Acceptance of cosmetic surgery: Personality and individual ...
Acceptance of cosmetic surgery: Personality and individual difference predictors
Viren Swami a,
*, Tomas Chamorro-Premuzic b
, Stacey Bridges a
, Adrian Furnham c
Department of Psychology, University of Westminster, 309 Regent Street, London W1B 2UW, UK
Department of Psychology, Goldsmiths, University of London, London, UK
Department of Psychology, University College London, London, UK
Cosmetic surgery refers to a subspecialty that is concerned
primarily with the maintenance, restoration, or enhancement of an
individual’s physical appearance through surgical and medical
techniques. In the Western hemisphere, the number of cosmetic
surgery procedures has risen dramatically in the past decade (e.g.,
Davis, 2003; Rohrich, 2003). In the United States, for instance, 11.7
million cosmetic procedures were performed in 2007, with the vast
majority being minimally invasive procedures (American Society for
Aesthetic Plastic Surgery, 2008). Moreover, Sarwer and Crerand
(2008) suggest that these statistics underestimate the actual number
of procedures being performed, as they do not cover appearance-
enhancing treatments performed by non-plastic surgeons.
As discussed by Sarwer and colleagues (Sarwer, Crerand, &
Gibbons, 2007; Sarwer & Magee, 2006; Sarwer, Magee, & Crerand,
2003), a number of factors may underscore this increase in the
popularity of cosmetic surgery. These include the growing
importance of physical appearance in contemporary Western
culture (Swami, 2007; Swami & Furnham, 2008), which has served
to normalise the pursuit of appearance-enhancing behaviours
(Sarwer et al., 2003). Higher disposable incomes among patients,
advances in surgical procedures (particularly in terms of safety),
and the lower cost of treatments have also served to reduce patient
anxiety about cosmetic procedures (Edmonds, 2007). Finally, the
past decade has witnessed a dramatic increase in media coverage
of cosmetic surgery (see Crockett, Pruzinsky, & Persing, 2007;
Sarwer et al., 2003), which has mainstreamed public awareness of
such procedures (Tait, 2007).
In line with these developments, there has emerged a relatively
large body of work examining psychological aspects of cosmetic
surgery. In terms of factors affecting the likelihood of having
cosmetic surgery, for instance, the available evidence suggests that
women report a greater likelihood of willingness to undergo
various cosmetic procedures compared with men (Brown, Furn-
ham, Glanville, & Swami, 2007; Swami, Arteche, Chamorro-
Premuzic, Furnham, Stieger, Haubner, et al., 2008), which has
been explained as a function of the greater sociocultural pressure
on women to attain ideals of physical and sexual attractiveness
(Swami, 2007; Swami & Furnham, 2008). This research has also
shown that lower self-ratings of physical attractiveness predict
higher likelihood of having cosmetic surgery (Brown et al., 2007),
and that media exposure may mediate the relationship between
participant sex and likelihood of having cosmetic surgery (Swami,
Arteche, et al., 2008).
In terms of attitudinal dispositions towards cosmetic surgery,
Sarwer et al. (2005) reported that their sample of college women
generally held favourable attitudes toward cosmetic surgery as a
means of appearance-enhancement. Henderson-King and Hen-
derson-King (2005), however, have argued that participants may
Body Image 6 (2009) 7–13
A R T I C L E I N F O
Received 7 July 2008
Received in revised form 22 September 2008
Accepted 26 September 2008
A B S T R A C T
This study examined the association between several attitudinal constructs related to acceptance of
cosmetic surgery, and participant demographics, personality, and individual difference variables. A
sample of 332 university students completed a battery of scales comprising the Acceptance of Cosmetic
Surgery Scale (ACSS) and measures of the Big Five personality factors, self-esteem, conformity, self-
assessed attractiveness, and demographics. Multiple regressions showed that the predictor variables
explained a large proportion of the variance in ACSS factors (Adj. R2
ranging between .31 and .60). In
addition, structural equation modelling revealed that distal factors (sex and age) were generally
associated with acceptance of cosmetic surgery through the mediate inﬂuence of more proximate
variables (in the ﬁrst instance, the Big Five personality factors, followed by self-esteem and conformity,
and ﬁnally self-assessed attractiveness). These results allow for the presentation of a preliminary model
integrating personality and individual differences in predicting acceptance of cosmetic surgery.
ß 2008 Elsevier Ltd. All rights reserved.
* Corresponding author. Tel.: +44 207 911 5000.
E-mail address: firstname.lastname@example.org (V. Swami).
