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University College London, London, United Kingdom Correspondence: Dr Adrian Furnham, University College of London, Main Campus, Gower Street, London WC1E 6BT, United Kingdom. Telephone 44-20-7679-2000, e-mail [email protected] The role of attractiveness in Western society has been extensively explored by evolutionary and social psychologists (1-3). A metaanalysis 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. Cosmetic surgery is concerned with the “maintenance, restoration or enhancement of one’s physical appearance through surgical and medical techniques” (7). The American Society for Aesthetic Plastic Surgery reported an increase of 446% in cosmetic procedures since 1997 and an overall increase of 8% in 2007, with a 17% increase in men undertaking cosmetic surgery (8). This increase is similar in the United Kingdom. The British Association of Plastic Surgeons recorded a 35% increase in procedures performed by its members from 2004 to 2005 (9). With the increased prevalence, accessibility and evolution of cosmetic surgery in Western society, it is becoming increasingly relevant to explore the various internal and external factors that motivate people to undergo cosmetic surgery. Sarwer et al (10) attribute this recent increase to the availability of plastic surgeons, the influence of the media, evolutionary interests and personal factors relating to the patient. The technological advances in cosmetic surgery have made it safer and less invasive, with a faster recovery time, as well as lowering the cost of procedures. Thus, people have become less anxious, and more willing to consider and accept cosmetic surgery as a possible option for altering their physical appearance (11). The decision to seek out plastic surgery has recently attracted a significant amount of attention (12-14). Studies have focused on evolutionary, psychosocial and health behavioural covariates of those who have undergone cosmetic surgery (15), as well as more attitudinal and belief system factors such as life satisfaction, self-esteem and body image (16). A comprehensive review by Ching et al (17) found a patient’s body image and perceived quality of life to be the strongest and most consistent determinants of aesthetic surgery outcomes. The present study focused on two factors previously disregarded in this literature: media consumption and religious beliefs. Markey and Markey (18) recently examined young American women’s interest in obtaining cosmetic surgery. They found that all four factors they investigated – namely, body dissatisfaction, physical appearance, teasing (being teased about 11 different body parts) and media influence (feeling pressured to appear like people in the media) – were related to the desire to have cosmetic surgery. The best predictor of their interest in obtaining cosmetic surgery was body dissatisfaction, which has been investigated extensively. The majority of studies exploring the reasons one may have for undertaking cosmetic surgery have focused on patient samples. There is a noticeable lack of research focusing on nonpatient samples. Delinsky (13) found that media exposure and vicarious experience predicted a greater likelihood of undergoing cosmetic surgery. Similarly, Brown et al (5) found that vicarious experience of cosmetic surgery increased the likelihood of undergoing cosmetic surgery for women. Their results also suggested that women are more likely to undergo cosmetic surgery than men, and that older men report less desire to undergo cosmetic surgery than younger men. Furthermore, contrary to Delinsky’s findings, they found that media exposure did not influence the likelihood of undergoing cosmetic surgery for either sex. They accounted for this finding by suggesting that the saturation of media sources with cosmetic surgery messages has caused awareness to reach a peak (5). Thus, they suggest that the effect of media influence is no longer as pronounced as it once was. This finding, however, needs to be replicated in a different culture. Sarwer et al (10) proposed that the growing awareness of this beauty bias is partly responsible for the increased number of people altering their appearance through cosmetic procedures. This awareness may cause some individuals to attribute their low life satisfaction to original article