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A Test of the Agency Hypothesis in Women’s Cosmetic Surgery Usage

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Abstract

Women’s agency—their ability to make conscious choices and to act on them—is a central consideration in feminist theories of cosmetic surgery. Several key issues in this longstanding debate are how much external or coercive influence women experience (or acknowledge) in their choice to pursue surgery, whether they are aware of sexist ideology more so than non-recipients, and whether their choice to pursue surgery exemplifies a strong sense of self worth. To test this agency hypothesis, we draw on survey data from a volunteer sample of 202 adult women ages 19–86 years from the southern California region in the U.S. to compare cosmetic surgery recipients to non-recipients across these key socio-cultural and personal domains. Results reveal that cosmetic surgery recipients were more likely to have friends who had undergone cosmetic surgery, endorsed more covert sexist beliefs, exhibited greater media usage, and had higher household incomes, than non-recipients. Recipients also evidenced lower ratings in global self-esteem than non-recipients. These findings challenge some of the notions attendant to agency claims, and engage with conceptions of autonomy introduced in the feminist philosophical literature.

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References

  • Allen, J. P., & Turner, E. (1997). The ethnic quilt: Population diversity in Southern California. Northridge: Center for Geographical Studies, California State University.

    Google Scholar 

  • Amato, P., & Booth, A. (1995). Changes in gender role attitudes and perceived marital quality. American Sociological Review, 60, 58–66.

    Article  Google Scholar 

  • American Society of Plastic Surgeons (ASPS) (2008). Cosmetic surgery procedures up in all ethnic groups except Caucasians in 2008. Retrieved from www.plasticsurgery.org/Media/Press_Release/Cosmetic_Procedures_Up_in_All_Ethnic_Groups_Except_Caucasions_in_2008.html.

  • American Society of Plastic Surgeons (ASPS) (2010). Procedural statistic trends 2009. Retrieved from http://www.plasticsurgery.org/Documents/Media/statistics/2009-US-cosmeticreconstructiveplasticsurgeryminimally-invasive-statistics.pdf

  • Ancheta, R. (2002). Discourse of rules: Women talk about cosmetic surgery. In K. Strother Ratcliff (Ed.), Women & health: Power, technology, inequality & conflict in a gendered world (pp. 143–148). New York: Allyn & Bacon.

    Google Scholar 

  • Bartky, S. (1997). Sympathy and solidarity: On a tightrope with Scheler. In D. Meyers (Ed.), Feminists rethink the self (pp. 177–196). Boulder: Westview.

    Google Scholar 

  • Benoit, C., Zadoroznyj, M., Hallgrimsdottir, H., Treloar, A., & Taylor, K. (2010). Medical dominance and neoliberalisation in maternal care provision: The evidence from Canada and Australia. Social Science & Medicine, 71, 475–481.

    Article  Google Scholar 

  • Blakely, T. A., Lochner, K., & Kawachi, I. (2002). Metropolitan area income inequality and self-rated health—a multi-level study. Social Science & Medicine, 54, 65–77.

    Article  Google Scholar 

  • Blascovich, J., & Tomaka, J. (1991). Measures of self-esteem. San Diego: Academic.

    Google Scholar 

  • Bordo, S. (1993). Unbearable weight: Feminism, western culture and the body. Berkeley: University of California.

    Google Scholar 

  • Braun, V. (2010). Female genital cosmetic surgery: A critical review of current knowledge and contemporary debates. Journal of Women’s Health, 17, 1393–1407.

    Article  Google Scholar 

  • Brooks, A. (2006). Under the knife and proud of it: An analysis of the normalization of cosmetic surgery. Critical Sociology, 30(2), 207–239.

    Article  Google Scholar 

  • Brooks, C., & Bolzendahl, C. (2004). The transformation of US gender role attitudes: Cohort replacement, social-structural change, and ideological learning. Social Science Research, 33, 106–133.

    Article  Google Scholar 

  • Brown, A., Furnham, A., Glanville, L., & Swami, V. (2007). Factors that affect the likelihood of undergoing cosmetic surgery. Aesthetic Surgery Journal, 27, 501–508.

    Article  PubMed  Google Scholar 

  • Buhl Conn, A., Hanges, P. J., Sipe, W. P., & Salvaggio, A. N. (1999). The search for ambivalent sexism: A comparison of two measures. Educational and Psychological Measurement, 59, 898–909.

    Article  Google Scholar 

  • Calogero, R. M., Pina, A., Park, L. E., & Rahemtulla, Z. (2010). Objectification theory predicts college women’s attitudes toward cosmetic surgery. Sex Roles, published online March 17, 2010.

  • Cash, T. F., Duel, L. A. and Perkins L. (2002). Women's Psychosocial outcomes of breast augmentation with silicone gell-filled implants: A 2-year prospective study. Plastic and Reconstructive Surgery, 109, 2112-2121

    Google Scholar 

  • Cheng, S., & Powell, B. (2005). Small samples, big challenges: Studying atypical family forms. Journal of Marriage and Family, 67, 926–935.

    Article  Google Scholar 

  • Clark, K., Shute, N., & Kelly, K. (2000, March). The new midlife. U.S. News & World Report, 128(11), 70–83. March.

    Google Scholar 

  • Clarke, L. H., Repta, R., & Griffin, M. (2007). Non-surgical cosmetic procedures: Older women’s perceptions and experiences. Journal of Women & Aging, 19, 69–87.

