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					                                                                           Body Image 6 (2009) 7–13

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Acceptance of cosmetic surgery: Personality and individual difference predictors
Viren Swami a,*, Tomas Chamorro-Premuzic b, Stacey Bridges a, Adrian Furnham c
  Department of Psychology, University of Westminster, 309 Regent Street, London W1B 2UW, UK
  Department of Psychology, Goldsmiths, University of London, London, UK
  Department of Psychology, University College London, London, UK

A R T I C L E I N F O                                  A B S T R A C T

Article history:                                       This study examined the association between several attitudinal constructs related to acceptance of
Received 7 July 2008                                   cosmetic surgery, and participant demographics, personality, and individual difference variables. A
Received in revised form 22 September 2008             sample of 332 university students completed a battery of scales comprising the Acceptance of Cosmetic
Accepted 26 September 2008
                                                       Surgery Scale (ACSS) and measures of the Big Five personality factors, self-esteem, conformity, self-
                                                       assessed attractiveness, and demographics. Multiple regressions showed that the predictor variables
Keywords:                                              explained a large proportion of the variance in ACSS factors (Adj. R2 ranging between .31 and .60). In
Cosmetic surgery
                                                       addition, structural equation modelling revealed that distal factors (sex and age) were generally
Body image
                                                       associated with acceptance of cosmetic surgery through the mediate influence of more proximate
Individual differences                                 variables (in the first instance, the Big Five personality factors, followed by self-esteem and conformity,
                                                       and finally self-assessed attractiveness). These results allow for the presentation of a preliminary model
                                                       integrating personality and individual differences in predicting acceptance of cosmetic surgery.
                                                                                                                          ß 2008 Elsevier Ltd. All rights reserved.

Introduction                                                                           and the lower cost of treatments have also served to reduce patient
                                                                                       anxiety about cosmetic procedures (Edmonds, 2007). Finally, the
   Cosmetic surgery refers to a subspecialty that is concerned                         past decade has witnessed a dramatic increase in media coverage
primarily with the maintenance, restoration, or enhancement of an                      of cosmetic surgery (see Crockett, Pruzinsky, & Persing, 2007;
individual’s physical appearance through surgical and medical                          Sarwer et al., 2003), which has mainstreamed public awareness of
techniques. In the Western hemisphere, the number of cosmetic                          such procedures (Tait, 2007).
surgery procedures has risen dramatically in the past decade (e.g.,                       In line with these developments, there has emerged a relatively
Davis, 2003; Rohrich, 2003). In the United States, for instance, 11.7                  large body of work examining psychological aspects of cosmetic
million cosmetic procedures were performed in 2007, with the vast                      surgery. In terms of factors affecting the likelihood of having
majority being minimally invasive procedures (American Society for                     cosmetic surgery, for instance, the available evidence suggests that
Aesthetic Plastic Surgery, 2008). Moreover, Sarwer and Crerand                         women report a greater likelihood of willingness to undergo
(2008) suggest that these statistics underestimate the actual number                   various cosmetic procedures compared with men (Brown, Furn-
of procedures being performed, as they do not cover appearance-                        ham, Glanville, & Swami, 2007; Swami, Arteche, Chamorro-
enhancing treatments performed by non-plastic surgeons.                                Premuzic, Furnham, Stieger, Haubner, et al., 2008), which has
   As discussed by Sarwer and colleagues (Sarwer, Crerand, &                           been explained as a function of the greater sociocultural pressure
Gibbons, 2007; Sarwer & Magee, 2006; Sarwer, Magee, & Crerand,                         on women to attain ideals of physical and sexual attractiveness
2003), a number of factors may underscore this increase in the                         (Swami, 2007; Swami & Furnham, 2008). This research has also
popularity of cosmetic surgery. These include the growing                              shown that lower self-ratings of physical attractiveness predict
importance of physical appearance in contemporary Western                              higher likelihood of having cosmetic surgery (Brown et al., 2007),
culture (Swami, 2007; Swami & Furnham, 2008), which has served                         and that media exposure may mediate the relationship between
to normalise the pursuit of appearance-enhancing behaviours                            participant sex and likelihood of having cosmetic surgery (Swami,
(Sarwer et al., 2003). Higher disposable incomes among patients,                       Arteche, et al., 2008).
advances in surgical procedures (particularly in terms of safety),                        In terms of attitudinal dispositions towards cosmetic surgery,
                                                                                       Sarwer et al. (2005) reported that their sample of college women
                                                                                       generally held favourable attitudes toward cosmetic surgery as a
    * Corresponding author. Tel.: +44 207 911 5000.                                    means of appearance-enhancement. Henderson-King and Hen-
      E-mail address: (V. Swami).                                   derson-King (2005), however, have argued that participants may

