectorate (Ethics Committee Approval No: Decision No. 4/8, March 2019/28)

Data analysis

The data from the ACSS were used as dependent variables, the data from the SAAS and the Personal Information Form were used as independent variables. Statistical analysis of the collected data was carried out using the IBM SPSS 22.0 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp) statistics package program. The data were analyzed using descriptive statistics (frequency, percentage distribution, arithmetic mean, standard deviation, minimum, and maximum), and skewness and kurtosis values were calculated to test whether the data satisfied the assumption of the normal distribution, then tested with the Shapiro–Wilk test. The Mann–Whitney U-test was used to analyze the relationship between two independent variables when the data did not comply with the normal distribution. Pearson's correlation analysis was used to identify the presence and the nature of relationships between variables. The significance level was accepted as P < 0.05.

  Results Top

This study was conducted with 316 nursing students. Their mean age was 21 ± 1.9 (17–29) and their mean body mass index (BMI) was 22.54 ± 3.8 (15–41).

The characteristics of the students included in the study are shown in [Table 1]. As shown in the table, 72.5% of the students are female and 2.8% are single. Fourth-year majors (31.6%) constituted the majority and only 0.9% had a history of aesthetic surgery.
Table 1: Characteristics of Participants

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Results of the Pearson's correlation analysis carried out for the correlation between ACSS and age and BMI are shown in [Table 2]. Pearson's correlation analysis showed low-positive correlation between the ACSS score and age (r = 0.204; P < 0.0001). Attitudes toward cosmetic surgery were seen to positively increase with age. Very low-level insignificant positive correlation was identified between the ACSS score and BMI (r = 0.071; P < 0.210).
Table 2: Correlation between Acceptance of Cosmetic Surgery Scale and age and body mass index

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[Table 3] shows the scores for SAAS, ACSS, and the sub-scales (interpersonal, emotional, and social) of SAAS. The overall median of SAAS was 34.85 ± 10.05. The overall median of ACSS was 45.73 ± 17.68; the median of the interpersonal sub-scale was 15.48 ± 6.24, the median of the social sub-scale was 12.32 ± 6.99, and the median of the consider sub-scale was 14.61 ± 6.28.
Table 3: Distribution of mean Acceptance of Cosmetic Surgery Scale and Social Appearance Anxiety Scale scores

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Pearson's correlation analysis showed low-positive correlation between the mean ACSS and SAAS scores of the students (r = 0.261; P < 0.0001) [Table 4]. Strong positive correlations were identified between the mean SAAS scores and the sub-scale scores of the ACSS, namely the interpersonal (r = 0.794; P < 0.0001), social (r = 0.857; P < 0.0001), and consider (r = 0.878; P < 0.0001).
Table 4: Analysis of the correlation between Acceptance of Cosmetic Surgery Scale and Social Appearance Anxiety Scale

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  Discussion Top

This study investigated whether the attitudes of university students toward aesthetic surgery were influenced by their sociodemographic characteristics and social appearance anxiety. The median ACSS value of 45.73 ± 17.68 (15–96) showed that the students had a moderate attitude toward opting for aesthetic surgery. The presence of a significant correlation between ACSS, its sub-scales and SAAS showed that students with higher social appearance anxiety could opt for aesthetic surgery in the future. The likelihood of opting for aesthetic surgery was also seen to be influenced by the sociodemographic characteristics of the students.

Our results also showed that the likelihood of the students to opt for aesthetic surgery increased together with their age. A correlation between opting for aesthetic surgery and age was, reported by another study which was similarly conducted with university students with a mean age of 24.74 ± 7.51 years.[15] Studies conducted with middle-aged women reported that age and aging anxiety led to an increase in opting for aesthetic surgery,[16],[17] and that women's likelihood of opting for were high despite their possible health risks associated with surgery.[18] There are also different studies in the literature reporting an increase in the tendency to undergo aesthetic surgery based on age and aging.[19],[20],[21] Our results and the reports in the literature suggest that the tendency to undergo aesthetic surgery increased not only with aging but also with the increase in age, starting from the university years.

Our study did not show any significant difference between the students' probability of opting for aesthetic surgery based on BMI values (22.54 ± 3.8). Some studies report that higher BMI values led to increased tendency to aesthetic surgery,[15],[16] whereas others report that BMI did not have any influence on the tendency to opt for aesthetic surgery.[2],[12] Reports in the literature indicate body weight to be a regular area of discontent for women,[22] whereas men tend to be more satisfied[23] with higher body weight. The absence of a correlation between BMI values and aesthetic surgery preference in our study may be due to the low number of students with BMI ≥25 kg/m2 (8.5%).

Our results showed a significantly positive correlation between ACSS scores and the interpersonal, social and consider sub-scale scores of ACSS, and social appearance anxiety (r = 0.261, r = 0.794, r = 0.857, r = 0.878, respectively, and P < 0.05 for all scores). Studies, similar to our results, report that the primary reason for opting for aesthetic surgery was related to social appearance anxiety associated with poor body image, and its most important effect were that individuals regarded aesthetic surgery as a means of improving their overall bodily appearance.[11],[12] Similarly, poor body image and aging anxiety are reported to cause body dissatisfaction, hence social appearance anxiety caused by body dissatisfaction to create a positive attitude toward aesthetic surgery.[18],[19] Reports in the literature state that social appearance anxiety positively affected individuals' choice of aesthetic surgery in relation to negative emotions and conceptions about their physical appearance, feeling unattractive, discomfort with their physical appearance, and feeling ashamed of their body.[4],[24],[25],[26] Individuals with social appearance anxiety try to eliminate this anxiety by altering their physical appearance through aesthetic surgery, and thereby create a positive appearance, especially in self-evaluation situations, to reduce the risk of social exclusion. Based on the obtained results and literature reports, age and social appearance anxiety of individuals are deemed to increase their likelihood of opting for aesthetic surgery.

  Conclusion Top

Scrutiny of the attitudes of university students toward the possibility of opting for plastic surgery showed that increased age and increased social appearance anxiety were factors that increase their likelihood of opting for aesthetic surgery. The results of this study demonstrated that university-age individuals see themselves as medium-level potential candidates for aesthetic surgery during their lifetime.

These results suggest that a better understanding of the psychological factors, such as aging anxiety and social appearance anxiety, which increases the likelihood of opting for aesthetic surgery would allow patients to assess their suitability more accurately for surgical intervention. Given the extraordinary increase in the number of aesthetic surgery procedures, identifying the psychological factors that lead patients to opt for aesthetic surgery will become ever more important. Integrating the physical needs of patients, as well as their psychosocial needs into the preoperative nursing care will help nurses to increase both the quality of care and patient satisfaction. More studies are advised to identify the factors that motivate individuals to seek plastic surgery.

Limitations of the study

That the study was conducted only with the students at a university in Karabuk may be a limitation in the generalizability of the results to all university students.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4]


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