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hold beliefs and attitudes that are accepting of cosmetic surgery
and yet show little or no interest in actually having cosmetic
procedures. In order to assess attitudes beyond likelihood of
having cosmetic surgery, therefore, these authors developed the
Acceptance of Cosmetic Surgery Scale (ACSS), a 15-item measure
that was found to factor into three components: (1) Intrapersonal,
which measures attitudes related to the self-oriented beneﬁts of
having cosmetic surgery (e.g., increased satisfaction with appear-
ance); (2) Social, which represents social motivations that
inﬂuence the decision to have cosmetic surgery (e.g., appearing
more attractive to one’s partner), and; (3) Consider, which
measures the likelihood of having cosmetic surgery, taking into
account factors that may inﬂuence the decision-making process
In a series of four studies within university settings, Henderson-
King and Henderson-King (2005) showed that the ACSS has high
internal reliability and test–retest reliability, as well as good
divergent and convergent validity. In addition, they reported that
women and older participants expressed more positive attitudes
on the Intrapersonal subscale and that older participants had more
favourable attitudes on the Social subscale. For women, age was
found to be a positive predictor of considering cosmetic surgery,
but no such relationship was found for men. Other recent work
using the ACSS has shown that greater acceptance of cosmetic
surgery among college women is associated their body image
experiences, with those who are dissatisﬁed with their appearance
or having greater body image disturbance viewing cosmetic
surgery more positively (Cash, Goldenberg-Bivens, & Grasso,
2005). Furthermore, Sperry, Thompson, Sarwer, and Cash (in
press) reported that viewership of reality cosmetic surgery
television shows was signiﬁcantly related to acceptance of
cosmetic surgery, where the latter was measured using total
scores from the ACSS. While these studies have begun the task of
delineating attitudes towards cosmetic surgery, it is also possible
to extend this research by examining individual difference
predictors of such attitudes.
The present study
Our ﬁrst aim in the present study was to examine the
relationship between the ACSS subscales and an individual’s
personality, where the latter was operationalised using the Big Five
personality framework (McCrae & Costa, 1997). The Big Five is a
hierarchical model of personality with ﬁve bipolar traits or factors
(Agreeableness, Conscientiousness, Emotional Stability, Openness,
and Extraversion), which represent personality at a broad level of
abstraction (McCrae & Costa, 1997). The Big Five framework has
been shown to have strong predictive validity in relation to various
real-world outcomes (Chamorro-Premuzic, 2007), including atti-
tudes towards body size (Swami, Buchanan, Furnham, & Tove´e,
2008), but it has not been speciﬁcally examined in relation to
attitudes towards cosmetic surgery.
Even so, there were reasons why we expected the Big Five
personality framework to be associated with acceptance of
cosmetic surgery. For one thing, previous work has shown that
the factors of Emotional Stability are associated with negative
appearance evaluation (e.g., Kvalem, von Soest, Roald, and
Skolleborg, 2006), appearance orientation (e.g., Davis, Dionne, &
Shuster, 2001), dissatisfaction with facial appearance (e.g., Thomas
& Goldberg, 1995), and self-objectiﬁcation (e.g., Miner-Rubino,
Twenge, & Frederickson, 2002). Self-objectiﬁcation in the latter
study was also associated with Agreeableness and Openness,
whereas Kvalem et al. (2006) reported a signiﬁcant association
between appearance orientation and Extraversion. More generally,
the Big Five factors are signiﬁcantly associated with differences in
affective experience (e.g., Mischel & Shoda, 1999), and are,
therefore, likely to inﬂuence dimensions of body image generally
and acceptance of cosmetic surgery speciﬁcally.
In addition to the Big Five, we also examined the relationship
between the ACSS and participants’ self-rated physical attractive-
ness, which previous work has shown to be negatively associated
with the likelihood of having cosmetic surgery (Brown et al., 2007;
Swami, Arteche, et al., 2008). Concurrently, we measured
participants’ global self-esteem, which is thought to be negatively
associated with the likelihood of having cosmetic surgery (that is,
individuals with low self-esteem may be more open to cosmetic
surgery as a means of improving global self-perceptions; cf.
Figueroa, 2003; Sarwer, 2007; Sarwer, Nordmann, & Herbert, 2000)
and may also be linked with low self-ratings of physical
attractiveness (cf. Koff, 1998). In the present study, we also
examined the association between the ACSS and conformity, which
Mehrabian (2005, p. 2) deﬁned as ‘‘a characteristic willingness to
identify with other and emulate them, to give in to others so as to
avoid negative interactions, and generally, to be a follower rather
than a leader’’ and which may be expected to be associated with
the Social subscale of the ACSS.
In short then, the present study examined the association
between the subscales of the ACSS and participants’ sex, age, Big
Five personality factors, self-rated physical attractiveness, self-
esteem, and conformity. The data was analysed using correlation
and structural equation modelling. Whilst the former method is
useful for identifying relationships between two variables, the
latter allows for simultaneous testing of several relationships
among different variables (including multiple criteria or ‘depen-
dent variables’) and is, therefore, ideal for testing or generating
models (Byrne, 2001).
The participants of this study were 332 (60.5% women, n = 201;
39.5% men, n = 131) university students from a metropolitan
university in Greater London (age M = 24.72, SD = 7.51). The
majority of participants were of European Caucasian descent
(72.6%, n = 241), with smaller groups of Asian (10.5%, n = 35),
African Caribbean (10.5%, n = 35), and other descent (6.3, n = 21). In
terms of religion, 59.6% of participants were Christians (n = 198),
12.0% were Muslims (n = 40), 7.5% were atheists (n = 25), and 20.8%
were of some other religious afﬁliation (n = 69). Most participants
were in a dating relationship (57.5%, n = 191), while others were
single (23.5%, n = 78), married (16.9%, n = 56), or of some other
marital status (2.1%, n = 7). Finally, most participants reported
never having had cosmetic surgery (84.0%, n = 279).
Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King &
This is a 15-item scale measuring various aspects of an
individual’s attitudes about cosmetic surgery and rated on a 7-
point scale (1 = strongly disagree, 7 = strongly agree). Three dimen-
sions of such attitudes are measured: (1) Intrapersonal (ﬁve items
representing attitudes related to the self-oriented beneﬁts of
cosmetic surgery; sample item: ‘In the future, I could end up
having some kind of cosmetic surgery’); (2) Social (ﬁve items
measuring social motivations for having cosmetic surgery; sample
item: ‘If it would beneﬁt my career, I would think about having
plastic surgery’), and; (3) Consider (ﬁve items assessing the
likelihood that a participant would consider having cosmetic
V. Swami et al. / Body Image 6 (2009) 7–138
surgery; sample item: ‘If I could have a surgical procedure done for
free I would consider trying cosmetic surgery’). Previous work has
shown that the ACSS has high internal consistency, good test–
retest reliability after three weeks, and good convergent and
discriminant validity (Henderson-King & Henderson-King, 2005).
In the present study, Cronbach’s as for the three subscales were:
Intrapersonal .92, Social .90, Consider .90.
Ten Item Personality Inventory (TIPI; Gosling, Rentfrow, & Swann,
This is a brief scale for assessing the Big Five personality facets,
which shows adequate convergent and discriminant validity, test–
retest reliability, and patterns of external correlates. Participants
rated the extent to which a pair of traits (e.g., ‘Extraverted,
enthusiastic’) applies to them on a 7-point scale (1 = Disagree
strongly, 7 = Agree strongly). Five items are reverse-coded, and two
items are averaged to arrive at scores for each of the Big Five
personality traits. Cronbach’s a coefﬁcients were as follows:
Extraversion .63, Agreeableness .66, Conscientiousness .63, Emo-
tional Stability .60, and Openness to Experience .61. These as are
acceptable given that they were measured using only two items
(see Youngman, 1979).
Self-assessed attractiveness (SAA; Swami, Furnham, Georgiades, &
Participants were provided with a graphical representation of a
normal distribution curve (M = 100, SD = 15) and asked to provides
self-estimates of their overall physical attractiveness, overall facial
attractiveness, and overall attractiveness of their body weight and
body shape. Although the original version of this scale includes a
range of items referring to various body parts, the four items used
in the present study refer to global self-perceptions and rotated
into a single factor (all loadings >.88, eigenvalue = 3.49, 87.26% of
the variance explained). Cronbach’s a for the four items was .95.
Conformity Scale (CS; Mehrabian, 2005)
This 11-item scale measures conformity on a 9-point scale
(À4 = Very strong disagreement, +4 = Very strong agreement; sample
item: ‘I often rely on, and act upon, the advice of others’). A total
score is computed by summing participants’ responses to seven
positively worded items and by subtracting this value from the
sum of their responses to four negatively worded items (a = .79).
Previous work has shown that the CS has good test–retest
reliability and construct validity (e.g., Mehrabian & Steﬂ, 1995).
Rosenberg Self-Esteem Scale (RSE; Rosenberg, 1965)
The RSE is a brief and widely used measure of self-worth,
consisting of 10 items rated on a 4-point scale (1 = Strongly
disagree, 4 = Strongly agree; sample item: ‘I certainly feel useless at
times’). Five items were reverse-coded prior to analysis, and an
overall score was computed by summing responses to all items.
The scale showed good internal consistency in the present study
(a = .77).
All participants provided their demographics consisting of sex,
age, ethnicity, religion, and marital status. Participants also
indicated on binary (1 = Yes, 2 = No) whether or not they had
had cosmetic surgery in the past.
Once ethical approval was obtained, a male and female
experimenter recruited about half the sample each using opportu-
nistic sampling techniques. In practice, this meant approaching
potential participants in various campus settings (e.g., cafeterias,
libraries, seminar rooms) to ensure that sampling would be
comparable across experimenters. The nature of the experiment
was explained to participants, and once they provided informed
consent, they were given a six-page questionnaire to complete along
withbrief instructions.All participants took partona voluntary basis
and were not remunerated for their participation. They were
verbally debriefed once they had completed and returned the
questionnaire to the experimenter.
Descriptive statistics (M and SD) for all variables are reported in
Table 1, which also shows the correlations of the three ACSS factors
with other variables. As can be seen, the three factors of the ACSS
were highly inter-correlated. Signiﬁcant correlates (from strongest
to weakest) of the ACSS Intrapersonal factors were Openness,
conformity, self-assessed attractiveness, and age. The same
variables were also correlated with the ACSS Consider factors,
with the addition of sex. For the ACSS Social factor, signiﬁcant
correlates were conformity, Conscientiousness, Openness, Emo-
tional Stability, self-esteem, and age.