1740-1445/$ – see front matter ß 2008 Elsevier Ltd. All rights reserved.
8                                                     V. Swami et al. / Body Image 6 (2009) 7–13

hold beliefs and attitudes that are accepting of cosmetic surgery            affective experience (e.g., Mischel & Shoda, 1999), and are,
and yet show little or no interest in actually having cosmetic               therefore, likely to influence dimensions of body image generally
procedures. In order to assess attitudes beyond likelihood of                and acceptance of cosmetic surgery specifically.
having cosmetic surgery, therefore, these authors developed the                  In addition to the Big Five, we also examined the relationship
Acceptance of Cosmetic Surgery Scale (ACSS), a 15-item measure               between the ACSS and participants’ self-rated physical attractive-
that was found to factor into three components: (1) Intrapersonal,           ness, which previous work has shown to be negatively associated
which measures attitudes related to the self-oriented benefits of             with the likelihood of having cosmetic surgery (Brown et al., 2007;
having cosmetic surgery (e.g., increased satisfaction with appear-           Swami, Arteche, et al., 2008). Concurrently, we measured
ance); (2) Social, which represents social motivations that                  participants’ global self-esteem, which is thought to be negatively
influence the decision to have cosmetic surgery (e.g., appearing              associated with the likelihood of having cosmetic surgery (that is,
more attractive to one’s partner), and; (3) Consider, which                  individuals with low self-esteem may be more open to cosmetic
measures the likelihood of having cosmetic surgery, taking into              surgery as a means of improving global self-perceptions; cf.
account factors that may influence the decision-making process                Figueroa, 2003; Sarwer, 2007; Sarwer, Nordmann, & Herbert, 2000)
(e.g., pain).                                                                and may also be linked with low self-ratings of physical
    In a series of four studies within university settings, Henderson-       attractiveness (cf. Koff, 1998). In the present study, we also
King and Henderson-King (2005) showed that the ACSS has high                 examined the association between the ACSS and conformity, which
internal reliability and test–retest reliability, as well as good            Mehrabian (2005, p. 2) defined as ‘‘a characteristic willingness to
divergent and convergent validity. In addition, they reported that           identify with other and emulate them, to give in to others so as to
women and older participants expressed more positive attitudes               avoid negative interactions, and generally, to be a follower rather
on the Intrapersonal subscale and that older participants had more           than a leader’’ and which may be expected to be associated with
favourable attitudes on the Social subscale. For women, age was              the Social subscale of the ACSS.
found to be a positive predictor of considering cosmetic surgery,                In short then, the present study examined the association
but no such relationship was found for men. Other recent work                between the subscales of the ACSS and participants’ sex, age, Big
using the ACSS has shown that greater acceptance of cosmetic                 Five personality factors, self-rated physical attractiveness, self-
surgery among college women is associated their body image                   esteem, and conformity. The data was analysed using correlation
experiences, with those who are dissatisfied with their appearance            and structural equation modelling. Whilst the former method is
or having greater body image disturbance viewing cosmetic                    useful for identifying relationships between two variables, the
surgery more positively (Cash, Goldenberg-Bivens, & Grasso,                  latter allows for simultaneous testing of several relationships
2005). Furthermore, Sperry, Thompson, Sarwer, and Cash (in                   among different variables (including multiple criteria or ‘depen-
press) reported that viewership of reality cosmetic surgery                  dent variables’) and is, therefore, ideal for testing or generating
television shows was significantly related to acceptance of                   models (Byrne, 2001).
cosmetic surgery, where the latter was measured using total
scores from the ACSS. While these studies have begun the task of             Method
delineating attitudes towards cosmetic surgery, it is also possible
to extend this research by examining individual difference                   Participants
predictors of such attitudes.
                                                                                The participants of this study were 332 (60.5% women, n = 201;
The present study                                                            39.5% men, n = 131) university students from a metropolitan
                                                                             university in Greater London (age M = 24.72, SD = 7.51). The
    Our first aim in the present study was to examine the                     majority of participants were of European Caucasian descent
relationship between the ACSS subscales and an individual’s                  (72.6%, n = 241), with smaller groups of Asian (10.5%, n = 35),
personality, where the latter was operationalised using the Big Five         African Caribbean (10.5%, n = 35), and other descent (6.3, n = 21). In
personality framework (McCrae & Costa, 1997). The Big Five is a              terms of religion, 59.6% of participants were Christians (n = 198),
hierarchical model of personality with five bipolar traits or factors         12.0% were Muslims (n = 40), 7.5% were atheists (n = 25), and 20.8%
(Agreeableness, Conscientiousness, Emotional Stability, Openness,            were of some other religious affiliation (n = 69). Most participants
and Extraversion), which represent personality at a broad level of           were in a dating relationship (57.5%, n = 191), while others were
abstraction (McCrae & Costa, 1997). The Big Five framework has               single (23.5%, n = 78), married (16.9%, n = 56), or of some other
been shown to have strong predictive validity in relation to various         marital status (2.1%, n = 7). Finally, most participants reported
real-world outcomes (Chamorro-Premuzic, 2007), including atti-               never having had cosmetic surgery (84.0%, n = 279).
tudes towards body size (Swami, Buchanan, Furnham, & Tovee,       ´
2008), but it has not been specifically examined in relation to               Measures
attitudes towards cosmetic surgery.
    Even so, there were reasons why we expected the Big Five                 Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King &
personality framework to be associated with acceptance of                    Henderson-King, 2005)
cosmetic surgery. For one thing, previous work has shown that                    This is a 15-item scale measuring various aspects of an
the factors of Emotional Stability are associated with negative              individual’s attitudes about cosmetic surgery and rated on a 7-
appearance evaluation (e.g., Kvalem, von Soest, Roald, and                   point scale (1 = strongly disagree, 7 = strongly agree). Three dimen-
Skolleborg, 2006), appearance orientation (e.g., Davis, Dionne, &            sions of such attitudes are measured: (1) Intrapersonal (five items
Shuster, 2001), dissatisfaction with facial appearance (e.g., Thomas         representing attitudes related to the self-oriented benefits of
& Goldberg, 1995), and self-objectification (e.g., Miner-Rubino,              cosmetic surgery; sample item: ‘In the future, I could end up
Twenge, & Frederickson, 2002). Self-objectification in the latter             having some kind of cosmetic surgery’); (2) Social (five items
study was also associated with Agreeableness and Openness,                   measuring social motivations for having cosmetic surgery; sample
whereas Kvalem et al. (2006) reported a significant association               item: ‘If it would benefit my career, I would think about having
between appearance orientation and Extraversion. More generally,             plastic surgery’), and; (3) Consider (five items assessing the
the Big Five factors are significantly associated with differences in         likelihood that a participant would consider having cosmetic
                                                                  V. Swami et al. / Body Image 6 (2009) 7–13                                                    9

