Abstract
Objective
The study was conducted to determine patients’ desire for being liked and the fear of negative evaluation before and after surgery.
Materials and Method
The study was conducted quasi-experimentally using a one-group pretest-posttest (sixth month) design. The study population consisted of rhinoplasty patients hospitalized in the ear, nose, and throat service. The study was completed with 60 people. Participant information form, the desire for being liked scale, and the brief fear of negative evaluation scale were used as data collection tools. The data of the study were collected face-to-face between November 15, 2021, and March 15, 2023.
Findings
It was determined that the mean scores of the desire for being liked were 19.43 ± 7.44 in the pretest and 12.15 ± 4.76 in the posttest, and the difference between the measurements was highly significant. Furthermore, it was determined that the mean score of fear of negative evaluation was 27.78 ± 9.81 in the pretest and 17.72 ± 6.91 in the posttest, and the difference between the measurements was highly significant. It was observed that there was a high, statistically significant, and positive relationship between the pretest and posttest fear of negative evaluation and desire for being liked scores.
Conclusion
Patients’ desire for being liked and fear of negative evaluation, which were high before surgery, decreased significantly six months after surgery.
Level of Evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online instructions to authors www.springer.com/00266.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
Rhinoplasty, which is one of the most preferred aesthetic surgical interventions, is one of the most frequently performed aesthetic operations to eliminate deformities and dysfunctions of the nose [1]. It has been reported that only 10% of rhinoplasties performed worldwide are related to function, while the rest aim for visual change [2]. On the other hand, the high rate of psychiatric diagnoses among rhinoplasty patients draws attention. For instance, in a study conducted in Iran, 41% of the rhinoplasty patient group met psychopathological diagnoses such as body dysmorphic disorder (BDD), obsessive-compulsive disorder (OCD), social anxiety, generalized anxiety disorder, and somatic delusions [1, 3]. It is seen that most people who have aesthetic surgery have a self-image related to physical appearance and therefore seek surgical change [4]. Therefore, it can be said that human beings, who are social beings, care about the impression they leave on others. According to Yousefi et al. [5], individuals make intense efforts to make an effective impression on others and to look attractive. This effort can be manifested in expensive clothes, make-up, aesthetic operations, and attempts to intervene in the body. Çepikkurt and Coşkun [6] emphasized that the effort of individuals to look more beautiful or attractive stems from the concern about being disliked and some people are more concerned about this issue than others. The desire for being liked is a motive arising from the need for love, respect, acceptance, and feeling successful and sufficient [7]. The desire for being liked may bring with it the fear of being evaluated negatively. It is seen that individuals with a high desire for being liked are more sensitive to the evaluations of others and make more effort to be liked [8]. It was also stated that individuals with high social anxiety have a strong core belief that they will be evaluated negatively in social environments [9]. It was reported that individuals who care about the impression they leave on the people they communicate with and whether they are approved by these people exhibit various behaviors/initiatives to avoid creating a negative impression [10]. Rhinoplasty, one of these interventions, is the most commonly performed plastic surgery in Turkey [11]. Applications are made to this surgery for nasal breathing or aesthetic purposes. Before applying for surgery, the positive and negative consequences of the procedure should be investigated in detail and individuals should be questioned psychologically [11].
It has been determined that there are few psychosocial studies in this patient group in the literature, and it seems that studies on social appearance anxiety have been addressed more [12, 13]. For instance, Yigman and Inan [13] collected data after three months and reported that psychological factors such as appearance anxiety may act as a bridge between patient satisfaction and rhinoplasty results. Moreover, in the study conducted by Tulacı and Arslan [12], it was determined that individuals with high social appearance anxiety in the preoperative evaluation had less satisfaction in the 6th month after surgery. It is thought that these studies are mostly related to social appearance anxiety, and different psychosocial data will support the literature. There are no studies in the literature that examine the desire to be liked and the fear of negative evaluation together in rhinoplasty patients. It is thought that this study will be the first study to address the desire to be liked and the fear of negative evaluation in this group of patients with a long follow-up (six months) through a pre-test, post-test quasi-experimental model and will add originality to sthe literature. Therefore, this study was conducted to determine patients’ desire for being liked and fear of negative evaluation before and after surgery.
Hypotheses of the Study
H1
There is a significant difference in desire for being liked scores before and after surgery in rhinoplasty patients.
H2
There is a significant difference in fear of negative evaluation scores before and after surgery in rhinoplasty patients.
Materials and Methods
Research Design
This study was conducted quasi-experimentally in a one-group pretest-posttest design to determine the desire for being liked and fear of negative evaluation before and after surgery in patients undergoing rhinoplasty surgery.
