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Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The authors received no financial support for the research, authorship, and publication of this article. References 1. American Society for Aesthetic Plastic Surgery (ASAPS). Statistical data, 2011. http://www.surgery.org/media/ statistics 2. Palmeri C. Economic trends. Business Week. December 3, 2001:28. 3m DC, Kim S, Mitra A. Perceptions and misconceptions of the plastic and reconstructive surgeon. Ann Plast Surg. 1997;38(4):426-430. 5. Dunkin CS, Pleat JM, Jones SA, Goodacre TE. Perception and reality: a study of public and professional perceptions of plastic surgery. Br J Plast Surg. 2003;56(5):437-443. 6. Hamilton GS, Carrithers JS, Karnell LH. Public perceptions of the term “cosmetic,” “plastic,” and “reconstructive” surgery. Arch Facial Plast Surg. 2004;6(5):315-320. 7. Ellin A. Putting the best face on cosmetic surgeons. New York Times. April 10, 2008. 8. Krieger LM, Shaw WW. The financial environment of aesthetic surgery: results of a survey of plastic surgeons. Plast Reconstr Surg. 1999;104:2305-2311. 9. Constantin M. The media and plastic surgery: on being what you want to become. Plast Reconstr Surg. 2003;111:1348-1349. 10. Darisi T, Thorne S, Iacobelli C. Influences on decisionmaking for undergoing plastic surgery: a mental models, and quantitative assessment. Plast Reconstr Surg. 2005;116(3):907-916. 11. Walden JL, Panagopoulos G, Shrader SW. Contemporary decision making and perception in patients undergoing cosmetic breast augmentation. Aesthetic Surg J. 2010;30(3):395-403. 12. Waltzman JT, Scholz T, Evans G. What patients look for when choosing a plastic surgeon. Annals of Plastic Surgery. 2011;66(6):643-647. 13. Kurkjian TJ, Kerikel JM, Sykes JM, Duffy SC. Impact of the current economy on facial aesthetic surgery. Aesthetic Surg J. 20ample of 204 British participants completed a questionnaire that assessed their attitude toward cosmetic surgery as well as measures of self-esteem, life satisfaction, self-rated physical attractiveness, religiosity and media consumption. Two factors emerged from a factor analysis of their attitudes toward surgery: likelihood to undergo, and benefits of undergoing, cosmetic surgery. Females with low self-esteem, low life satisfaction, low self-rated attractiveness and little religious beliefs who were heavy television watchers reported a greater likelihood of undergoing cosmetic surgery. Stepwise regression analysis with the two attitude factors as criterion variables showed two major predictors for likelihood: religiousness and low self-esteem, and four major predictors for benefit: religousness, media consumption, life satisfaction and sex. The role of religion is considered in this context. Keywords: Attractiveness, Cosmetic surgery, Sex differences The role of attractiveness in Western society has been extensively explored by evolutionary and social psychologists (1–3). A meta-analysis of more than 900 studies by Langlois et al (4) provides further support that people are treated differently based on how physically attractive they are perceived to be. Given the influence that physical attractiveness has in our everyday lives, it is perhaps not surprising that people seek a means to alter their appearance to conform to societal ideals of attractiveness. The present study investigated attitudes toward cosmetic surgery by replicating and extending three studies in this area (5–7). The focus of the present study was on how media consumption and religious beliefs, in addition to self-esteem and life satisfaction, influence attitudes to cosmetic surgery. form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk, and external genitalia. It uses aesthetic surgical principles not only to improve undesirable qualities of normal structures, but in all reconstructive procedures as well. Among the problems managed by plastic surgeons are congenital anomalies of the head and neck. Clefts of the lip and palate are the most 6 common, but many other head and neck congenital deformities exist. In addition, the plastic surgeon treats injuries to the face, including fractures of craniofacial skeleton. Craniofacial surgery is a discipline developed to reposition and reshape the bones of the face and skull through inconspicuous incisions. Severe deformities of the cranium and face, which previously were uncorrectable or corrected with great difficulty, can now be better reconstructed employing these new techniques. Such deformities may result from a tumor resection, congenital defect, previous surgery, or previous injury. Treatment of tumors of the head and neck and reconstruction of these regions after the removal of these tumors is also within the scope of plastic surgery. Another area of expertise for the plastic surgeon is hand surgery, including the management of acute hand injuries, the correction of hand deformities and reconstruction of the hand. Microvascular surgery, a technique that allows the surgeon to connect blood vessels of one millimeter or less in diameter, is a necessary skill in hand surgery for reimplanting amputated parts or in moving large pieces of tissue from one part of the body to another. Defects of the body surface resulting from burns or from injuries, previous surgical treatment, or congenital deformities may also be treated by the plastic surgeon. One of the most common of such procedures is reconstruction of the breast following mastectomy. Breasts may also be reduced in size, increased in size, or changed in shape to improve the final aesthetic appearance. Operations of this type are sometimes cosmetic in purpose, but in cases where the patient has a significant asymmetry or surgical defect, the procedure serves important therapeutic purposes. The most highly visible area of plastic surgery is aesthetic or cosmetic surgery. Cosmetic surgery includes facelifts, breast enlargements and enhancement, nasal surgery, body sculpting, and other similar operations to enhance one’s appearance. The results of the plastic surgeon’s expertise and ability are highly visible, leading to a high degree of professional and personal satisfaction. Plastic surgery is an innovative specialty. Advances such as transplantation, microvascular surgery, fat grafting, and various medical devices have been spearheaded and advanced by plastic surgeons. The discipline requires meticulous attention to detail, sound judgment and technical expertise in performing the intricate and complex procedures associated with plastic surgery. In addition, plastic surgeons must possess a flexible approach that will enable them to work daily with a tremendous variety of surgical problems. Most importantly, the plastic surgeon must have creativity, curiosity, insight, and an understanding of human psychology. Students interested in a career in plastic and reconstructive surgery would benefit from rotating on their institution’s plastic surgery service to gain experience in and exposure to the field. In addition, finding a mentor within the field to help guide in one’s development, decision-making, and to answer questions is advised. 7 The pathway to a career in plastic surgery can follow in one of two ways. The first is through an integrated or categorical plastic surgery residency program. Programs are six years in duration; however, several programs also dedicate one or more years to research. The other route, known as the independent route, is to complete residency in general surgery, otolaryngology, urology, orthopedic surgery, or neurosurgery and then complete a three-year independent plastic surgery residency. After the completion of either the integrated or independent pathway, one is eligible to sit for the plastic surgery board examination. In addition, one can attain further training in a plastic surgery fellowship program. Fellowships are typically one year in duration and are offered for specialty training in hand surgery, craniofacial surgery, microsurgery, facial aesthetics, cosmetic surgery, body contouring surgery, and burn surgery. Traditionally, plastic surgeons have established their practices in large urban settings. However, there is an increasing need for more plastic surgeons in the smaller communities and rural areas of this country - many metropolitan areas with populations of 65,000 to 268,000 have no plastic surgeons, leaving many areas needing plastic surgery expertise. There are approximately 7,000 board certified plastic surgeons in the United States; many of those currently certified by The American Board of Plastic Surgery received certification in the past ten years. Despite this recent rapid growth, there are opportunities for plastic surgeons in community and academic practice. Plastic surgery is an old specialty with references that date back thousands of years. It has survived and flourished because it is a changing specialty built by imaginative, creative and innovative surgeons with a broad
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