surgery; sample item: ‘If I could have a surgical procedure done for                     Rosenberg Self-Esteem Scale (RSE; Rosenberg, 1965)
free I would consider trying cosmetic surgery’). Previous work has                          The RSE is a brief and widely used measure of self-worth,
shown that the ACSS has high internal consistency, good test–                            consisting of 10 items rated on a 4-point scale (1 = Strongly
retest reliability after three weeks, and good convergent and                            disagree, 4 = Strongly agree; sample item: ‘I certainly feel useless at
discriminant validity (Henderson-King & Henderson-King, 2005).                           times’). Five items were reverse-coded prior to analysis, and an
In the present study, Cronbach’s as for the three subscales were:                        overall score was computed by summing responses to all items.
Intrapersonal .92, Social .90, Consider .90.                                             The scale showed good internal consistency in the present study
                                                                                         (a = .77).
Ten Item Personality Inventory (TIPI; Gosling, Rentfrow, & Swann,
2003)                                                                                    Demographics
    This is a brief scale for assessing the Big Five personality facets,                    All participants provided their demographics consisting of sex,
which shows adequate convergent and discriminant validity, test–                         age, ethnicity, religion, and marital status. Participants also
retest reliability, and patterns of external correlates. Participants                    indicated on binary (1 = Yes, 2 = No) whether or not they had
rated the extent to which a pair of traits (e.g., ‘Extraverted,                          had cosmetic surgery in the past.
enthusiastic’) applies to them on a 7-point scale (1 = Disagree
strongly, 7 = Agree strongly). Five items are reverse-coded, and two                     Procedure
items are averaged to arrive at scores for each of the Big Five
personality traits. Cronbach’s a coefficients were as follows:                                Once ethical approval was obtained, a male and female
Extraversion .63, Agreeableness .66, Conscientiousness .63, Emo-                         experimenter recruited about half the sample each using opportu-
tional Stability .60, and Openness to Experience .61. These as are                       nistic sampling techniques. In practice, this meant approaching
acceptable given that they were measured using only two items                            potential participants in various campus settings (e.g., cafeterias,
(see Youngman, 1979).                                                                    libraries, seminar rooms) to ensure that sampling would be
                                                                                         comparable across experimenters. The nature of the experiment
Self-assessed attractiveness (SAA; Swami, Furnham, Georgiades, &                         was explained to participants, and once they provided informed
Pang, 2007)                                                                              consent, they were given a six-page questionnaire to complete along
    Participants were provided with a graphical representation of a                      with brief instructions. All participants took part on a voluntary basis
normal distribution curve (M = 100, SD = 15) and asked to provides                       and were not remunerated for their participation. They were
self-estimates of their overall physical attractiveness, overall facial                  verbally debriefed once they had completed and returned the
attractiveness, and overall attractiveness of their body weight and                      questionnaire to the experimenter.
body shape. Although the original version of this scale includes a
range of items referring to various body parts, the four items used                      Results
in the present study refer to global self-perceptions and rotated
into a single factor (all loadings >.88, eigenvalue = 3.49, 87.26% of                    Descriptive statistics
the variance explained). Cronbach’s a for the four items was .95.
                                                                                            Descriptive statistics (M and SD) for all variables are reported in
Conformity Scale (CS; Mehrabian, 2005)                                                   Table 1, which also shows the correlations of the three ACSS factors
    This 11-item scale measures conformity on a 9-point scale                            with other variables. As can be seen, the three factors of the ACSS
(À4 = Very strong disagreement, +4 = Very strong agreement; sample                       were highly inter-correlated. Significant correlates (from strongest
item: ‘I often rely on, and act upon, the advice of others’). A total                    to weakest) of the ACSS Intrapersonal factors were Openness,
score is computed by summing participants’ responses to seven                            conformity, self-assessed attractiveness, and age. The same
positively worded items and by subtracting this value from the                           variables were also correlated with the ACSS Consider factors,
sum of their responses to four negatively worded items (a = .79).                        with the addition of sex. For the ACSS Social factor, significant
Previous work has shown that the CS has good test–retest                                 correlates were conformity, Conscientiousness, Openness, Emo-
reliability and construct validity (e.g., Mehrabian & Stefl, 1995).                       tional Stability, self-esteem, and age.

