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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 29  |  Issue : 2  |  Page : 121-127

How does socioeconomic level change women's perspectives and preferences on aesthetic applications?


Ayhan Okumuş Aesthetic, Plastic and Reconstructive Surgery Clinic, Bursa, Turkey

Date of Submission25-May-2019
Date of Acceptance07-Nov-2019
Date of Web Publication26-Mar-2021

Correspondence Address:
Dr. Ayhan Okumus
Bulvar 224 B - Blok No: 1/B Kat: 6 D: 10, Nilufer, Bursa
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_43_19

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  Abstract 


The rapid developments in aesthetic medicine and the exaggerated results promised on the social media platform drive people to spend considerable budgets on such procedures to look more beautiful. Individuals often work extra jobs, take out bank loans, or borrow from friends to be able to pay for the prices that exceed what they can afford. This study is a survey designed to feel the pulse of the community on the economic aspect of aesthetic procedures. The study was carried out during March 30 to April 30, 2019, in the province of Bursa. Face-to-face interviews were conducted with participants selected based on the socioeconomic status and age according to the data of the Turkish Researchers' Association and the Turkish Statistical Institute. The distribution by age statistical data provided by the Turkish Statistical Institute for the province of Bursa was taken as the base in the selection of the participants. The survey was conducted with women as they undergo more aesthetic procedures and drive the cosmetic industry. Five hundred women, half of whom had undergone aesthetic intervention, were asked 15 questions to understand their viewpoint on the economic aspect of aesthetic procedures. The questions asked to all participants, i.e., those who had and had not undergone aesthetic intervention, were structured as easy-to-understand phrases without specifically guiding the participants and with clear response options such as “yes,” “no,” and “I have no idea.” The participants could also elaborate on their response using free text. The results were shown in percentile. Intra-analysis and cross-analysis were performed to interpret the results. The results of our study suggest that people tend to push the limits of their budget for aesthetic procedures. More importantly, however, the study showed that aesthetic procedures are often performed at incompetent centers. Most of those who have undergone a procedure in such places are of high education and economic levels, i.e., of high socioeconomic status (A and B) with undergraduate or postgraduate degree, which depicts a hard-to-understand and a troubling picture.

Keywords: Aesthetic procedures, illegal aesthetic procedures, socioeconomic level, survey


How to cite this article:
Okumus A. How does socioeconomic level change women's perspectives and preferences on aesthetic applications?. Turk J Plast Surg 2021;29:121-7

How to cite this URL:
Okumus A. How does socioeconomic level change women's perspectives and preferences on aesthetic applications?. Turk J Plast Surg [serial online] 2021 [cited 2021 Apr 21];29:121-7. Available from: http://www.turkjplastsurg.org/text.asp?2021/29/2/121/312183




  Introduction Top


Today, aesthetic procedures have penetrated all segments of the society and cannot be associated with specific sociocultural stratum, gender, age, or economic class. All individuals, albeit different brands at different prices, use cosmetic products, dye their hair, reshape their eyebrows according to the latest fashion, and reserve a budget, whether small or big, for aesthetic procedures. Minimally invasive procedures that can be performed outside of the hospital environment, e.g., injections, laser applications, skin care, and mesotherapy, are offered in increasing varieties and product ranges and are in high demand.

While these constitute a segment that has become a huge sector worth billions of dollars both in Turkey and across the world, ethical and regulatory compliance issues are often encountered. Institutions that appeal to all budgets, fraudsters, and businesses that operate under different names, all are in a cutthroat race to get a share of the cake. These persons, institutions, and companies – many of which are unauthorized – can offer affordable prices for all budgets with a range of products of different qualities, making these procedures attractive even to people with minimal income.

The Internet and the social media platform, together with the ubiquity of smart digital phones, began to diminish the importance of cultural and national borders. The hairstyle of a person in a different part of the world can now be copied by persons in a remote part of our country, surgeries can be viewed live, the amazing changes enabled by cosmetic applications can be clearly seen, and all of these have come easily affect the desires of people. This outcome can have serious influence on persons who have problems with their appearance or want to change their looks. At present, we see that many people get a job to raise the money for aesthetic procedures, take out bank loans, do illicit work, or save from their food money.

The study was conducted in Bursa, which is a province representative of the country at large, as it lies close to the largest cities, accommodates people of all economic levels, and is an industrial and agricultural province with migration from all across Turkey. A survey was conducted with 500 women to evaluate the perspectives of the city's female residents on the economic aspect of aesthetic applications.