Study Population and Sample
The population of the study consisted of rhinoplasty patients hospitalized in the ear, nose, and throat service. To determine the sample of the study, studies on the desire for being liked and fear of negative evaluation in rhinoplasty patients could not be reached. Studies that would support the hypotheses of the desire for being liked and fear of negative evaluation in our study were also not found. A pilot study was needed for this. Sim and Lewis applied the upper confidence limit approach in their study and determined that a pilot trial of 55 participants with a 95% upper confidence limit would minimize the overall sample size for small to medium standardized effect sizes (0.2–0.6). Sim and Lewis’ 95% upper confidence limit was preferred because it has an effect of increasing the required sample size estimates compared to Kieser and Wassmer for both pilot and main trials [14, 15]. Sim and Lewis [14] stated the minimum pilot sample size as 55 and above. Accordingly, the minimum sample size for our study was planned to be 55 people, and considering the possible loss, a total of 65 people were invited by taking 20% more samples. Five of these patients were excluded from the study due to incomplete filling of the scale questions.
Participants
The study included individuals who were 18 years of age or older, who would undergo rhinoplasty surgery, who did not have cognitive impairment, who could speak Turkish, and who volunteered to participate in the study. The data were collected face-to-face between November 15, 2021, and March 15, 2023.
Data Collection Tools
Introductory Information Form
The diagnostic information form includes information such as age, gender, and chronic diseases of the patients.
The Desire for Being Liked Scale
The scale developed by Kaşıkara and Doğan [7] consists of nine items. There are no reverse items in the scale and the scale has a single-factor structure. The scale is graded on a four-point Likert scale (1 = Strongly Disagree, 4 = Strongly Agree). The lowest score that can be obtained from the scale is nine and the highest score is 36. The higher the scores obtained from the scale, the higher the desire to be liked. Cronbach’s alpha internal consistency coefficient of the scale is 0.81, while it was determined to be 0.97 in the present study.
The Brief Fear of Negative Evaluation Scale
The scale created by Leary [16] was adapted into Turkish by Çetin et al. [17]. In the scale, items 2, 6, and 9 are reverse coded and the scale consists of 11 items in total. The scale is graded on a five-point Likert scale (1 = Not at all appropriate, 5 = completely appropriate). The highest score that can be obtained from the scale is 55, and high scores indicate that the fear of negative evaluation is high. Cronbach’s alpha internal consistency coefficient of the scale is 0.84, while it was 0.96 in the present study.
Data Collection
The data were collected by the researchers in two stages (pre-test and 6th month) by face-to-face interview technique. The purpose of the study was explained to the patients admitted to the hospital, questionnaires were given to the participants who agreed to participate, and the individuals filled out the forms themselves. For the pretest data, the introductory information form, the desire for being liked scale, and the brief fear of negative evaluation scale were used. Moreover, the desire for being liked and the brief fear of negative evaluation scales were administered to the patients at the sixth month measurements. During the answering period, the researchers were present with the individuals and answered the questions asked about the forms. It took approximately ten minutes to complete the forms.
Data Evaluation
Data were evaluated in the IBM SPSS Statistics 21 statistical package program. Summary statistics of the variables were given as number of units (n), percentage (%), mean (x̄), and standard deviation (SD). In examining the relationships between variables, the Kolmogorov-Smirnov test was used to examine whether the variables met the normality assumption. According to the kurtosis and skewness coefficients of the variables and the coefficient of variation, the variables were determined to be normally distributed [18]. A paired two-sample t-test was applied to evaluate the dependent data in the pre-test and post-test measurements. Independent samples t-test was used for independent two-group measurements and ANOVA test was used for three-group measurements. Pearson’s test was used for correlation between variables. In comparisons, p < 0.05 was considered statistically significant.
Ethical Dimension of the Research
Approval from the Ethics Committee of the relevant university (2021/731) and institutional permission from the relevant service were obtained for the research. Individuals were informed about the purpose of the study that participation in the study was voluntary, they could leave the study at any time, their names would be kept confidential, and consent was obtained.
Findings
Table 1 shows that the mean age of the patients who participated in our study was 32.57 ± 11.61, 53.3% were female, 55% were married, 53.3% were higher education graduates, 56.7% had children, 33.3% were government employees, 71.7% had moderate income, 60% were not working, 78.3% lived in the provincial center, 60% had not undergone any previous surgery, 16.7% had a chronic disease, and 61.9% had undergone surgery for a deviated septum.
Table 2 shows the comparison of preoperative and postoperative scale mean scores in rhinoplasty patients. It was determined that the mean DBLS scores of rhinoplasty patients were 19.43 ± 7.44 in the pre-test and 12.15 ± 4.76 in the post-test and the difference between the measurements was highly significant (p < 0.001). Furthermore, the mean BFNE scores of rhinoplasty patients were 27.78 ± 9.81 in the pretest and 17.72 ± 6.91 in the posttest and the difference between the measurements was highly significant (p < 0.001).
Table 3 shows the comparison of the preoperative and postoperative mean scale scores of the patients according to their descriptive characteristics. Statistically significant differences were obtained between the place of residence, presence of chronic disease, and pretest DBLS and BFNE mean scores (p < 0.05). It was determined that these significant differences were caused by those living in the city center and those without chronic disease, respectively. The posttest DBLS mean score was higher in those working in the private sector and this difference was significant (p < 0.05). Besides, the post-test BFNE mean score was higher in working people and this difference was significant (p < 0.05).
Table 4 shows the preoperative and postoperative age variables of the patients and the correlation between the scales. There was a statistically significant and positive correlation between pretest BFNE and DBLS scores at a high level (r = 0.857; p < 0.05) and between posttest BFNE and DBLS scores at a high level (r = 0.867; p < 0.05). Moreover, there was a weak (r = − 0.259; p < 0.05) statistically significant and negative correlation between post-test DBLS and age score.
Discussion
In the present study, it was determined that the desire for being liked and fear of negative evaluation decreased after surgery in rhinoplasty patients and there was a significant and positive relationship between the desire for being liked and fear of negative evaluation. As a result of the literature review, it is seen that the current study is the first study conducted in these patients. In this respect, the study adds originality to the literature. Due to the limited number of studies, the findings were discussed in line with the literature with similar studies as much as possible.
In the present study, the preoperative desire for being liked and fear of negative evaluation levels of patients living in the provincial center and without chronic diseases were determined to be higher and this difference was significant. It was observed that the desire for being liked after surgery was higher in patients working in the private sector. Furthermore, the levels of fear of negative evaluation after surgery were higher in working people. When the literature was examined, no similar study was found. In Turkey, people have an accepting attitude due to the low population in settlements such as villages and towns and everyone knows each other. In line with these results, it is thought desire for being liked increases in people according to the proportion to the size of the place of residence. Furthermore, those working in the private sector may have to pay more attention to their appearance and may also experience anxiety related to dismissal. These situations may trigger the desire for being liked.
In the present study, it was determined that the desire for being liked decreased as the age of the postoperative patients increased. In a previous study on social appearance anxiety, it was stated that age had a significant effect on the anxiety levels of the participants before and after surgery [13]. In the literature, unlike our study, in a study conducted with female undergraduate students, it was indicated that body appreciation increased with increasing age [19]. Working in a young age group is a limitation that distinguishes this study from the current study. In young people, the desire for being liked can be more intense with the contribution of psychosocial development, and as age progresses, these concerns are replaced by productivity, and the intensity of these desires may decrease [20].
Needs such as receiving positive feedback, and being loved and appreciated play a role in the desire for being liked [8]. With rhinoplasty, a person’s self-confidence and self-esteem can increase, and the long-term mental, emotional, and psychosocial functioning and well-being of that patient can increase [21, 22]. In the present study, it was determined that the desire for being liked, which was present in patients before surgery, decreased significantly after surgery. When similar studies are examined, it is seen that body image and self-esteem increase after surgery [23,24,25]. Physical appearance is a strong determinant of an individual’s body image, especially for women [26, 27]. These results may suggest that the physical appearance of the patients is as they want after surgery, and in relation to this, patients may think that they are more admired by the individual and society, and as a result, patients’ desire to be admired may decrease.
Self-perception is important in terms of fear of negative evaluation. In this study, it was determined that the fear of negative evaluation that existed in patients before surgery decreased significantly after surgery. In a previous qualitative study, it was determined that individuals were exposed to pressure and negative discourses about the nose and needed comprehensive counseling about the process [28]. In another study, a significant negative correlation was stated between patients’ preoperative social appearance anxiety and postoperative patient satisfaction [12]. In another study, it was reported that patients had better mental status after rhinoplasty surgery [29]. These results suggest that the preoperative fears of the patients due to their physical appearance decreased with the surgery and positively affected their mental state.
In this study, it was observed that as the desire for being liked increased before surgery, the fear of negative evaluation increased and as the desire for being liked decreased after surgery, the fear of negative evaluation decreased. These results show that the patients think that they are liked by themselves and society when their nasal shapes are as they want and that their fear of negative evaluation decreases with the power and self-confidence given by their physical appearance.