Table 1
Descriptive statistics and bivariate correlation coefficients (Pearson’s r).

                                               M Æ SD                                     ACSS Intrapersonal              ACSS Consider               ACSS Social

ACSS Intrapersonal                             M Æ SD = 4.41 Æ 1.37                       –                                .84**                        .58**
ACSS Consider                                  M Æ SD = 3.89 Æ 1.61                                                       –                             .53**
ACSS Social                                    M Æ SD = 2.90 Æ 1.35                                                                                    –

Age                                            M Æ SD = 24.74 Æ 7.51                       .19**                           .13*                       À.11*
Sex                                                                                       À.00                             .16**                      À.05

Extraversion                                   M Æ SD = 10.18 Æ 2.50                       .07                            À.08                        À.00
Agreeableness                                  M Æ SD = 11.11 Æ 1.82                      À.00                            À.09                        À.01
Conscientiousness                              M Æ SD = 10.49 Æ 1.88                      À.05                            À.01                        À.37**
Emotional Stability                            M Æ SD = 9.05 Æ 2.73                        .03                            À.06                         .20**
Openness                                       M Æ SD = 10.38 Æ 2.42                      À.42**                          À.43**                      À.33**

Self-esteem                                    M Æ SD = 30.08 Æ 3.70                      À.03                            À.09                        À.18**
Conformity                                     M Æ SD = À4.85 Æ 13.95                      .21**                           .25**                       .47**

Self-assessed attractiveness                   M Æ SD = 101.02 Æ 13.42                    À.16**                          À.34**                      À.07

N = 332, sex coded: 1 = men, 2 = women.
     p < .05.
     p < .001.
10                                                        V. Swami et al. / Body Image 6 (2009) 7–13

