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surgery is performed on normal structures of the body and is usually done to improve appearance and form (American Society of Plastic Surgeons 2018). Cosmetic surgery has become an increasingly popular means of enhancing one’s appearance, with around 30,000 procedures being carried out last year according to the British Association for Aesthetic Plastic Surgeons (2017), and is an industry that is heavily influenced by ‘popular culture’. For example, the American Academy of Facial Plastic and Reconstructive Surgery (2013) reported an increase in requests for surgery as a result of social media photo sharing. Of the procedures mostly likely to be requested as a result of social media influence were rhinoplasty, Botox and facelifts, suggesting that young people may be influenced to undergo cosmetic procedures by what they see online. Similarly, a study has shown that among cosmetic surgery patients, Facebook, YouTube and Instagram are high in use and engagement for information regarding procedures, such as practice information, before and-after photographs, and contests (Sorice et al. 2017). However, despite the growing popularity in cosmetic procedures, the social and psychological factors that influence attitudes towards cosmetic surgery are yet to be fully explored. Predictors of the Desire to Undergo Cosmetic Surgery There are several factors that have been reported to predict an individual’s desire to undergo cosmetic surgery. Consistently, body dissatisfaction has been shown to be a key motivational factor for cosmetic surgery among both women and men (Pertschuk et al. 1998; Sharp 2018). Body dissatisfaction relates to the negative thoughts that an individual has about their body. It involves feelings of discrepancy between the actual body shape and an ideal one (Grogan 2008). Markey and Markey (2009) found that out of physical appearance, teasing and media influence, body dissatisfaction was the best predictor of interest in undergoing cosmetic surgery. On the contrary, young women who were satisfied with their bodies were the least likely to desire bodily change (Lee et al. 2009). It may be that body dissatisfaction acts as a mediator between young women’s perceptions of their bodies and attempts to change them. As such, women who negatively perceive themselves may become dissatisfied with their appearance which in turn makes them express a greater desire for engaging in appearance-changing strategies such as cosmetic surgery (Markey and Markey 2005). Additionally, self-esteem has been shown to be related to the likelihood of undergoing cosmetic surgery, with those who have lower self-esteem being significantly more likely to want to have cosmetic procedures (Furnham and Levitas 2012). Self-esteem can be classified as the extent to which Curr Psychol individuals value and accept themselves and think favourably of themselves (Blascovich and Tomaka 1991). Relatedly, selfesteem has been found to significantly increase in some individuals as a result of undergoing cosmetic surgery (Soest et al. 2009), suggesting that their low-self-esteem functions as a motivating factor for decisions in the first place. Weight and diet are also found to be related to the motivation to have cosmetic surgery. For example, heavier women desire more cosmetic procedures (Henderson-King and Brooks 2009). Conversely, a study looking at female university students found that a low BMI predicted a greater consideration of cosmetic surgery (Swami 2009). As such, there may be an increased motivation for cosmetic surgery at either extremes of the BMI scale. Moreover, Body Dysmorphic Disorder (BDD) has consistently been found to be related to the desire to undergo cosmetic surgery. Among individuals who seek cosmetic enhancements it is estimated that 7% to 15% have the condition (Crerand et al. 2006). Individuals with BDD have a preoccupation with an imagined or minimal defect in their appearance (American Psychiatric Association 2013). Appearance-changing strategies such as cosmetic surgery are then often conceived as a way to get rid of this perceived defect. Paradoxically, individuals with BDD who engage in cosmetic surgery as a way to treat their BDD often display significantly negative outcomes, such as being dissatisfied with the result of the surgery, exhibiting higher levels of psychopathology and low self-esteem (Mulkens et al. 2012). As cosmetic treatments rarely resolve the symptoms of BDD and in some cases can make symptoms worse (Mulkens et al. 2012), the evaluation of the psychological condition and motivation of the patient in cosmetic treatment options is imperative. In addition, the social environment has a significant influence on individuals’ desire to have cosmetic surgery. Here, experiences of bullying and teasing are motivating factors for people to undertake cosmetic surgery and to fix their body dissatisfaction. Teased individuals also report lower levels of physical attractiveness and appearance satisfaction and higher levels of anxiety and depression (Jackson et al. 2012). This applies in particular to women with a history of teasing which makes them more likely to have cosmetic surgery (Soest et al. 2006). Also, the extent to which cosmetic surgery is socially accepted exerts an impact on the motivation for cosmetic surgery. Hearing about other people’s experiences of
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