Conclusions and Recommendations
As a result, it was determined that preoperative desire for being liked and fear of negative evaluation of rhinoplasty patients decreased significantly after surgery. Moreover, a high correlation was observed between preoperative and postoperative desire for being liked and fear of negative evaluation. Due to the increase in rhinoplasty today, it is recommended that individuals who will undergo surgery should be psychologically evaluated and, if necessary, psychiatry consultations should be requested and necessary counseling should be provided to individuals. Experimental and quasi-experimental studies with other variables that will reveal the psychological status of rhinoplasty patients are recommended.
Data Availability
The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.
References
Yarar EZ (2021) Kozmetik rinoplastide psikolojik süreçler: sistematik derleme. Turkiye Klinikleri J Med Sci 41(1):95–106. https://doi.org/10.5336/medsci.2020-80566
Eser BC, İlhan AE (2021) Inferior turbinate surgery with a piezo device in rhinoplasty. Facial Plast Surg Aesthet Med 23(1):70–72. https://doi.org/10.1089/fpsam.2020.0015
Alavi M, Kalafi Y, Dehbozorgi GR, Javadpour A (2011) Body dysmorphic disorder and other psychiatric morbidity in aesthetic rhinoplasty candidates. J Plast Reconstr Aesthet Surg 64(6):738–741. https://doi.org/10.1016/j.bjps.2010.09.019
Kucur C, Kuduban O, Ozturk A, Gozeler MS, Ozbay I, Deveci E, Simsek E, Kaya Z (2016) Psychological evaluation of patients seeking rhinoplasty. Eurasian J Med 48(2):102–106. https://doi.org/10.5152/eurasianjmed.2015.103
Yousefi B, Hassani Z, Shokri O (2009) Reliability and factor validity of the 7-item of social physique anxiety scale (SPAS-7) among university students in Iran. World J Sport Sci 2(3):201–204
Çepikkurt F, Coşkun F (2010) Social physique anxiety and body image satisfaction levels of collegian dancers. Pamukkale J Sport Sci 1(2):17–24
Kaşıkara G, Doğan U (2017) Beğenilme arzusu: Ölçek geliştirme, güvenirlik ve geçerlik çalışması. MSKU Eğitim Fakültesi Dergisi 4(2):51–60. https://doi.org/10.21666/muefd.345573
Bingül F, Çelik E (2021) Yalnızlığın bağlanma stilleri, beğenilme arzusu ve olumsuz değerlendirilme korkusu açısından incelenmesi. Ekev Akademik Dergisi 85:187–202
Carter M, Sbrocco T, Riley S, Mitchell F (2012) Comparing fear of positive evulation to fear of negative evulation in predicting anxiety from a social challenge. J Exp Psychopathol 3:782–793. https://doi.org/10.5127/jep.022211
Çam S, Sevimli D, Yerlikaya E (2010) Olumsuz değerlendirilmekten korkma ölçeğine (ODKÖ) ilişkin bir geçerlik ve güvenirlik çalışması. Çukurova Üniversitesi Sosyal Bilimler Enstitüsü Dergisi 19(1):132–140
Gökçen F (2020) İslam hukukuna göre cerrrahi nitelikli estetik operasyonlar. Uludağ Üniversitesi Sosyal Bilimler Enstitüsü, Master’s Thesis, Bursa
Tulacı KG, Arslan E (2020) Septorinoplasti yapılan hastalarda sosyal görünüş kaygısının hasta memnuniyetine etkisinin araştırılması. KBB-Forum 19(3):318–323
Yigman F, Inan S (2022) Relationship between the beliefs on social appearance, anxiety, and ıntolerance of uncertainty ın rhinoplasty patients. Psychological factors associated with rhinoplasty satisfaction. Ann Clin Anal Med 13(3):340–344. https://doi.org/10.4328/ACAM.21071
Sim J, Lewis M (2012) The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. J Clin Epidemiol 65:301–308. https://doi.org/10.1016/j.jclinepi.2011.07.011
Kieser M, Wassmer G (1996) On the use of the upper confidence limit for the variance from a pilot sample for sample size determination. Biom J 8:941–949. https://doi.org/10.1002/bimj.4710380806
Leary MR (1983) A brief version of the fear of negative evaluation scale. Pers Soc Psychol Bull 9(3):371–375. https://doi.org/10.1177/0146167283093007
Çetin B, Doğan T, Sapmaz F (2010) Olumsuz değerlendirilme korkusu ölçeği kısa formu’nun Türkçe uyarlaması: Geçerlik ve güvenirlik çalışması. Eğitim ve Bilim 35(156):205–2016