Multiple regressions                                                             affected by conformity and self-esteem. The two latter variables, in
                                                                                 turn, were hypothesised to be affected by all Big Five personality
    A series of stepwise multiple regressions were carried out to                traits, which, in turn, were hypothesised to be affected by sex and
examine the amount of variance in each of the ACSS factors                       age. Thus, the model progressively moved from more distal
explained by the other variables. We chose stepwise regressions in               exogenous variables (to the left) to less distal variables (to the
order to select the fewest number of variables offered to the model              right).
that best describe the occurrence of the outcome. Three regres-                      Although the model is predictive rather than causal, from a
sions were conducted (one for each ACSS factor) and in each                      theoretical standpoint, sex and age are justified as exogenous
regression, age, sex, the Big Five factors, self-esteem, conformity,             variables as they are not influenced by any of the other variables.
and self-assessed attractiveness were entered as predictors in the               On the other hand, the Big Five personality factors are more general
same block. The regression predicting Intrapersonal accounted for                and ‘trait-like’ than self-esteem and conformity (which are
31.1% of the variance, with Openness (b = À.62, t = 10.85, p < .001,             arguably more influenced by situational factors, though they still
R2 = .18), Emotional Stability (b = .42, t = 6.59, p < .001, DR2 = .08),         have a trait-like basis). With regards to self-assessed attractive-
sex (b = .21, t = 3.76, p < .001, DR2 = .02), Extraversion (b = .19,             ness, we decided to treat this variable as less distal than self-
t = 3.63, p < .001, DR2 = .02), and self-assessed attractiveness                 esteem (a more over-arching self-construct) and conformity,
(b = (.12, t = 2.07, p < .05, DR2 = .01) being retained as significant            primarily to assess whether self-assessed attractiveness may
predictors.                                                                      explain some of the effects of self-esteem and conformity on the
    The regression predicting Social accounted for 60.6% of the                  ACSS factors. Finally, the ACSS factors were considered endogenous
variance and Emotional Stability (b = .73, t = 16.75, p < .001,                  not only in light of the aims of the current study, but also as these
R2 = .23), conformity (b = .46, t = 9.86, p < .001, DR2 = .23), Open-            attitudinal variables can be expected to be much more situational
ness (b = À.42, t = 8.75, p < .001, DR2 = .06), age (b = À.28, t = 7.13,         and less trait-like than the variables we treated as predictors.
p < .001, DR2 = .05), and Conscientiousness (b = À.18, t = 4.61,                     The hypothesised model did not fit the data well: x2 (df = 49,
p < .001, DR2 = .02) were significant predictors. Finally, the                    N = 332) = 1330,      p < .01,    GFI = .70,    CFI = .50,   PGFI = .38,
regression predicting Consider explained 40.8% of the variance,                  RMSEA = .28 (low = .26, high = .29), AIC = 1414.3, CN = 14. Thus
with Openness (b = À.63, t = 11.01, p < .001, DR2 = .19), Emotional              modifications were made in order to improve fit. In line with the
Stability (b = .52, t = 8.34, p < .001, DR2 = .02), sex (b = .47, t = 8.71,      modification indices, the Big Five were allowed to inter-correlate,
p < .001, DR2 = .09), self-assessed attractiveness (b = À.26, t = 5.41,          and non-significant estimates were eliminated from the model. In
p < .001, DR2 = .05), Agreeableness (b = À.32, t = 5.74, p < .001,               addition, conformity and self-esteem were allowed to inter-
DR2 = .02), Conscientiousness (b = .25, t = 4.67, p < .001,                      correlate, and direct paths from more distal to endogenous
DR2 = .02), and age (b = À.13, t = 2.48, p < .001, DR2 = .01) all                variables (e.g., from sex to the ACSS factors, from the Big Five
emerging as significant predictors.                                               factors to the ACSS factors, and from self-esteem to the ACSS
    It is noteworthy that Emotional Stability emerged as a strong                factors) were drawn in accordance to the modification indices. The
predictor of the three ACSS factors despite being uncorrelated with              modified model (shown in Fig. 1) fitted the data well: x2 (df = 17,
two of these factors and only modestly correlated with the other                 N = 332) = 46.7, p < .01, GFI = .98, CFI = .99, PGFI = .34, RMSEA = .06
ACSS Social, which suggests suppressor effects in the regressions.               (low = .04, high = .09), AIC = 194.7, CN = 14. Although the x2 value
In order to explore a tentative model for integrating the various                was significant, this is to be expected even in well-fitting models
predictors of ACSS, we next conducted structural equation                        (Byrne, 2001).
modelling (SEM) with the data.                                                       Direct paths into the endogenous variables (ACSS factors) were
                                                                                 found for several variables. Thus, women, more conscientious, less
Structural equation modelling                                                    agreeable, less open, and more emotionally stable individuals, as
                                                                                 well as those who rated themselves lower in attractiveness, were
    SEM was performed using AMOS 4.0 (Arbuckle & Wothke, 1999;                   more likely to consider cosmetic surgery. Of these factors,
Byrne, 2001). Fitness of the model was assessed using the following              Openness, in particular was a strong predictor of the ACSS
indices: x2 (Bollen, 1989; tests the hypothesis that an uncon-                   Consider factor. ACSS Social, on the other hand, was predicted
strained model fits the covariance or correlation matrix as well as               by conformity (the main single predictor), followed by Emotional
the given model; ideally values should not be significant);                       Stability and Conscientiousness (a negative predictor). Therefore,
Goodness-of-Fit Indicator (GFI; Tanaka & Huba, 1985; a measure                   the less neurotic, conscientious, and more conformist an indivi-
of fitness where values close to 1 are acceptable); Parsimony                     dual, the more likely she or he is to emphasise social motivations
Goodness-of-Fit Indicator (PGFI; Mulaik et al., 1989; a measure of               for having cosmetic surgery. Finally, the Intrapersonal factor of the
power that is optimal around .50); Comparative Fit Index (CFI;                   ACSS was predicted by Openness (negatively) and, to a lesser
Bentler, 1990; comparison of the hypothesised model with a model                 extent, Emotional Stability, indicating that the less open and more
in which all correlations among variables are zero, and where                    emotionally stable an individual, the more likely she or he holds
values around .90 indicate very good fit); Root-Mean-Square Error                 strong attitudes related to the self-oriented benefits of cosmetic
of Approximation (RMSEA; Browne & Cudeck, 1993; values of .08                    surgery.
or below indicate reasonable fit for the model; Akaike’s Informa-
tion Criterion (AIC; Akaike, 1973; gives the extension to which the              Discussion
parameter estimates from the original sample will cross-validate
in future samples; Hoelter’s Critical N (CN; Hoelter, 1983; provides                The results of the present study extend previous work with the
the maximum sample size for which a model with same sample                       ACSS by showing that acceptance of cosmetic surgery is reliably
size and df would be acceptable at .01 level).                                   (albeit moderately) associated with participants’ sex, age, Big Five
    The modified model consisted of a hierarchical path analysis                  personality factors, self-esteem, conformity, and self-assessed
where the three factors of ACSS were treated as inter-correlated,                attractiveness. Overall, these variables explained a substantial
endogenous variables (to the very right of the model). Direct paths              portion of the variance in the ACSS factors (particularly for Social),
to the three endogenous variables were then drawn from self-                     and significantly predicted each ACSS factor (though not always in
assessed attractiveness, which, in turn, was hypothesised to be                  the same manner). Although it is important to note that this is a
                                                                  V. Swami et al. / Body Image 6 (2009) 7–13                                                                 11

