Introduction
Standards of appearance vary according to age and country, but considering survey results [
1] in which more than 65% of participants were willing to have surgical and non-surgical cosmetic procedures in relation to employment and marriage, it is clear that the self-image of an individual, which is evaluated to a significant extent through appearance, also affects perceptions of social roles in the world. Further, in the same survey, the portion of respondents who answered that appearance was reasonably important in life continuously increased from 45% in 1994, to 58% in 2004 and to 61% in 2014, indicating a growing proportion of Koreans for whom body image was important for living in the twenty-first century. This rising trend has become more widespread with the development of the Internet and mass media, and the role of appearance as a means for social enhancement has become more entrenched. In particular, Korea already has the highest global rate of cosmetic procedures relative to its population [
2,
3]. This involves the younger generation in their 20s, particularly women, as women’s desire to be more beautiful goes beyond hair styles and fashion, increasing the likelihood of a more aggressive appearance change, that is, an acceptance of and willingness to have cosmetic procedures [
4‐
6].
This high acceptance of cosmetic procedures affects in turn the likelihood of experiencing cosmetic procedures. A willingness to accept cosmetic procedures is influenced by the level of desire for cosmetic procedures and the degree of perceived necessity of cosmetic procedures for successful social life or self-improvement [
6]. In Korean research on university students, factors such as sex, grade level, cosmetic procedure experience, and self-esteem have been found to influence the acceptance of cosmetic procedures [
7].
Unreasonable and repetitive cosmetic procedures cause economic, physical, and psychological distress to the individual concerned, and can lead to serious maladies within families and society, such as divorce and suicide [
8]. According to the Korea Consumer Agency [
9], consultations on medical consumer injuries related to cosmetic procedures have shown a rising trend, and more than 100 cases have been advanced annually since 2013. Because undesirable side effects are increasing with the rise in cosmetic procedures, research is needed to understand the characteristics of cosmetic procedures, such as the level of acceptance of cosmetic surgery, self-esteem, and other related factors among those most interested in cosmetic procedures, namely women in their 20s.
The purpose of this study is to provide baseline data for the study of cosmetic procedures and for health policy settings, through a randomized survey of women in their 20s as those most concerned with and most likely to undergo cosmetic procedures, to understand better the present status of cosmetic procedures in Korea. The survey also aimed to better understand people’s experience and acceptance of cosmetic procedures.
Discussion
This study investigated the experience of cosmetic procedures, perception of side effects, levels of acceptance, and the factors influencing the experience of cosmetic procedures among Korean women in their 20s.
The mean age of participants was 25.02 years. Although 97.9% of participants had obtained information on the side effects of cosmetic procedures, most had received information through the “Internet” or “TV, newspaper, magazine,” whereas obtaining such information through a “doctor” was very low at 0.9%. This rate for those obtaining side-effects information and the rate for using the “Internet” and “TV, newspaper, magazine” as channels of awareness were higher in this study than in results by Kim et al. [
7]. In addition, 37.6% of participants had undergone 1 or more cosmetic procedures, and 59.0% answered “yes” to considering further cosmetic procedures. Amid increasing cases of consultation in relation to side effects involving cosmetic procedures [
9], in addition to consideration of individual experiences and expectations concerning cosmetic procedures, it is necessary to find a means to increase the diffusion of side-effects information on cosmetic procedures through medical experts.
In this study, the ACS score was 66.52, which was higher than the 60.89 score found in a previous study of undergraduate students [
7]. This difference was considered to arise due to differences among the participants, because students accounted for approximately a quarter of the participants in this study; the majority of participants were women fully engaged in social life through work or other commitments, and that it was likely that an internalization of social standards in respect to appearance had already been made to some extent.
Appearance satisfaction displayed a positive correlation with self-esteem and a negative correlation with BMI. This finding supports previous results showing that there was a positive correlation between BMI and body dissatisfaction [
12], and that high BMI values were predictors of high body/body image dissatisfaction [
13,
14]. In addition, appearance satisfaction was negatively correlated with ACS in this study. This result was also similar to previous study results [
15] showing that body satisfaction was a negative influence factor on ACS. Considering these results, it could be assumed that a high BMI for women in their 20s was associated with low body image, and that low body image and low appearance satisfaction were likely to lead to a decrease in self-esteem. The social assessment of appearance affects self-esteem [
16], and low self-esteem related to BMI among women in their 20s who have just entered the working arena can lead to depression [
14]. As approximately three quarters of the participants in this study were not students but had just began their social working-life experience in their 20s, it is highly likely that they would have experienced appearance evaluation through work or part-time jobs, either directly or indirectly. Given awareness that levels of self-esteem according to appearance satisfaction can be directly linked to the health of women in their 20s, a comprehensive means to bring about changes in social norms and values in respect of appearance satisfaction should also be sought.
The study participants were 1.17 more times likely to have had cosmetic procedure experience as their age increased by 1 year. This could be interpreted as due to the probability of having had increasing experience of cosmetic procedures, as well as of reaching an age where it was easier to try more aggressive methods to meet appearance satisfaction and where the participants were exposed to more competition in areas such as employment. Support for these findings could also be inferred through the results of a study that found the lower the self-esteem of high school girls, the higher the desire for cosmetic procedures [
17], and a study finding that body dissatisfaction among male and female adolescents increases with age [
13]. As the probability of selecting cosmetic surgery increases with age, following entry into adulthood after adolescence when interest in appearance rapidly increases; it is necessary to identify and apply effective measures for improving self-esteem before adolescence.
The study participants were 1.06 more times likely to have had cosmetic surgery experience as their ACS score increased by 1 point. This finding supports the research that suggests people with a personal or indirect experience of cosmetic procedures are more likely to accept undergoing future cosmetic procedures [
4,
7,
18]. Past cosmetic procedure experience leads to an increased interest in self-care after a cosmetic procedure, and it seems likely that a mindset that wishes to promote acceptance of one’s cosmetic surgery experience also plays a role in influencing acceptance of future cosmetic procedures.
The study participants were 0.84 times less likely to have had cosmetic procedure experience as their BMI score increased by 1 point. This finding supports research by Swami [
19] that reported consideration for cosmetic procedures and BMI was negatively correlated, but diverges from the research findings of Henderson-King and Henderson-King [
6] in which a negative correlation was found only among men. Further, as our finding contradicts another Korean study [
17] that found that a desire for cosmetic procedures increased with a higher BMI, there needs to be further studies on the relationship between BMI and ACS.
Young women are more interested in dieting than any other group, even when BMI is normal [
20]. In particular, many Korean women in their 20s are exposed to nutritional imbalance and health problems through attempting excessive weight loss even when they are not overweight or obese [
12,
21,
22]. Considering a study [
23] that showed that those who diet or use dietary supplements were more satisfied with their body shape than those who did not, there is a need to explore various relevant variables that affect the appearance satisfaction of women in their 20s. In addition, related policies and publicity are needed to promote healthy and widely shared values relating to appearance. We recommend a long-term follow-up study, involving more population groups, concerning both the willingness to undergo cosmetic procedures and undergoing them, despite a high awareness of the side effects of cosmetic procedures.
Conclusion
This study aimed to provide relevant baseline data for measures and policies to improve the body image and the self-esteem of young women living in modern society, through comparing the cosmetic procedure experience and the cosmetic procedure characteristics of Korean women in their 20s, and understanding better what was involved. The results of our survey conducted using random sampling of 330 women in their 20s showed that appearance satisfaction had a negative correlation with ACS and BMI, a positive correlation with self-esteem, and that age, ACS, and BMI affect the cosmetic procedure experience. The limitation of this study was that it did not investigate perceptions of cosmetic procedure side effects in more detail.
As the demand for cosmetic procedures in Korea continues to increase, it is important for society generally to understand the relevant aspects of the cosmetic procedure experience and how and why choices are made regarding cosmetic procedures. Considering that the phenomenon of body image concern in society appears to be spreading beyond the boundaries of sex, we suggest a follow-up study of women and men in their 20s to clarify the relationship between sociocultural-related variables and personal characteristics that affect the cosmetic procedure experience in addition to appearance satisfaction. Furthermore, along with a cross-sectional study, we recommend a longitudinal study on appearance satisfaction, ACS, cosmetic procedure experience, appearance satisfaction following cosmetic procedures, and self-esteem, in relation to general characteristics.