  Materials and Methods Top


The survey was carried out during March 30 to April 30, 2019, in the province of Bursa. Face-to-face interviews were conducted with the participants selected based on socioeconomic status and age according to the data of the Turkish Researchers' Association and the Turkish Statistical Institute [Figure 1], [Figure 2]. First information was given about the study, and then, the survey was continued without time limit with those who agreed to be interviewed. The survey was completed once all questions were read and answered by the participants. The distribution by age statistical data provided by the Turkish Statistical Institute for the province of Bursa was taken as the base in the selection of the participants. Education levels and marital statuses were random [Figure 3], [Figure 4]. The survey was conducted with women aged over 18 years as they are ones who undergo aesthetic procedures and drive the cosmetic industry. Five hundred women, half of whom had undergone aesthetic intervention, were asked 15 questions to understand their viewpoint on the economic aspect of aesthetic procedures. The questions are as given below:
Figure 1: Socioeconomic status data based on the Turkish Statistical Institute (TSI) data

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Figure 2: Age distribution for Bursa province based on the TSI data

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Figure 3: Education statistics of the respondents

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Figure 4: Marital status of the respondents

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Q1. What is the maximum amount you would pay for the most common aesthetic surgeries? i.e., (1) Nose remodeling, (2) Liposuction, (3) Tummy tuck, (4) Facelift.

Q2. Let us assume you want to have an aesthetic procedure, but you cannot afford it under your current economic conditions and you do not have a job. Would you consider working a job until you earn the amount you need?

Q3. Let us assume you want to have an aesthetic procedure, but you cannot afford it under your current economic conditions. Would you borrow money from your friends/family to pay for the procedure?

Q4. Let us assume you want to have an aesthetic procedure, but you cannot afford it under your current economic conditions. Would you take out a bank loan to pay for the procedure?

Q5. Do you think a person should have an aesthetic intervention even if their household income does not suffice?



Q6. When considering having an aesthetic intervention, what would be your primary/top concern once you make up your mind?

Q7. When considering an aesthetic intervention, what would be your most important priority in the decision-making process?

Q8. You are considering an aesthetic intervention and the price you are given is lower than what you predicted. What would your impression be?

Q9. You consider having an aesthetic procedure, but the cost turns out to be much higher than you predicted. How would this affect your decision?

Q10. When considering an aesthetic intervention, which would be your primary preference regarding your choice of institution/doctor?

Q11. Recently, there has been a rise in the advertisements and campaigns promoting aesthetic interventions on the Internet and on some television (TV) channels. What do you think about these?

Q12. Recently, in the media, we see the news that nonexperts such as hairdressers, beauty parlors, pharmacies, and veterinary clinics offer procedures such as toxin applications. What is your viewpoint on these offers?

Q13. Have you ever had these types of procedures in such centers?

Q14. Are there people in your environment who have had these types of procedures in such centers?

Q15. Is there a difference between aesthetic centers and beauty centers?

The questions aimed to reveal whether the economic conditions of the participants influenced the choice of aesthetic intervention or the center where the procedure was performed; to what extent they strained their budget; the social perception of what the average price for the most common aesthetic procedures is; and the budgets spared for aesthetic procedures by different age and status groups. The questions asked to all participants, i.e., those who had and had not undergone aesthetic intervention, were structured as easy-to-understand phrases without specifically guiding the participants and with clear response options such as “yes,” “no,” and “I have no idea” along with the free-text responses.

Evaluation

Participants' responses to the question inquiring about the average prices of the four most common procedures were 5250 TL for aesthetic nose surgery, 6638 TL for liposuction, 6314 TL for tummy tuck, and 6206 TL for face lift [Figure 5]. Further, to these average prices, responses to the question if they would consider getting a job just for the sake of making the money for a procedure were 40.8% “Yes, I would work a job until I earn the money” and 59.2% “No, I would not consider working for the sake of an aesthetic procedure” [Figure 6]. While 89.2% responded that they “would not borrow money from others” [Figure 7], 78.6% responded that they “would not take out a bank loan,” and 21.4% responded that they “would take out a bank loan” [Figure 8] to pay for a procedure. Responses to the question of whether a person should “have an aesthetic intervention even if their household income does not suffice” were 15.8% “yes,” 61.4% “no,” and 22.8% “I don't know” [Figure 9].
Figure 5: Responses to question 1

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Figure 6: Responses to question 2

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Figure 7: Responses to question 3

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Figure 8: Responses to question 4

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Figure 9: Responses to question 5

