Predicting Acceptance of Cosmetic Surgery: The Effects of Body Image, Appearance Orientation, Social Anxiety, and Fear of Negative Evaluation

Cosmetic surgery is more widely accepted than ever. Appearance dissatisfaction and increased investment in appearance, or appearance orientation, have been linked to more favorable attitudes towards cosmetic surgery. Cognitive behavioral models of social anxiety were reviewed and integrated with existing theories of body image to provide a theoretical background for the exploration of influences on acceptance of cosmetic surgery. In this investigation, the relationships between subjective evaluations of appearance, appearance orientation (AO), fear of negative evaluation (FNE), and attitudes towards cosmetic surgery using the Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King & Henderson-King, 2005) were explored in two samples of women. Sample 1 consisted of 327 undergraduate women (M age = 20.50, SD = 4.30); Sample 2 consisted of 102 female volunteers (M age = 34.04, SD = 9.18). In Sample 1, lower overall and feature-specific attractiveness and greater dissatisfaction with appearance were related to increased ACSS, and AO was positively correlated with FNE, which was strongly related to ACSS. In both samples, individuals with lower self-rated attractiveness and appearance satisfaction had higher FNE. In Sample 1, FNE partially mediated the relationship between AO and general attitudes towards surgery, social motivations for surgery, and consideration of future surgery. FNE did not mediate the relationship between AO and acceptance of surgery based on intrapersonal factors, nor was there evidence of mediation by FNE for any of the ACSS factors in Sample 2. Next, a reverse mediation model was tested to examine the initial hypothesized ordering of variables. In Sample 1, AO partially or fully mediated the relationship between FNE and the ACSS total and factor scores, calling into question the hypothesized ordering of predictors in our initial model. There was no evidence of mediation by AO in Sample 2. Lastly, a model in which FNE was hypothesized to strengthen the ability of AO to predict ACSS was tested. No evidence of a moderation effect for any of the factors of ACSS was found in either sample. The results of this investigation suggest that features of social anxiety may be a fruitful area for continued research that may inform a more thorough understanding of body image and its influences on attitudes towards, pursuit of, and satisfaction with cosmetic surgery.