Invited Response on: "Letter to the Editor: Neuromodulators Raising Eyebrows: Having Is Not So Pleasing, After All, As Wanting".

This response letter emphasizes the relevance of adopting a psychosocial approach for cosmetic surgeons, particularly concerning the impact of social media on the acceptance of cosmetic surgery among both women and men. Special attention has been directed toward social phenomena that appear to contribute to the formation and maintenance of positive attitudes toward aesthetic surgery and its normalization, including Snapchat Dysmorphia, the Angelina Jolie Effect, and the Mirror Effect, the Exposure Bias. Furthermore, this response letter highlights the critical importance of comprehensive aesthetic education and appropriate training for professionals in the field of cosmetic procedures, especially regarding the topic of body image.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Self-awareness and Social Influences as Predictors of Body Dissatisfaction and Acceptance of Cosmetic Surgery for Social Reasons Among Men.

BACKGROUND: Body dissatisfaction and the use of surgery for purely aesthetic reasons among men is steadily increasing. Nevertheless, compared to women, few studies have focused on specific sociocultural and individual factors predicting men's body dissatisfaction and interest in cosmetic surgery procedures. The present study investigated the role of media, significant others, public and private self-awareness in predicting men's body dissatisfaction and acceptance of cosmetic surgery for social reasons. METHODS: Participants were 203 men (mean-age 24 years), who completed a questionnaire containing the Sociocultural Attitudes Toward Appearance Questionnaire-4R, the Situational Self-Awareness Scale, the Muscular internalization subscale, the Male Body Attitudes Scale, and the Social subscale of the Acceptance of Cosmetic Surgery Scale. A path analysis was performed. RESULTS: The influence of significant others and public self-awareness predicted men's body dissatisfaction directly and indirectly, via muscularity internalization, while media was only directly associated with body dissatisfaction. A significant link between private self-awareness and body dissatisfaction was found. Moreover, media was not associated with cosmetic surgery either directly or indirectly and public self-awareness showed only a significant association with internalization. CONCLUSIONS: These findings provide information about the role that self-awareness and sociocultural factor play on body dissatisfaction and acceptance of surgery for social reasons among men. The study highlighted the importance of designing preventive programs aimed at enhancing men's ability to resist various forms of pressure regarding body image and its management. Moreover, the advantages of focusing one's attention on internal states and feelings can limit body dissatisfaction and can discourage consideration of cosmetic surgery for social benefits. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Retouched or Unaltered? That is the Question. Body Image and Acceptance of Cosmetic Surgery in Young Female Instagram Users.

BACKGROUND: Viewing Instagram altered images of attractive women has negative effects on women's body image. This study examined the effects of exposure to a 'before' and 'after' retouched image, in combination with a disclaimer, on female Instagram users' thin-ideal internalization, body dissatisfaction and acceptance of cosmetic surgery. METHODS: An experimental design with a control group without pretesting was adopted. Participants (N = 105) were randomly assigned to one of three groups: Group 1 was exposed to a replica of an Instagram post with an enhanced image of a woman; Group 2 was shown the same enhanced image and the original one in combination with a disclaimer that the enhanced image had been digitally edited; Group 3 (the control) was exposed to a neutral image. RESULTS: The MANOVA showed that participants in Group 2 reported lower levels of thin-ideal internalization and acceptance of cosmetic surgery for social reasons compared to those in Group 1. Contrary to our hypothesis, the degree of body dissatisfaction was not significantly different among the three groups. CONCLUSIONS: The present study could be promising for the development of brief interventions aimed at reducing the negative effects of Instagram exposure on young women's body image. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Not All That Glitters Is Gold: Attractive Partners Provide Joys and Sorrows.

Through a 2 × 2 experimental vignette design, we tested if partner perceived attractiveness in interaction with appearance-related comments from one's partner might affect women and men's body dissatisfaction, body shame, acceptance of cosmetic surgery, and perceived relationship quality. Participants were 154 women and 157 men living in Italy (mean age = 30.97; all of them were in a couple relationship), who read a vignette describing the purchase of a swimsuit, through which partner attractiveness (poor versus high) and partner commentary (negative versus positive) were manipulated. Some ANCOVAs were performed on women and men separately. For men, partner commentary affected body dissatisfaction with low body fat. Moreover, the main effect of partner attractiveness was found in their consideration of undergoing cosmetic procedures. Among women, a significant partner attractiveness X partner commentary interaction effect emerged on acceptance of cosmetic surgery for social reasons. As regards relationship quality, for women, there was a main effect of partner attractiveness on relational communication, while a marginally significant interaction effect between partner attractiveness and partner commentary emerged for men's self-disclosure. Our findings suggest that partner attractiveness is generally beneficial, but when combined with negative feedback concerning the appearance, it might lose its advantages. These findings should be considered for planning interventions aimed at both preventing body dissatisfaction and acceptance of cosmetic surgical procedures for not medical reasons and promoting relationship satisfaction among women and men.