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Responses to the question inquiring about their “primary/top concern when considering an aesthetic intervention” were 35.2% “whether the result will be as I expect,” 34% “risk of complications after the procedure,” 21% “whether the institution/doctor to perform the procedure is qualified,” 6.4% “the very high costs of the procedures,” and 3.0% “reactions of my friends/family” [Figure 10]. The question “when considering an aesthetic intervention, what would be your most important priority in the decision-making process” was responded “choosing the right doctor/institution” by 53.2%, “experience of the doctor” by 26.4%, and “whether my financial conditions would allow” by 20.2% [Figure 11]. When asked about what they would think if the price they are given “is lower than what they predicted,” 32.8% responded “nothing, I would be happy,” 34.2% responded “The low price would arouse suspicion,” 28.2% responded “I would think the quality of the procedure would not be as I expect,” and 7.4% responded “I would think they will require extra payment later on” [Figure 12]. When asked about how it would affect their decision if the price they are given a price “much higher than what they predicted,” 38.4% responded “I would delay the procedure until I gather the money,” 26.8% responded “my decision would not change; I would go ahead with the procedure,” 18% responded “I would look for a doctor/hospital that offers a cheaper price,” and 16.4% responded “I would waive the procedure” [Figure 13]. When asked about their “primary preference regarding their choice of institution/doctor,” 35% responded “a private hospital,” 32.4% responded “aesthetic centers,” 22.6% responded “a private practitioner,” 8.6% responded “state hospitals,” while 0.4% responded “beauty parlors” or “competent persons who work independently/from their home” [Figure 14].
Figure 10: Responses to question 6

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Figure 11: Responses to question 7

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Figure 12: Responses to question 8

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Figure 13: Responses to question 9

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Figure 14: Responses to question 10

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To the question about the advertisements and campaigns on the Internet and the TV channels, 40% responded “I don't believe them,” 30.4% responded “I partially believe them,” 15.6% responded “I believe them,” 12.2% responded “I don't believe them by any means,” and 1.8% responded “I greatly believe them” [Figure 15]. When asked about their opinion on toxin injections and mesotherapy applications performed by nonexperts such as hairdressers, beauty parlors, pharmacies, and veterinary clinics, 76.2% responded “these procedures should definitely not be performed by any persons other than legally authorized experts,” 12.4% responded “I would not mind as long as they know what they are doing,” 8.8% responded “it makes no difference for me as long as no problems occur,” and 2.6% responded “I would accept if it is economic” [Figure 16]. When asked if they ever had any of these procedures in such places, 49.4% responded “no, never,” 47.7% responded “yes, once,” and 2.1% responded “I considered, but did not” [Figure 17]. When further asked whether they knew anyone who have had such procedures in such places, 70.2% responded “no” and 29.4% responded “yes” [Figure 18].
Figure 15: Responses to question 11

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Figure 16: Responses to question 12

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Figure 17: Responses to question 13

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Figure 18: Responses to question 14

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When asked about the difference between the often confused aesthetic centers and beauty centers, 77.8% responded “yes, they are different,” 11.6% responded “no, both are the same thing,” and 10.6% responded “I have no idea, I cannot tell the difference” [Figure 19].
Figure 19: Responses to question 15

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  Discussion Top


The rapid increase in the aesthetic applications and variety in the industry lead to uncontrollable outcomes. Recently, large-scale surveys are conducted to follow-up on patient satisfaction about the performed procedures and to assess the viewpoints in the society.[1],[2],[3] While these surveys often are studies conducted with the participation of multiple centers, Internet-based surveys are preferred when wider participation is desired.[4] Surveys concerning certain procedures or operations are performed more frequently, whereas those aiming to assess the general viewpoint of society are limited.[5],[6]

At present, violations of the borders between the medical branches, efforts of unauthorized people to establish themselves in the aesthetic sector, sacrificing healthcare to political prospects, lack of governance, and frequently changing laws and regulations have created an environment of disorder. While similar issues are experienced all across the world, this environment has been gaining ever more presence in Turkey in the recent period. In such environment, all who aim to get a share from the large and yearly growing aesthetic market try to attract potential clients from all economic backgrounds, especially by playing with the prices and the quality of their products. We should note that this survey bears importance in terms of revealing, amid such environment, what people tend to accept or reject, to the extent allowed by their economic conditions, how much they are aware of the possibility of being wronged, and how much importance they attach to the advertisements of the social media platform and on the Internet.

In today's high-unemployment environment, as many as 40.8% of the participants are willing to get a job just for the sake of raising the money for an aesthetic procedure is worth noting. This rate is also statistically significant in showing the extent to which the cosmetic industry has penetrated and gained priority in our lives via the social media and the Internet channels. A majority of the participants who would get a job to raise the money for an aesthetic procedure but would not borrow the money from others suggest that we, as a society, are still skeptic about aesthetic applications and many procedures are kept confidential. Similarly, the existence of 21.4% of people who would consent to incurring a debt by taking out a loan in these economic conditions is also significant, even though most would not consider this an option.

Those who have decided in favor of having an aesthetic intervention despite its financial burden tend to doubt the quality and the outcome of the procedure once the quoted price turns out to be lower than they expected. In a similar manner, high prices do not deter people from their intentions, they consider postponing the procedures until they have enough savings rather than questioning the prices. This situation in fact reinforces the perception that aesthetic procedures are costly among the society. This situation, in fact, reinforces the social perception that aesthetic procedures are expensive.

The discussion about where and by whom aesthetic interventions should be performed, as well as frequently changing laws and regulations, seems to have caused confusion also in the society. While the responses to the question of where they would undergo an aesthetic procedure mostly indicated private hospitals, private practitioners, and state hospitals, part of the participants, even if small minority, have openly indicated that they would go to beauty parlors, hairdressers, or persons who work from their home. This tendency is so openly revealed is indeed troubling. In fact, in response to another question, almost half of the participants indicated that they at least once had an aesthetic procedure in an unauthorized, nonmedical institution. That the question openly enquires about illegal practices brings to mind that some participants could have responded “no” whereas they actually did have procedures in such places. This is to say that the rate of persons who undergo invasive procedures in such unauthorized, untrained, and highly risky places seems to be higher than admitted. That in an environment, which aesthetic procedures are kept secret as much as possible, 30% of the respondents indicated that they knew persons who have undergone a procedure in such places supports the idea that this rate may be much higher. While this tendency may be due to “lower cost expectations,” it also brings to the mind that such unauthorized persons may be spreading the rumors that doctors and hospitals are overly expensive. When the responses given to Q13 are crossed with the economic levels of participants, 85.2% of those who indicate to have had a procedure in such places are, surprisingly, fall in the top (A and B) socioeconomic status quartile [Figure 20]. A more surprising finding comes forth when the same responses (Q13) are crossed with the education levels of the participants: 57% of the participants with a postgraduate degree and 42.8% of those with an undergraduate degree have undergone procedures performed by unauthorized and nonmedical persons and institutions. More than 70% of the mentioned participants indicated that they had family and friends who underwent procedures in unauthorized places. Likewise, while the rate of those who indicated to believe the overstated advertising claims on TV channels and the Internet was 85% and 65% among those with an undergraduate and postgraduate degree, respectively, the rate was 35% among those with a technical college degree.
Figure 20: The comparison of the socioeconomic status (SES) of those who indicate to have had a procedure in unauthorized places

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That state hospitals recently began to offer aesthetic procedures may have caused the below-average responses regarding price predictions. It is possible that persons with lower income levels prefer state hospitals which they think that it would be cheaper. Nevertheless, the big price differences between the minimum prices set for state institutions and the prices of private institutions can be confusing for patients.

Advertisements on the Internet and on TV channels, websites, and platforms, specially set up to promote and market such activities and campaigns, take advantage of all methods to attract their target groups while promising very low prices. Almost half of the participants indicated to believe that these claims show the high number of individuals who may potentially fall victim to these advertisements and campaigns.

While there is confusion in how the terms “aesthetic center, beauty center, beauty parlor, etc.” are used by institutions, the terms are also confused by consumers. In the absence of a discriminating word, phrase, or modifier, “Aesthetic Centers,” which are run by doctors and specialize in the medical department, are often confused with the “Beauty Centers” run by hairdressers. This confusion is primarily due to the interchangeable use of the terms “aesthetic” and “beauty” in the sector with the aim of attracting more clients. The legal procedures performed by medical institutions are also offered illegally by some other institutions which further contribute to this confusion. Another contributing factor, however, that should be acknowledged is that whereas frequent amendments are made to the laws and regulations, these are not directed at ending the misconception in the society and eliminating unlawful practitioners, institutions, or centers.

As a result, the virtual realm depicted by the Internet and the social media platforms, as well as the lead actors of the aesthetic industry who most often use this virtual realm for commercial purposes, show their audience a film through rose-colored glasses in which any defect can be concealed and any feature of beauty dreamed of can be turned into reality whatever the economic possibilities. Those who fall under the spell of this film use every means possible to have aesthetic interventions in hope of getting the promoted results. In their endeavor, individuals either force their limits and get in debt to ensure safer procedures or settle for what they can afford with their income. Many, however, fall victim to the malpractice of unauthorized and irresponsible persons for the sake of getting better results for less money. Interestingly, individuals with the highest economic and educational levels are more prone to fall victim to such malpractice. Moreover, this makes it more difficult to fight these unauthorized institutions, organizations, and persons.

Acknowledgment

I would like to thank İzlem Research Company for their contributions in preparing the questionnaire and conducting the survey.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19], [Figure 20]



 

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