Descriptive statistics and bivariate correlation coefﬁcients (Pearson’s r).
M Æ SD ACSS Intrapersonal ACSS Consider ACSS Social
ACSS Intrapersonal M Æ SD = 4.41 Æ 1.37 – .84**
ACSS Consider M Æ SD = 3.89 Æ 1.61 – .53**
ACSS Social M Æ SD = 2.90 Æ 1.35 –
Age M Æ SD = 24.74 Æ 7.51 .19**
Sex À.00 .16**
Extraversion M Æ SD = 10.18 Æ 2.50 .07 À.08 À.00
Agreeableness M Æ SD = 11.11 Æ 1.82 À.00 À.09 À.01
Conscientiousness M Æ SD = 10.49 Æ 1.88 À.05 À.01 À.37**
Emotional Stability M Æ SD = 9.05 Æ 2.73 .03 À.06 .20**
Openness M Æ SD = 10.38 Æ 2.42 À.42**
Self-esteem M Æ SD = 30.08 Æ 3.70 À.03 À.09 À.18**
Conformity M Æ SD = À4.85 Æ 13.95 .21**
Self-assessed attractiveness M Æ SD = 101.02 Æ 13.42 À.16**
N = 332, sex coded: 1 = men, 2 = women.
p < .05.
p < .001.
V. Swami et al. / Body Image 6 (2009) 7–13 9
A series of stepwise multiple regressions were carried out to
examine the amount of variance in each of the ACSS factors
explained by the other variables. We chose stepwise regressions in
order to select the fewest number of variables offered to the model
that best describe the occurrence of the outcome. Three regres-
sions were conducted (one for each ACSS factor) and in each
regression, age, sex, the Big Five factors, self-esteem, conformity,
and self-assessed attractiveness were entered as predictors in the
same block. The regression predicting Intrapersonal accounted for
31.1% of the variance, with Openness (b = À.62, t = 10.85, p < .001,
= .18), Emotional Stability (b = .42, t = 6.59, p < .001, DR2
sex (b = .21, t = 3.76, p < .001, DR2
= .02), Extraversion (b = .19,
t = 3.63, p < .001, DR2
= .02), and self-assessed attractiveness
(b = (.12, t = 2.07, p < .05, DR2
= .01) being retained as signiﬁcant
The regression predicting Social accounted for 60.6% of the
variance and Emotional Stability (b = .73, t = 16.75, p < .001,
= .23), conformity (b = .46, t = 9.86, p < .001, DR2
= .23), Open-
ness (b = À.42, t = 8.75, p < .001, DR2
= .06), age (b = À.28, t = 7.13,
p < .001, DR2
= .05), and Conscientiousness (b = À.18, t = 4.61,
p < .001, DR2
= .02) were signiﬁcant predictors. Finally, the
regression predicting Consider explained 40.8% of the variance,
with Openness (b = À.63, t = 11.01, p < .001, DR2
= .19), Emotional
Stability (b = .52, t = 8.34, p < .001, DR2
= .02), sex (b = .47, t = 8.71,
p < .001, DR2
= .09), self-assessed attractiveness (b = À.26, t = 5.41,
p < .001, DR2
= .05), Agreeableness (b = À.32, t = 5.74, p < .001,
= .02), Conscientiousness (b = .25, t = 4.67, p < .001,
= .02), and age (b = À.13, t = 2.48, p < .001, DR2
= .01) all
emerging as signiﬁcant predictors.
It is noteworthy that Emotional Stability emerged as a strong
predictor of the three ACSS factors despite being uncorrelated with
two of these factors and only modestly correlated with the other
ACSS Social, which suggests suppressor effects in the regressions.
In order to explore a tentative model for integrating the various
predictors of ACSS, we next conducted structural equation
modelling (SEM) with the data.
Structural equation modelling
SEM was performed using AMOS 4.0 (Arbuckle & Wothke, 1999;
Byrne, 2001). Fitness of the model was assessed using the following
(Bollen, 1989; tests the hypothesis that an uncon-
strained model ﬁts the covariance or correlation matrix as well as
the given model; ideally values should not be signiﬁcant);
Goodness-of-Fit Indicator (GFI; Tanaka & Huba, 1985; a measure
of ﬁtness where values close to 1 are acceptable); Parsimony
Goodness-of-Fit Indicator (PGFI; Mulaik et al., 1989; a measure of
power that is optimal around .50); Comparative Fit Index (CFI;
Bentler, 1990; comparison of the hypothesised model with a model
in which all correlations among variables are zero, and where
values around .90 indicate very good ﬁt); Root-Mean-Square Error
of Approximation (RMSEA; Browne & Cudeck, 1993; values of .08
or below indicate reasonable ﬁt for the model; Akaike’s Informa-
tion Criterion (AIC; Akaike, 1973; gives the extension to which the
parameter estimates from the original sample will cross-validate
in future samples; Hoelter’s Critical N (CN; Hoelter, 1983; provides
the maximum sample size for which a model with same sample
size and df would be acceptable at .01 level).
The modiﬁed model consisted of a hierarchical path analysis
where the three factors of ACSS were treated as inter-correlated,
endogenous variables (to the very right of the model). Direct paths
to the three endogenous variables were then drawn from self-
assessed attractiveness, which, in turn, was hypothesised to be
affected by conformity and self-esteem. The two latter variables, in
turn, were hypothesised to be affected by all Big Five personality
traits, which, in turn, were hypothesised to be affected by sex and
age. Thus, the model progressively moved from more distal
exogenous variables (to the left) to less distal variables (to the
Although the model is predictive rather than causal, from a
theoretical standpoint, sex and age are justiﬁed as exogenous
variables as they are not inﬂuenced by any of the other variables.
On the other hand, the Big Five personality factors are more general
and ‘trait-like’ than self-esteem and conformity (which are
arguably more inﬂuenced by situational factors, though they still
have a trait-like basis). With regards to self-assessed attractive-
ness, we decided to treat this variable as less distal than self-
esteem (a more over-arching self-construct) and conformity,
primarily to assess whether self-assessed attractiveness may
explain some of the effects of self-esteem and conformity on the
ACSS factors. Finally, the ACSS factors were considered endogenous
not only in light of the aims of the current study, but also as these
attitudinal variables can be expected to be much more situational
and less trait-like than the variables we treated as predictors.
The hypothesised model did not ﬁt the data well: x2
(df = 49,
N = 332) = 1330, p < .01, GFI = .70, CFI = .50, PGFI = .38,
RMSEA = .28 (low = .26, high = .29), AIC = 1414.3, CN = 14. Thus
modiﬁcations were made in order to improve ﬁt. In line with the
modiﬁcation indices, the Big Five were allowed to inter-correlate,
and non-signiﬁcant estimates were eliminated from the model. In
addition, conformity and self-esteem were allowed to inter-
correlate, and direct paths from more distal to endogenous
variables (e.g., from sex to the ACSS factors, from the Big Five
factors to the ACSS factors, and from self-esteem to the ACSS
factors) were drawn in accordance to the modiﬁcation indices. The
modiﬁed model (shown in Fig. 1) ﬁtted the data well: x2
(df = 17,
N = 332) = 46.7, p < .01, GFI = .98, CFI = .99, PGFI = .34, RMSEA = .06
(low = .04, high = .09), AIC = 194.7, CN = 14. Although the x2
was signiﬁcant, this is to be expected even in well-ﬁtting models
Direct paths into the endogenous variables (ACSS factors) were
found for several variables. Thus, women, more conscientious, less
agreeable, less open, and more emotionally stable individuals, as
well as those who rated themselves lower in attractiveness, were
more likely to consider cosmetic surgery. Of these factors,
Openness, in particular was a strong predictor of the ACSS
Consider factor. ACSS Social, on the other hand, was predicted
by conformity (the main single predictor), followed by Emotional
Stability and Conscientiousness (a negative predictor). Therefore,
the less neurotic, conscientious, and more conformist an indivi-
dual, the more likely she or he is to emphasise social motivations
for having cosmetic surgery. Finally, the Intrapersonal factor of the
ACSS was predicted by Openness (negatively) and, to a lesser
extent, Emotional Stability, indicating that the less open and more
emotionally stable an individual, the more likely she or he holds
strong attitudes related to the self-oriented beneﬁts of cosmetic
The results of the present study extend previous work with the
ACSS by showing that acceptance of cosmetic surgery is reliably
(albeit moderately) associated with participants’ sex, age, Big Five
personality factors, self-esteem, conformity, and self-assessed
attractiveness. Overall, these variables explained a substantial
portion of the variance in the ACSS factors (particularly for Social),
and signiﬁcantly predicted each ACSS factor (though not always in
the same manner). Although it is important to note that this is a
V. Swami et al. / Body Image 6 (2009) 7–1310
preliminary attempt at integrating predictors according to their
more-or-less distal position with respect to the ACSS factors, a
number of conclusions are worthy of further comment.
First, our results showed that women were more likely than
men to consider having cosmetic surgery, which is consistent with
previous work in which participants were asked to rate their
likelihood of having various cosmetic procedures (Brown et al.,
2007; Frederick, Lever, & Peplau, 2007; Swami, Arteche, et al.,
2008). As discussed elsewhere, this sex difference may reﬂect the
greater sociocultural pressure that women experience to live up to
idealised images of physical perfection (Swami, 2007; Swami &
Furnham, 2008). Our results also suggest that individuals who
rated themselves lower in physical attractiveness were more likely
to consider cosmetic surgery, which is consistent with previous
work (Brown et al., 2007; Swami, Arteche, et al., 2008).
However, our results also suggest that more conscientiousness,
less agreeable, less open, and more emotionally stable individuals
were more likely to consider cosmetic surgery, thus centrally
implicating the Big Five personality framework in such decisions.
Openness to Experience, in particular, was a strong negative
predictor of considering having cosmetic surgery. Previous work
has reported a positive association between Openness and positive
self-evaluations of appearance (Kvalem et al., 2006). Extrapolating
from this evidence, it might be suggested that Closed individuals
have a more negative appearance evaluation (possibly as a
function of their lower likelihood of accepting unconventional
societal norms of attractiveness; cf. Swami, Buchanan, Furnham, &
Tove´e, 2008), which increases their likelihood of wanting to have
cosmetic surgery to enhance their appearance. It is also important
to note that, in the present study, low self-esteem was not
correlated with higher likelihood of having cosmetic surgery.
Rather, self-esteem was associated with self-assessed attractive-
ness, which in turn was negatively associated with greater
likelihood of considering cosmetic surgery.
Our results also showed that the Social factor of the ACSS, which
measures social motivations for wanting to have cosmetic surgery,
was strongly predicted by conformity. This is perhaps not surprising,
given that the Conformity Scale measures the extent to which an
individual is willing to emulate and give in to others so as to avoid
any negative interactions. Thus, this association may be tapping into
conforming individuals’ greater likelihood of accepting cosmetic
surgery in order to satisfy their partners or other close relationships.
Moreover, our results also suggest that the Big Five personality
factors of Conscientiousness and Emotional Stability help explain
more positive social attitudes towards cosmetic surgery. It may be
the case more neurotic individuals are anxious about the
consequences of cosmetic surgery and focus on potential negative
effects (e.g., pain). Likewise, high conscientious individuals may be
more wary of cosmetic surgery, perhaps stemming from their higher
degree of carefulness, thoroughness, and deliberation.
Finally, our results suggest that less open and more emotionally
stable individuals had a greater likelihood of accepting cosmetic
surgery in order to maximise its self-oriented beneﬁts. As
suggested above, Closed individuals may maintain more negative
evaluations of their appearance, which in turns leads to a greater
acceptance of cosmetic surgery if it is able to enhance their
appearance. Emotional stability, on the other hand, may be linked
with the Intrapersonal factor because neurotic individuals are
more likely to experience negative affect associated with negative
self-evaluations of appearance (see also Kvalem et al., 2006).
All in all, our results suggest a complex model linking
participant demographics, personality, and a number of individual
difference variables with acceptance of cosmetic surgery as
measured on the ACSS. As can be seen in Fig. 1, the Intrapersonal
factor of the ACSS was strongly affected by Openness and modestly
affected by Emotional Stability. The Social factor was strongly
affected by Emotional Stability and Conformity, and to a lesser
degree, Conscientiousness. Most notably, consideration of cos-
metic surgery was affected by 6 of the 10 predictors (including four
of the Big Five factors), namely Openness, sex, self-assessed
attractiveness, Agreeableness, Emotional Stability, and Conscien-
tiousness. In sum, these results indicate that most of the variance
in ACSS factors was explained by the Big Five, with all traits except
Extraversion affecting one ACSS factor or more.
Fig. 1. A possible model for understanding the determinants of acceptance of cosmetic surgery. Note: All coefﬁcients are Standard Beta values signiﬁcant at p < .001. SAA: Self-
assessed attractiveness, RSE: self-esteem, CONF: Conformity; Intra: ACSS Intrapersonal, Social: ACSS Social, Consider: ACSS Consider, ES: Emotional Stability (low
neuroticism), E: Extraversion, O: Openness to Experience, A: Agreeableness, C: Conscientiousness; sex coded 1 = men, 2 = women. Regression paths <.20, error variances, and
covariances not shown here for simplicity.
V. Swami et al. / Body Image 6 (2009) 7–13 11
Limitations and conclusion
It is important to bear in mind a number of limitations to the
present study. First, although our results generally mirror ﬁndings
from community samples (e.g., Brown et al., 2007; Swami, Arteche,
et al., 2008), it is nevertheless the case that our reliance on
university students limits the generalisability of our ﬁndings.
Second, it will be important to replicate the present work more
reliable measures of the Big Five personality framework, such as
Costa and McCrae’s (1992) revised NEO personality inventory
(NEO-PI-R), as this may reveal more conclusively which aspects of
personality are associated with acceptance of cosmetic surgery.
Similarly, it would be useful to further explicate the relationship
between self-esteem and acceptance of cosmetic surgery, given
possible associations between self-esteem and narcissism, and
between narcissism and interest in cosmetic surgery.
Third, we have not fully examined the relationships between
acceptance of cosmetic surgery and constructs of body image.
Previous work, for example, has shown that attitudes about
cosmetic surgery, as measured using the Cosmetic Surgery
Attitudes Questionnaire, were predicted by greater psychological
investment in physical appearance and greater internalisation of
mass media images of physical beauty (Sarwer et al., 2005). In a
similar vein, while we have focused on a number of relevant
variables to acceptance of cosmetic surgery, our study in no way
exhausts the list of potential variables that could be included in a
study of this type. For instance, future work may wish to include
such factors as media exposure, vicarious experience of cosmetic
surgery, and perfectionism, which previous studies have found to
be associated with the likelihood of having cosmetic procedures
(Brown et al., 2007; Delinsky, 2005; Sherry, Hewitt, Flett, & Lee-
Baggley, 2007; Swami, Arteche, et al., 2008).
These limitations notwithstanding, our results suggest that
any model attempting to predict acceptance of cosmetic surgery
must include individual difference variables, particularly person-
ality. Speciﬁcally, when considering motivations for surgery,
cosmetic surgeons should consider the conﬂuence of patients’
personalities in addition to factors such as sociocultural pressure,
post-operative expectations, and negative body image. Given the
phenomenal increase in the number of cosmetic surgery
procedures, a fuller understanding of the inﬂuence of personality
may allow surgeons to more accurately assess the suitability of
patients for surgery. Further research in this area may lead to a
better understanding of the psychological aspects of cosmetic
surgery, as well as strengthen the basis for the promotion of
healthier body image.
Akaike, H. (1973). Information theory and an extension of the maximum likelihood
principle. In B. N. Petrov & F. Csaki (Eds.), In Proceedings of the 2nd international
symposium on information theory (pp. 267–281). Budapest: Akademiai Kiado.
American Society for Aesthetic Plastic Surgery. (2008). Quick facts: Highlights of the
ASAPS 2007 statistics on cosmetic surgery. Online publication at www.surgery.org.
Retrieved September 17, 2008.
Arbuckle, J., & Wothke, W. (1999). AMOS 4 user’s reference guide. Chicago, IL: Small-
Bentler, P. M. (1990). Comparative ﬁt indexes in structural models. Psychological
Bulletin, 107, 238–246.
Bollen, K. A. (1989). Structural equations with latent variables. New York, NY: Wiley.
Brown, A., Furnham, A., Glanville, L., & Swami, V. (2007). Factors that affect the
likelihood of undergoing cosmetic surgery. Aesthetic Surgery Journal, 27, 501–
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model ﬁt. In K. A.
Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Newbury
Park, CA: Sage.
Byrne, B. (2001). Structural equation modeling using AMOS: Basic concepts, applications,
and programming. Mahwah, NJ: Lawrence Erlbaum Associates.
Cash, T. F., Goldenberg-Bivens, R. B., & Grasso, K. (2005, November 19). Multidimen-
sional body-image predictors of college women’s attitudes and intentions vis-a`-vis
cosmetic surgery. Poster presented at the Conference of the Association for Beha-
vioral and Cognitive Therapies, Washington, DC.
Chamorro-Premuzic, T. (2007). Personality and individual differences. Oxford: Blackwell.
Costa, P. T., Jr., & McCrae, R. R. (1992). Revised NEO Personality Inventory (NEO-PI-R) and
NEO Five-Factor Inventory (NEOFFI): Professional manual. Odessa, FL: Psychological
Crockett, R. J., Pruzinsky, T., & Persing, J. A. (2007). The inﬂuence of plastic surgery
‘reality TV’ on cosmetic surgery patient expectations and decision making. Plastic
and Reconstructive Surgery, 120, 316–324.
Davis, K. (2003). Dubious equalities and embodied differences: Cultural studies on cosmetic
surgery. Lanhan, MD: Rowman and Littleﬁeld.
Davis, C., Dionne, M., & Shuster, B. (2001). Physical and psychological correlates of
appearance orientation. Personality and Individual Differences, 30, 21–30.
Delinsky, S. S. (2005). Cosmetic surgery: A common and accepted form of self-
improvement? Journal of Applied Social Psychology, 35, 2012–2028.
Edmonds, A. (2007). ‘The poor have the right to be beautiful’: Cosmetic surgery in
neoliberal Brazil. Journal of the Royal Anthropological Institute, 13, 363–381.
Figueroa, C. (2003). Self-esteem and cosmetic surgery: Is there a relationship between
the two? Plastic Surgical Nursing, 23, 21–25.
Frederick, D. A., Lever, J., & Peplau, L. A. (2007). Interest in cosmetic surgery and body
image: Views of men and women across the lifespan. Plastic and Reconstructive
Surgery, 120, 1407–1415.
Gosling, S. D., Rentfrow, P. J., & Swann, W. B., Jr. (2003). A very brief measure of the Big-
Five personality domains. Journal of Research in Personality, 37, 504–528.
Henderson-King, D., & Henderson-King, E. (2005). Acceptance of cosmetic surgery:
Scale development and validation. Body Image, 2, 137–149.
Koff, E. (1998). Breast size perception and satisfaction, body image, and psychological
functioning in Caucasian and Asian American college women. Sex Roles, 38, 655–
Kvalem, I. L., von Soest, T., Roald, H. E., & Skolleborg, K. C. (2006). The interplay of
personality and negative comments about appearance in predicting body image.
Body Image, 3, 263–273.
McCrae, R. R., & Costa, P. T., Jr. (1997). Personality trait structure as a human universal.
American Psychologist, 52, 509–516.
Mehrabian, A. (2005). Manual for the Conformity Scale. Monterey, CA: University of
California, Los Angeles.