Invited Response on: "Letter to the Editor: Predictors of Acceptance of Cosmetic Surgery- Instagram Images-Based Activities, Appearance Comparison and Body Dissatisfaction Among Women".

This response letter highlights the importance for cosmetic surgeons to take a psychosocial perspective, considering the role of social media influences on the acceptance of cosmetic surgery in young women. Furthermore, through this article we have provided a brief overview of possible interventions useful to prevent the negative influences that social media can have on body image and the acceptance of procedures aimed at modifying one's body for purely aesthetic reasons. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Predictors of Acceptance of Cosmetic Surgery: Instagram Images-Based Activities, Appearance Comparison and Body Dissatisfaction Among Women.

BACKGROUND: This study aimed to test a model in which Instagram images-based activities related to self, friends, and celebrities were associated with acceptance of cosmetic surgery via Instagram appearance comparison and body dissatisfaction. We predicted that Instagram use for images-related activities involving celebrities and self (but not friends) was associated with acceptance of cosmetic surgery both directly and indirectly. METHODS: The study participants were 305 Italian women (mean age, 23 years). They completed a questionnaire containing the Instagram Image Activity Scale, the Instagram Appearance Comparison Scale, the Body Shape Questionnaire-14, the Acceptance of Cosmetic Surgery Scale. A path analysis was performed in which the Instagram images-based activities were posited as predictors of the Instagram appearance comparison, body dissatisfaction and acceptance of cosmetic surgery, respectively. RESULTS: We found that only image-based activities related to celebrities and self were significantly related to acceptance of cosmetic surgery, whereas friends' Instagram-related activities were not significantly related to this criterion variable. Moreover, the indirect effect of both Instagram self- and celebrities-images activities on acceptance of cosmetic surgery through Instagram appearance comparison and body dissatisfaction was significant. Friends' Instagram images-related activities were not associated with acceptance of cosmetic surgery. CONCLUSIONS: Overall, these findings provide information about the role that activities carried out on Instagram, appearance comparison and body dissatisfaction, play on the acceptance of surgery for aesthetic reasons among women. The study highlighted the importance for surgeons to consider some psychological aspects and the influence of sociocultural factors on the interest for cosmetic surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Exploring the Links Between Self-Compassion, Body Dissatisfaction, and Acceptance of Cosmetic Surgery in Young Italian Women.

This study aimed to examine the association between positive (self-kindness, common humanity, and mindfulness) and negative (isolation, self-judgment, and over-identification) components of self-compassion, and both body dissatisfaction and acceptance of cosmetic surgery among women, through the mediation (for the negative components) of internalization and physical appearance comparison. The participants were 220 young Italian women aged 19-31 (M = 21) years, who completed a questionnaire assessing the variables of interest. Path analysis indicated that higher mindfulness was directly linked to lower acceptance of cosmetic surgery. Mindfulness presented the strongest link with cosmetic surgery, as it was directly associated with acceptance of cosmetic surgery for both social and interpersonal motivations and with consideration of undergoing some cosmetic procedures. Common humanity and self-kindness were related to acceptance of cosmetic surgery for social reasons. Over-identification seemed to be associated with body dissatisfaction and acceptance of cosmetic surgery both directly and indirectly through internalization and physical appearance comparison. Self-judgment and isolation did not present a significant association with either body dissatisfaction or acceptance of cosmetic surgery. These findings confirm that psychological assessment of women who are interested in cosmetic surgery is highly recommended. Interventions should not consider self-compassion as a whole, but they should rather focus on some of its components. The role of over-identification seems to be especially pivotal, as higher scores on this dimension are linked to higher levels of body dissatisfaction and greater acceptance of cosmetic surgery.

Why are men interested in cosmetic surgery procedures? Examining the role of different forms of peer influence, social comparison, internalization, and body dissatisfaction.