Fig. 1. A possible model for understanding the determinants of acceptance of cosmetic surgery. Note: All coefficients are Standard Beta values significant at p < .001. SAA: Self-
assessed attractiveness, RSE: self-esteem, CONF: Conformity; Intra: ACSS Intrapersonal, Social: ACSS Social, Consider: ACSS Consider, ES: Emotional Stability (low
neuroticism), E: Extraversion, O: Openness to Experience, A: Agreeableness, C: Conscientiousness; sex coded 1 = men, 2 = women. Regression paths <.20, error variances, and
covariances not shown here for simplicity.

preliminary attempt at integrating predictors according to their                           given that the Conformity Scale measures the extent to which an
more-or-less distal position with respect to the ACSS factors, a                           individual is willing to emulate and give in to others so as to avoid
number of conclusions are worthy of further comment.                                       any negative interactions. Thus, this association may be tapping into
    First, our results showed that women were more likely than                             conforming individuals’ greater likelihood of accepting cosmetic
men to consider having cosmetic surgery, which is consistent with                          surgery in order to satisfy their partners or other close relationships.
previous work in which participants were asked to rate their                               Moreover, our results also suggest that the Big Five personality
likelihood of having various cosmetic procedures (Brown et al.,                            factors of Conscientiousness and Emotional Stability help explain
2007; Frederick, Lever, & Peplau, 2007; Swami, Arteche, et al.,                            more positive social attitudes towards cosmetic surgery. It may be
2008). As discussed elsewhere, this sex difference may reflect the                          the case more neurotic individuals are anxious about the
greater sociocultural pressure that women experience to live up to                         consequences of cosmetic surgery and focus on potential negative
idealised images of physical perfection (Swami, 2007; Swami &                              effects (e.g., pain). Likewise, high conscientious individuals may be
Furnham, 2008). Our results also suggest that individuals who                              more wary of cosmetic surgery, perhaps stemming from their higher
rated themselves lower in physical attractiveness were more likely                         degree of carefulness, thoroughness, and deliberation.
to consider cosmetic surgery, which is consistent with previous                                Finally, our results suggest that less open and more emotionally
work (Brown et al., 2007; Swami, Arteche, et al., 2008).                                   stable individuals had a greater likelihood of accepting cosmetic
    However, our results also suggest that more conscientiousness,                         surgery in order to maximise its self-oriented benefits. As
less agreeable, less open, and more emotionally stable individuals                         suggested above, Closed individuals may maintain more negative
were more likely to consider cosmetic surgery, thus centrally                              evaluations of their appearance, which in turns leads to a greater
implicating the Big Five personality framework in such decisions.                          acceptance of cosmetic surgery if it is able to enhance their
Openness to Experience, in particular, was a strong negative                               appearance. Emotional stability, on the other hand, may be linked
predictor of considering having cosmetic surgery. Previous work                            with the Intrapersonal factor because neurotic individuals are
has reported a positive association between Openness and positive                          more likely to experience negative affect associated with negative
self-evaluations of appearance (Kvalem et al., 2006). Extrapolating                        self-evaluations of appearance (see also Kvalem et al., 2006).
from this evidence, it might be suggested that Closed individuals                              All in all, our results suggest a complex model linking
have a more negative appearance evaluation (possibly as a                                  participant demographics, personality, and a number of individual
function of their lower likelihood of accepting unconventional                             difference variables with acceptance of cosmetic surgery as
societal norms of attractiveness; cf. Swami, Buchanan, Furnham, &                          measured on the ACSS. As can be seen in Fig. 1, the Intrapersonal
Tovee, 2008), which increases their likelihood of wanting to have                          factor of the ACSS was strongly affected by Openness and modestly
cosmetic surgery to enhance their appearance. It is also important                         affected by Emotional Stability. The Social factor was strongly
to note that, in the present study, low self-esteem was not                                affected by Emotional Stability and Conformity, and to a lesser
correlated with higher likelihood of having cosmetic surgery.                              degree, Conscientiousness. Most notably, consideration of cos-
Rather, self-esteem was associated with self-assessed attractive-                          metic surgery was affected by 6 of the 10 predictors (including four
ness, which in turn was negatively associated with greater                                 of the Big Five factors), namely Openness, sex, self-assessed
likelihood of considering cosmetic surgery.                                                attractiveness, Agreeableness, Emotional Stability, and Conscien-
    Our results also showed that the Social factor of the ACSS, which                      tiousness. In sum, these results indicate that most of the variance
measures social motivations for wanting to have cosmetic surgery,                          in ACSS factors was explained by the Big Five, with all traits except
was strongly predicted by conformity. This is perhaps not surprising,                      Extraversion affecting one ACSS factor or more.
12                                                                    V. Swami et al. / Body Image 6 (2009) 7–13

