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concern with appearance decreases with age and women become more accepting of themselves, focusing on things other than appearance: ‘When you’re younger there’s a lot more pressure around you to look better, but as you get older you sort of realise there’s no point really, you are who you are.’ Theme 2. Acceptability of cosmetic surgery: “I don't know how people can get through life thinking the only way of fixing things is to have surgery.” Girls' perceptions of how acceptable and justified CS is varied depending on the conditions under which CS is chosen. In discussing the stimulus articles, girls were more accepting of the girl who was being bullied having surgery (although not without reservations), than the girl who had surgery for her prom. Participants said appearance-based bullying happens a lot in UK schools, that they understood the pain of it and therefore perhaps the decision to have surgery. On the contrary, the idea of surgery for a prom was characterised as “extreme” and “silly”. Concerns about surgery in RUNNING HEAD: Adolescents’ views on cosmetic surgery 10 response to bullying included the ideas that bullying also relates to a person’s self-confidence. Therefore, one concern was that although a specific feature may be ‘fixed’ through surgery, the person’s confidence may not change, which could lead to bullying about a different feature: ‘I think [surgery] would stop them bullying her about her nose...but they would find something else to bully her about.’ A further concern about CS in response to bullying was that surgery cannot deal with the psychological and emotional challenges that are caused by bullying. ‘...if people think that's the only way to deal with it; at such a young age they're being taught the only way you can deal with it is go and get plastic surgery, you can't work it out yourself, you can't talk to people, you just go on and get this procedure. I don't know how people can get through life thinking the only way of fixing things is to have surgery.’ ‘I think it's a really bad message to give people ‘if you're suffering from bullying, then you can just go get it fixed and you'll be fine’. It's, you know, it's not that easy to fix, it's not just a physical problem, it's gonna take its toll mentally as well.’ Related to this idea, was that surgery may simply mask and leave unresolved other underlying insecurities. In this sense, CS was viewed as a “quick fix”, with the potential of underlying problems eventually resurfacing. ‘There are other ways of dealing with [low self-esteem]. You can have counselling...which can boost your self-esteem. I don't think covering [insecurities] up by having cosmetic surgery is a good idea 'cos they're still underneath, you'll still think about them, you still won't be happy with them.’ Acceptance of CS also varied as a function of the age of people undergoing it. Participants expressed a strong concern about young girls undergoing surgery in the sense that they may not have fully developed yet. ‘I think it's a bit worrying at 18...I mean, you're still not fully developed, you're still RUNNING HEAD: Adolescents’ views on cosmetic surgery 11 growing...so I really think it's damaging in a way...I think there should really be a minimum age for surgery.’ Type of surgery also affected the extent to which it was perceived as acceptable. Surgery for features which cannot be altered through other means was seen as more acceptable than procedures on features which can change and be improved without surgery. ‘It depends on what kind of surgery it is, whether it is a nose job, which is something you can't fix, or whether it's something like liposuction 'cos they're a bit overweight - then you'd say “why don't you try dieting first?”’ Irrespective of the conditions under which CS is selected, participants felt strongly that surgery should be a last resort. They stated that there are other, less drastic ways in which people can make themselves feel better about their appearance, such as going to the hairdresser or buying clothes which are flattering for one’s body type, saying ‘I think if you can fix it without surgery, you should do that’ and ‘I don't think surgery should be the initial answer to everything. I think that should be the last resort.’ Theme 3. Feelings about undergoing cosmetic surgery. “I think everyone would consider it at some point” This theme summarises girls’ feelings and opinions about the prospect of undergoing CS. Girls expressed concern about CS in terms of potential poor awareness and consideration of risks associated with procedures. Without being against the idea of CS, girls made the point that careful consideration of the risks associated with procedures is essential, saying ‘it's a whole life-changing thing. I think maybe young people should be more aware of the risks... There's so many things that could go wrong’ and ‘You're kind of risking your life when you go for surgery, the anaesthetics and stuff, it's really dangerous, so you gotta weigh out the benefits.’ Discussion of the article about the girl having surgery for her prom raised further concerns over the desire for more surgery. Girls thought that if this girl chose surgery for a special event, she is likely to do it again. The risk of becoming addicted to surgery was also discussed in terms of RUNNING HEAD: Adolescents’ views on cosmetic surgery 12 appearance dissatisfaction, such that when one feature is improved, the desire and temptation to improve
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