Tabachnick BG, Fidell LS, Ullman JB (2013) Using multivariate statistics, vol 6, 7th edn. Pearson, Boston, MA, pp 497–516
Swami V (2009) Body appreciation, media influence, and weight status predict consideration of cosmetic surgery among female undergraduates. Body Image 6(4):315–317. https://doi.org/10.1016/j.bodyim.2009.07.001
Aybak T, İpek M (2021) Ergenlik dönemindeki çocuğa sahip ebeveynlerin yaşadıkları sorunlar. Aydın Sağlık Dergisi 7(2):141–165. https://doi.org/10.17932/IAU.ASD.2015.007/asd_v07i2004
Brucoli M, Zeppegno P, Benech R, Boffano P, Benech A (2019) Psychodynamic features associated with orthognathic surgery: a comparison between conventional orthognathic treatment and “surgery-first” approach. J Oral Maxillofac Surg 77(1):157–163. https://doi.org/10.1016/j.joms.2018.06.005
Jafrani S, Zehra N, Zehra M, Ali SMA, Mohsin SAA, Azhar R (2017) Assessment of personality type and medical specialty choice among medical students from Karachi; using Myers-Briggs type indicator (MBTI) tool. J Pak Med Assoc 67(4):520–526
Borujeni LA, Pourmotabed S, Abdoli Z, Ghaderi H, Mahmoodnia L, Sedehi M, Hasanpour Dehkordi A (2020) A comparative analysis of patients’ quality of life, body image and self-confidence before and after aesthetic rhinoplasty surgery. Aesth Plast Surg 44:483–490. https://doi.org/10.1007/s00266-019-01559-3
Radman M, Pourhoseinali L (2022) Effect of rhinoplasty on changing body images in candidates for surgery. J Family Med Prim Care 11(9):5535–5539. https://doi.org/10.4103/jfmpc.jfmpc_2116_21
Ullah S, Hakeem A, Razaq N, Waleem SU, Saeed Z (2022) A comparative analysis of body ımage, life satisfaction and self-esteem of patients before and after rhinoplasty. Pak Armed Forces Med J 72(5):1791–1794. https://doi.org/10.51253/pafmj.v72i5.7968
Göksu Ö (2019) Determination of gender role attitudes and non-functional attitudes of the women who have a plastic surgery. Hacettepe University, Graduate School of Health Sciences, Gynecology and Obstetrics Nursing Program Master of Science Thesis, Ankara
Milothridis P, Pavlidis L, Haidich AB, Panagopoulou E (2016) A systematic review of the factors predicting the interest in cosmetic plastic surgery. Indian J Plast Surg 49(3):397–402. https://doi.org/10.4103/0970-0358.197224
Küçük Öztürk G, Nahya ZN (2023) The psychosocial experiences of men with rhinoplasty: a qualitative study. Turkiye Klinikleri J Med Sci 43(1):119–126. https://doi.org/10.5336/medsci.2022-92945
Ghahremani L, Motevasel M, Fararooei M, Rakhshani T (2019) Mental health in rhinoplasty applicants, before and after surgery. Arch Psych Psych 4(2):45–51. https://doi.org/10.12740/APP/106077
Acknowledgement
Thank you to the patients who participated in the study.
Funding
Open access funding provided by the Scientific and Technological Research Council of Türkiye (TÜBİTAK). None.
Author information
Authors and Affiliations
Contributions
Conceptualization was done by Eda Albayrak, Nurcan Uzdil, Kerem Kökoğlu; Methodology was done by Eda Albayrak, Nurcan Uzdil; Formal analysis and investigation were done by: Nurcan Uzdil; Writing—original draft preparation were done by Eda Albayrak; Writing—review and editing were done by Eda Albayrak, Nurcan Uzdil; Resources was done by: Eda Albayrak; Supervision was done by Eda Albayrak, Nurcan Uzdil, Kerem Kökoğlu.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
Approval from the Ethics Committee of the relevant university (2021/731) and institutional permission from the relevant service were obtained for the research.
Informed Consent
Individuals were informed about the purpose of the study that participation in the study was voluntary, they could leave the study at any time, their names would be kept confidential, and consent was obtained.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Albayrak, E., Uzdil, N. & Kökoğlu, K. The Desire for Being Liked and the Fear of Negative Evaluation in Rhinoplasty Patients. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-03979-2
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00266-024-03979-2