Limitations and conclusion                                                                       cosmetic surgery. Poster presented at the Conference of the Association for Beha-
                                                                                                 vioral and Cognitive Therapies, Washington, DC.
                                                                                             Chamorro-Premuzic, T. (2007). Personality and individual differences. Oxford: Blackwell.
    It is important to bear in mind a number of limitations to the                           Costa, P. T., Jr., & McCrae, R. R. (1992). Revised NEO Personality Inventory (NEO-PI-R) and
present study. First, although our results generally mirror findings                              NEO Five-Factor Inventory (NEOFFI): Professional manual. Odessa, FL: Psychological
                                                                                                 Assessment Resources.
from community samples (e.g., Brown et al., 2007; Swami, Arteche,                            Crockett, R. J., Pruzinsky, T., & Persing, J. A. (2007). The influence of plastic surgery
et al., 2008), it is nevertheless the case that our reliance on                                  ‘reality TV’ on cosmetic surgery patient expectations and decision making. Plastic
university students limits the generalisability of our findings.                                  and Reconstructive Surgery, 120, 316–324.
                                                                                             Davis, K. (2003). Dubious equalities and embodied differences: Cultural studies on cosmetic
Second, it will be important to replicate the present work more
                                                                                                 surgery. Lanhan, MD: Rowman and Littlefield.
reliable measures of the Big Five personality framework, such as                             Davis, C., Dionne, M., & Shuster, B. (2001). Physical and psychological correlates of
Costa and McCrae’s (1992) revised NEO personality inventory                                      appearance orientation. Personality and Individual Differences, 30, 21–30.
                                                                                             Delinsky, S. S. (2005). Cosmetic surgery: A common and accepted form of self-
(NEO-PI-R), as this may reveal more conclusively which aspects of
                                                                                                 improvement? Journal of Applied Social Psychology, 35, 2012–2028.
personality are associated with acceptance of cosmetic surgery.                              Edmonds, A. (2007). ‘The poor have the right to be beautiful’: Cosmetic surgery in
Similarly, it would be useful to further explicate the relationship                              neoliberal Brazil. Journal of the Royal Anthropological Institute, 13, 363–381.
between self-esteem and acceptance of cosmetic surgery, given                                Figueroa, C. (2003). Self-esteem and cosmetic surgery: Is there a relationship between
                                                                                                 the two? Plastic Surgical Nursing, 23, 21–25.
possible associations between self-esteem and narcissism, and                                Frederick, D. A., Lever, J., & Peplau, L. A. (2007). Interest in cosmetic surgery and body
between narcissism and interest in cosmetic surgery.                                             image: Views of men and women across the lifespan. Plastic and Reconstructive
    Third, we have not fully examined the relationships between                                  Surgery, 120, 1407–1415.
                                                                                             Gosling, S. D., Rentfrow, P. J., & Swann, W. B., Jr. (2003). A very brief measure of the Big-
acceptance of cosmetic surgery and constructs of body image.                                     Five personality domains. Journal of Research in Personality, 37, 504–528.
Previous work, for example, has shown that attitudes about                                   Henderson-King, D., & Henderson-King, E. (2005). Acceptance of cosmetic surgery:
cosmetic surgery, as measured using the Cosmetic Surgery                                         Scale development and validation. Body Image, 2, 137–149.
                                                                                             Koff, E. (1998). Breast size perception and satisfaction, body image, and psychological
Attitudes Questionnaire, were predicted by greater psychological                                 functioning in Caucasian and Asian American college women. Sex Roles, 38, 655–
investment in physical appearance and greater internalisation of                                 673.
mass media images of physical beauty (Sarwer et al., 2005). In a                             Kvalem, I. L., von Soest, T., Roald, H. E., & Skolleborg, K. C. (2006). The interplay of
                                                                                                 personality and negative comments about appearance in predicting body image.
similar vein, while we have focused on a number of relevant
                                                                                                 Body Image, 3, 263–273.
variables to acceptance of cosmetic surgery, our study in no way                             McCrae, R. R., & Costa, P. T., Jr. (1997). Personality trait structure as a human universal.
exhausts the list of potential variables that could be included in a                             American Psychologist, 52, 509–516.
                                                                                             Mehrabian, A. (2005). Manual for the Conformity Scale. Monterey, CA: University of
study of this type. For instance, future work may wish to include
                                                                                                 California, Los Angeles.
such factors as media exposure, vicarious experience of cosmetic                             Mehrabian, A., & Stefl, C. A. (1995). Basic temperament components of loneliness,
surgery, and perfectionism, which previous studies have found to                                 shyness, and conformity. Social Behavior and Personality, 23, 253–264.
be associated with the likelihood of having cosmetic procedures                              Miner-Rubino, K., Twenge, J. M., & Fredrickson, B. L. (2002). Trait self-objectification in
                                                                                                 women: Affective and personality correlates. Journal of Research in Personality, 36,
(Brown et al., 2007; Delinsky, 2005; Sherry, Hewitt, Flett, & Lee-                               147–172.
Baggley, 2007; Swami, Arteche, et al., 2008).                                                Mischel, W., & Shoda, Y. (1999). Integrating dispositions and processing dynamics
    These limitations notwithstanding, our results suggest that                                  within a unified theory of personality: The cognitive-affective personality system.
                                                                                                 In L. A. Pervin & O. P. John (Eds.), Handbook of personality: Theory and research (2nd
any model attempting to predict acceptance of cosmetic surgery                                   ed., pp. 197–218). New York, NY: The Guilford Press.
must include individual difference variables, particularly person-                           Mulaik, S. A., James, L. R., van Alstine, J., Bennett, N., Lind, S., & Stilwell, C. D. (1989).
ality. Specifically, when considering motivations for surgery,                                    Evaluation of goodness-of-fit indices for structural equation models. Psychological
                                                                                                 Bulletin, 105, 430–445.
cosmetic surgeons should consider the confluence of patients’                                 Rohrich, R. J. (2003). The American Society of Plastic Surgeons’ procedural statistics:
personalities in addition to factors such as sociocultural pressure,                             What they really mean. Plastic and Reconstructive Surgery, 112, 1389–1392.
post-operative expectations, and negative body image. Given the                              Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton
                                                                                                 University Press.
phenomenal increase in the number of cosmetic surgery                                        Sarwer, D. B. (2007). The psychological aspects of cosmetic breast augmentation. Plastic
procedures, a fuller understanding of the influence of personality                                and Reconstructive Surgery, 120, 110S–117S.
may allow surgeons to more accurately assess the suitability of                              Sarwer, D. B., Cash, T. F., Magee, L., Williams, E. F., Thompson, J. K., Roehrig, M., et al.
                                                                                                 (2005). Female college students and cosmetic surgery: An investigation of
patients for surgery. Further research in this area may lead to a
                                                                                                 experiences, attitudes, and body image. Plastic and Reconstructive Surgery,
better understanding of the psychological aspects of cosmetic                                    115, 931–938.
surgery, as well as strengthen the basis for the promotion of                                Sarwer, D. B., & Crerand, C. E. (2008). Body dysmorphic disorder and appearance
healthier body image.                                                                            enhancing medical treatments. Body Image, 5, 50–58.
                                                                                             Sarwer, D. B., Crerand, C. E., & Gibbons, L. M. (2007). Cosmetic surgery to enhance body
                                                                                                 shape and muscularity. In J. K. Thompson & G. Cafri (Eds.), The muscular ideal:
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