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Women in surgery: a history of adversity, resilience, and accomplishment. J Am Coll Surg. 2016;223(4):670-673. 15. Plana NM, Khouri KS, Motosko CC, et al. The evolving presence of women in academic plastic surgery: a study of the past 40 years. Plast Reconstr Surg. 2018;141(5): 1304-1310. 16. Gast KM, Kuzon WM Jr, Adelman EE, Waljee JF. Influence of training institution on academic affiliation and productivity among plastic surgery faculty in the United States. Plast Reconstr Surg. 2014;134(3):570-578. 17. Sasor SE, Cook JA, Duquette SP, et al. Scholarly activity in academic plastic surgery: the gender difference. J Surg Res. 2018;229:332-336. 18. Ridgway EB, Sauerhammer T, Chiou AP, LaBrie RA, Mulliken JB. Reflections on the mating pool for women in plastic surgery. Plast Reconstr Surg. 2014;133(1):187-194. 19. Santosa KB, Larson EL, Vannucci B, et al. Gender imbalance at academic plastic surgery meetings. Plast Reconstr Surg. 2019;143(6):1798-1806. 20. Nahai F. “Me too” Utah Women Stats Research Snapshot Cosmetic Surgery and Body Image Among Utah Women Setting the Stage National media and scholars have puzzled over the high levels of plastic surgery among Utah women, 1 and a national magazine even called Salt Lake City the “Vainest City in America.” 2 Many wonder why Salt Lake City, capital of one of the most religious states in the nation,3 would employ more plastic surgeons per capita than Los Angeles.4 In fact, two-thirds of Utah Mormon women know someone who has undergone cosmetic plastic surgery. 5 In a state known for its conservative and wholesome values, visitors are surprised at the large quantity of billboards lining Utah’s interstate freeway advertising plastic surgery and other bodymanipulating procedures. 6 Pinning down causes for this phenomenon is difficult, but this report will attempt to shed light on the cultural and personal factors contributing to the high numbers of elective plastic surgeries (specifically for aesthetic purposes) in Utah. This research snapshot focuses on four key areas: 1) Defining body image and exploring the pressure to conform to societal standards of beauty, 2) Data on cosmetic surgery nationally and in Utah, 3) Possible explanations for the high levels of plastic surgery in the state, and 4) A discussion of ongoing efforts, both nationally and in Utah, to improve body image among women. Body Image and Societal Standards of Beauty Approximately 80% of U.S. women do not like how they look;7 furthermore, research shows that poor body image affects girls and women worldwide.8 Body image is “the perception that a person has of their physical self and the thoughts and feelings that result from that perception. These feelings can be positive, negative, or both and are influenced by individual and environmental factors.” 9 Researchers have found that many factors (e.g., media, family, peers) cause women to internalize societal beauty ideals that can lead to satisfaction or dissatisfaction with their bodies. 10 A mother’s body image usually serves as the primary model for how daughters think about their own bodies.11 These pressures can begin at an early age and intensify through adolescence, a time when experts say “girls are becoming increasingly aware of the fact that their appearances are a barometer of their self-worth in our media-intense culture.”12 Societal ideals of beauty can influence some girls and women to focus significant time, energy, and money on their appearance. Utah women’s close attention to personal appearance manifests in various ways. Forbes magazine reported that in 2006 Salt Lake City residents spent $2.2 mil-lion on hair coloring and $6.9 million on cosmetics and skin-care products—more than ten times the amount residents of similarly sized cities spent. 13 In addition, minimally invasive cosmetic procedures are becoming increasingly common for those who want to improve their appearance. Nationally, dermatologists report that Botox injections have become almost as great a part of their business as skin cancer treatments. 14 Elective cosmetic surgery is another option for those wishing to improve their appearance. Research shows that body image plays a part in the decision to undergo elective plastic surgery and other body enhancements. Kathy Davis, a leading scholar in this field, says, “Cosmetic surgery belongs to a broad regime of technologies, practices and discourses which define the female body as deficient and in need of constant transformation.”15 Indeed, research has shown that women who received high scores on a scale of body shame and self-surveillance were more likely to express positive feelings about plastic surgery and to report a likelihood that they would modify their own bodies in the future.16 Yet, despite the demonstrable connection between poor body image and severe societal pressures on girls and women to conform to unattainable standards of physical beauty, some see no problem with plastic surgery and even encourage it.17 Furthermore, a Yale University metaanalysis of “experimental literature found that physically attractive people were perceived as more sociable, dominant, sexually warm, mentally healthy, intelligent, and socially skilled than physically unattractive people.”18 Hence, some may feel that efforts to improve their physical appearance (no matter how
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