The present research examined the roles of different forms of peer influence, internalization, social comparison, and body dissatisfaction in men's interest in cosmetic surgery. Participants were 204 Italian men (Mage = 34.02, SD = 11.21). Regression analyses showed that appearance conversations with friends and peer attribution were associated with consideration of cosmetic surgery for social reasons, while teasing on muscularity (but not teasing on general body and shape) was linked to interest in cosmetic surgery for intrapersonal motives. Social comparison was significantly and positively associated with men's interest in cosmetic surgery, while internalization was not. Dissatisfaction with body fat was linked to men's consideration of cosmetic surgery for social motivations, while muscularity and height dissatisfaction did not emerge as significant correlates of cosmetic surgery attitudes. These findings highlight the importance of psychosocial factors, such as peer influence, body fat dissatisfaction, and social comparison in men's interest in cosmetic procedures.

Beyond Sociocultural Influence: Self-monitoring and Self-awareness as Predictors of Women's Interest in Breast Cosmetic Surgery.

BACKGROUND: The aim of the present research was to analyze the role of self-awareness, self-monitoring, perceived media pressures, and peer attributions on the consideration of breast cosmetic surgery among women. The internalization of thin ideals was taken into account as a key moderating variable. METHODS: Participants were 132 Italian women (mean age = 33.62), who completed a questionnaire aimed at measuring the variables of interest. Path analysis was used to test our hypotheses. RESULTS: The results indicated that perceived media pressure, self-monitoring, and peer attributions influenced participants' interest in breast modification procedures through the internalization of thin ideals. Self-awareness (both private and public) had a direct effect on women's consideration of breast cosmetic surgery. CONCLUSIONS: This research is one of few analyzing how specific aspects of the self could influence women's interest in cosmetic surgery. These findings contribute to the understanding of the reasons that trigger women's interest in cosmetic surgery. Not only sociocultural influences contribute to the development of favorable attitudes toward cosmetic surgery, but also specific aspects of the self have a relevant role. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the table of contents or the online Instructions to Authors www.springer.com/00266 .

The factor structure and psychometric properties of the Italian version of the Acceptance of Cosmetic Surgery Scale.

The current study examined the validity of the Italian version of the Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King & Henderson-King, 2005) in a sample of 378 Italian adult women. A series of confirmatory factor analyses were conducted. A three-factor solution provided the best fit to the data and confirmed the Intrapersonal, Social, and Consider dimensions. The three factors were strongly inter-correlated. Cronbach's alphas were high (all alphas>.86). The scale showed good convergent and discriminant validity (estimated by Composite Reliability and the Average Variance Extracted). The nomological validity of the Italian version of the ACSS was confirmed by its significant correlations with participants' body dissatisfaction and sociocultural influences (internalization of thin ideals and perceived media pressure). The ACSS seems to be a useful measure of acceptance of cosmetic surgery in the Italian context. This instrument can be used with Italian speakers for research, health promotion, and preventive interventions.

Psychosocial predictors in consideration of cosmetic surgery among women.

BACKGROUND: This study aimed to analyze the influence of psychosocial factors on the consideration of cosmetic surgery. The authors hypothesized that the internalization of thin ideals and social comparisons mediate the relationship between media pressure, family and peer influence (appearance conversations, perception of teasing, and peer attributions), and the desire to pursue cosmetic surgery. METHODS: The study participants were 429 Italian women (mean age, 33 years). They completed a questionnaire containing the Appearance Conversations With Friends Scale, the Perception of Teasing Scale for Friends, the Peer Attribution Scale, the "Pressure and Internalization-General" subscales of the Sociocultural Attitudes Towards Appearance Questionnaire-3, the Feedback on Physical Appearance Scale, the Physical Appearance Comparison Scale, and the "Consider" subscale of the Acceptance of Cosmetic Surgery Scale. Hierarchical linear regression was performed. RESULTS: The results indicated that media pressure and appearance conversations with peers predicted the outcome variable through the full mediation of internalization of thin ideals. The relation between peer attributions and interest in cosmetic surgery was partially mediated by internalization of thin ideals. Although social comparison was significantly related to both sociocultural variables and consideration of cosmetic procedures, it was not a significant mediator of this relationship. Neither family influence nor perception of teasing predicted the outcome variable. CONCLUSIONS: Overall, these results provide important information about the factors implicated in the consideration of cosmetic surgery by women. This research confirms that cosmetic surgeons need to adopt a base psychological approach. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .