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control their body’s appearance (Mazzeo, Trace, Mitchell, & Gow, 2007). It therefore appears that among young women, CS media may lead to a short-term negative body image, as well as to more favourable attitudes towards surgery. Research on adolescents in this field is sparse. Studies of adolescents have predominantly focused on guidelines for appropriate patient selection (McGrath & Mukerji, 2000; Zuckerman & Abraham, 2008), and postoperative satisfaction (Kamburoğlu & Özgür, 2007; Simis, Verhulst, & Koot, 2001). For example, Simis and colleagues investigated body image changes between three RUNNING HEAD: Adolescents’ views on cosmetic surgery 5 groups of adolescents: those undergoing reconstructive surgery for congenital or disease-related deformities; those undergoing surgery for aesthetic purposes; and those with self-reported ‘deformities’ who were not planning to have surgery (Simis, Verhulst, & Koot, 2001). A significant decrease in body image burdens was noted across all groups. However, this decrease was most pronounced in adolescents undergoing corrective surgery, which suggests that such improvements in body image are more prominent following surgery than the expected natural developmental changes that occur during adolescence. The authors concluded that adolescents are appropriate candidates for CS in the sense that they gain bodily satisfaction and body-related burdens decrease. To date, only one study has looked at adolescent boys’ and girls’ attitudes towards CS (Pearl & Weston, 2003). This survey found that 30% of adolescents were interested in having surgery and the main reasons they would not choose it were health risks, cost and fear of a bad result. In sum, researchers have started to investigate CS media and the impact on individuals' attitudes toward surgery, but very little research has looked at the impact on adolescents. This is a particularly important population to investigate for several reasons. First, in many societies adolescents are the first generation to be raised in an environment where CS is a commonplace and acceptable form of appearance enhancement (Frederick, Lever, & Peplau, 2007). Second, they are at an age where their body image and self-concept is still developing, which may make them particularly sensitive to options for appearance change or enhancement. Adolescents may therefore be more prone to considering CS, which could be problematic due to its inherent riskiness. We therefore aimed to obtain a detailed account of adolescent girls' views about CS. Given the lack of previous research examining this, qualitative focus groups were most appropriate. Focus groups enable the canvassing of a larger number of adolescents (compared to individual interviews), and facilitate the exploration and discussion of social norms and influences on the topic. By using focus groups we aimed to gain a better understanding of girl’s individual views, as well as using group discussion to produce more elaborated co-constructed accounts (Wilkinson, 1998). More RUNNING HEAD: Adolescents’ views on cosmetic surgery 6 specifically, we investigated adolescent girls’ (1) attitudes toward CS; (2) perceptions of how their peers feel about CS; (3) attitudes towards undergoing CS for different motives; and (4) opinions about how CS is portrayed within the media and how this influences them. Method Participants Participants were 27 girls attending a higher education college in England who took part in an annual ‘Psychology Day’ organised by the college in February 2010 and March 2011. Four focus groups were run in 2010, each consisting of 3-4 participants. In 2011, a further three focus groups were run, each consisting of 3-5 participants. Participants were all students at the same college, and often signed up with friends to take part in the study. Participants were all White European with an age range of 15-18 years (mean 16.78). This is broadly reflective of the local population, which is predominantly White European (90.7%; Office of National Statistics, 2011) Materials and interview schedule To instigate discussion, we used two excerpts from published articles. The first excerpt was taken from an article published in ‘Sugar’ (July, 2009) on ‘Operation Prom’. This article focused on a 15- year-old girl who underwent liposuction and breast augmentation for her prom night. The second article, ‘Teenage Bullying - Is Plastic Surgery the Solution?’ was published in a number of online newspapers and reported the case of a girl who received rhinoplasty after changing schools because of bullying related to her nose. Both articles were short, approximately 500 words each, and required no more than three minutes to be read. The content of these articles also allowed us to explore whether different motivations for undergoing surgery play a role in girls’ acceptance of it. A semi-structured interview was used, in which we focused on the articles first, then asked about CS more generally. Initial discussion of the articles explored adolescents’ attitudes towards people who undergo surgery for different motives. The general discussion of CS focused on the media’s portrayal of CS; adolescents’ personal attitudes toward and expectations of CS; and their RUNNING HEAD: Adolescents’ views on cosmetic surgery 7 perceptions of how their peers feel about surgery. We used follow-up
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