Mehrabian, A., & Steﬂ, C. A. (1995). Basic temperament components of loneliness,
shyness, and conformity. Social Behavior and Personality, 23, 253–264.
Miner-Rubino, K., Twenge, J. M., & Fredrickson, B. L. (2002). Trait self-objectiﬁcation in
women: Affective and personality correlates. Journal of Research in Personality, 36,
Mischel, W., & Shoda, Y. (1999). Integrating dispositions and processing dynamics
within a uniﬁed theory of personality: The cognitive-affective personality system.
In L. A. Pervin & O. P. John (Eds.), Handbook of personality: Theory and research (2nd
ed., pp. 197–218). New York, NY: The Guilford Press.
Mulaik, S. A., James, L. R., van Alstine, J., Bennett, N., Lind, S., & Stilwell, C. D. (1989).
Evaluation of goodness-of-ﬁt indices for structural equation models. Psychological
Bulletin, 105, 430–445.
Rohrich, R. J. (2003). The American Society of Plastic Surgeons’ procedural statistics:
What they really mean. Plastic and Reconstructive Surgery, 112, 1389–1392.
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton
Sarwer, D. B. (2007). The psychological aspects of cosmetic breast augmentation. Plastic
and Reconstructive Surgery, 120, 110S–117S.
Sarwer, D. B., Cash, T. F., Magee, L., Williams, E. F., Thompson, J. K., Roehrig, M., et al.
(2005). Female college students and cosmetic surgery: An investigation of
experiences, attitudes, and body image. Plastic and Reconstructive Surgery,
Sarwer, D. B., & Crerand, C. E. (2008). Body dysmorphic disorder and appearance
enhancing medical treatments. Body Image, 5, 50–58.
Sarwer, D. B., Crerand, C. E., & Gibbons, L. M. (2007). Cosmetic surgery to enhance body
shape and muscularity. In J. K. Thompson & G. Cafri (Eds.), The muscular ideal:
Psychological social, and medical perspectives (pp. 183–198). Washington, DC:
American Psychological Association.
Sarwer, D. B., & Magee, L. (2006). Physical appearance and society. In D. B. Sarwer, T.
Pruzinsky, T. F. Cash, R. M. Goldwyn, J. A. Persing, & L. A. Whitaker (Eds.),
Psychology of reconstructive and cosmetic plastic surgery: Clinical, empirical,
and ethical perspectives (pp. 23–36). Philadelphia, PN: Lippincott, Williams, &
Sarwer, D. B., Magee, L., & Crerand, C. E. (2003). Cosmetic surgery and cosmetic medical
treatments. In J. K. Thompson (Ed.), Handbook of eating disorders and obesity (pp.
718–737). Hoboken, NJ: Wiley.
Sarwer, D. B., Nordmann, J. E., & Herbert, J. D. (2000). Cosmetic breast augmentation
surgery: A critical overview. Journal of Women’s Health & Gender-Based Medicine, 9,
Sherry, S. B., Hewitt, P. L., Flett, G. L., & Lee-Baggley, D. L. (2007). Perfectionism and
undergoing cosmetic surgery. European Journal of Plastic Surgery, 29, 349–354.
Sperry, S., Thompson, J. K., Sarwer, D. B., & Cash, T. F. (in press). Cosmetic surgery reality
TV viewership: Relations with cosmetic surgery attitudes, body image, and dis-
ordered eating, Annals of Plastic Surgery.
Swami, V. (2007). The missing arms of Ve´nus de Milo: Reﬂections on the science of physical
attractiveness. Brighton: Book Guild.
Swami, V., Arteche, A., Chamorro-Premuzic, T., Furnham, A., Stieger, S., Haubner, T.,
et al. (2008). Looking good: Factors affecting the likelihood of having cosmetic
surgery. European Journal of Plastic Surgery, 30, 211–218.
V. Swami et al. / Body Image 6 (2009) 7–1312
Swami, V., Buchanan, T., Furnham, A., & Tove´e, M. J. (2008). Five factor personality
correlates of perceptions of women’s body sizes. Personality and Individual Differ-
ences, 45, 697–699.
Swami, V., & Furnham, A. (2008). The psychology of physical attraction. London: Routledge.
Swami, V., Furnham, A., Georgiades, C., & Pang, L. (2007). Evaluating self and partner
physical attractiveness. Body Image, 4, 97–101.
Tait, S. (2007). Television and the domestication of cosmetic surgery. Feminist Media
Studies, 7, 119–135.
Tanaka, J. S., & Huba, G. J. (1985). A ﬁt index for covariance structure models under
arbitrary GLS estimation. British Journal of Mathematical and Statistical Psychology,
Thomas, C. S., & Goldberg, D. P. (1995). Appearance, body-image and distress in facial
dysmorphophobia. Acta Psychiatrica Scandinavica, 92, 231–236.
Youngman, M. B. (1979). Analyzing social and educational research data. New York, NY:
V. Swami et al. / Body Image 6 (2009) 7–13 13