    Article  Google Scholar 

  • Cotten, S. (1999). Marital status and mental health revisited: Examining the importance of risk factors and resources. Family Relations, 48(3), 225–233.

    Article  Google Scholar 

  • Crerand, C. E., Cash, T. F., & Whitaker, L. A. (2006). Cosmetic surgery of the face. In D. B. Sarwer, T. Pruzinsky, T. F. Cash, R. M. Goldwyn, J. A. Persing, & L. A. Whitaker (Eds.), Psychological aspects of reconstructive and cosmetic plastic surgery: Clinical, empirical, and ethical perspectives (pp. 233–249). Philadelpha: Lippincott Williams & Wilkins.

    Google Scholar 

  • Cunningham, M., Beutel, A., Barber, J., & Thornton, A. (2005). Reciprocal relationships between attitudes about gender and social contexts during young adulthood. Social Science Research, 34, 862–892.

    Article  Google Scholar 

  • Davis, K. (1995). Reshaping the female body: The dilemma of cosmetic surgery. New York: Routledge.

    Google Scholar 

  • Davis, K. (2003). Dubious equalities and embodied differences: Cultural studies on cosmetic surgery. Lanham: Rowman & Littlefield.

    Google Scholar 

  • Davis, S. (2007). Gender ideology construction from adolescence to young adulthood. Social Science Research, 36, 1021–1041.

    Article  Google Scholar 

  • Davis, D., & Vernon, M. (2002). Sculpting the body beautiful: Attachment style, neuroticism, and use of cosmetic surgeries. Sex Roles, 47, 129–138.

    Article  Google Scholar 

  • Delinsky, S. S. (2005). Cosmetic surgery: A common and accepted form of self-improvement? Journal of Applied Social Psychology, 25, 2012–2028.

    Article  Google Scholar 

  • Didie, E., & Sarwer, D. (2003). Factors that influence the decision to undergo cosmetic breast augmentation surgery. Journal of Women’s Health, 12, 241–253.

    Article  PubMed  Google Scholar 

  • Dillman, D. (2000). Mail and internet surveys: The tailored design method. New York: Wiley.

    Google Scholar 

  • Fan, P., & Marini, M. (2000). Influences on gender-role attitudes during the transition to adulthood. Social Science Research, 29, 258–283.

    Article  Google Scholar 

  • Flores-Lima, G., & Eppley, B. L. (2009). Body contouring with solid silicone implants. Aesthetic Plastic Surgery, 33, 140–146.

    Article  PubMed  Google Scholar 

  • Forbes, G. B., Doroszewicz, K. C., & Adams-Curtis, L. (2004). Association of the thin body ideal, ambivalent sexism, and self-esteem with body acceptance and the preferred body size of college women in Poland and the United States. Sex Roles, 50, 331–345.

    Article  Google Scholar 

  • Frankfurt, H. (1988). The importance of what we care about. New York: Cambridge University Press.

    Google Scholar 

  • Franzoi, S. L. (2001). Is female body esteem shaped by benevolent sexism? Sex Roles, 44, 177–188.

    Article  Google Scholar 

  • Frederick, D. A., Lever, J., & Peplau, L. A. (2006). Interest in cosmetic surgery and body image: Views of men and women across the lifespan. Plastic and Reconstructive Surgery Journal, 120, 1407–1415.

    Article  Google Scholar 

  • Friedman, M. (1999). Autonomy, social disruption and women. In C. MacKenzie & N. Stoljar (Eds.), Relational autonomy: Feminist perspectives on autonomy, agency and the social self (pp. 35–51). New York: Oxford University Press.

    Google Scholar 

  • Gagne, P., & McGaughey, D. (2002). Designing women: Cultural hegemony and the exercise of power among women who have undergone elective mammoplasty. Gender & Society, 16, 814–838.

    Article  Google Scholar 

  • Gillespie, R. (1996). Women, the body and brand extension in medicine: Cosmetic surgery and the paradox of choice. Women & Health, 24, 69–85.

    Article  Google Scholar 

  • Gimlin, D. (2000). Cosmetic surgery: Beauty as commodity. Qualitative Sociology, 23, 77–98.

    Article  Google Scholar 

  • Gorman, B. K. and Braverman, J. (2008). Family structure differences in health care utilization among U.S. children. Social Science & Medicine, 67, 1766-1775

    Google Scholar 

  • Harris, R., & Firestone, J. (1998). Changes in predictors of gender role ideologies among women: A multivariate analysis. Sex Roles, 38, 239–252.

    Article  Google Scholar 

  • Henderson-King, D., & Brooks, K. D. (2009). Materialism, sociocultural appearance messages, and paternal attitudes predict college women’s attitudes about cosmetic surgery. Psychology of Women Quarterly, 33, 133–142.

    Article  Google Scholar 

  • Henderson-King, D., & Henderson-King, E. (2005). Acceptance of cosmetic surgery: Scale development and validation. Body Image, 2, 137–149.

    Article  PubMed  Google Scholar 

  • Hunter, M. (2005). Race, gender, and the politics of skin tone. New York: Routledge.

    Google Scholar 

  • International Society for Aesthetic Plastic Surgery (ISAPS) (2009). Top Procedures for 25 Countries. Retrieved from http://www.isaps.org/uploads/news_pdf/Raw_data_Survey2009.pdf

  • Kirkland, A., & Tong, R. (1996). Working within contradiction: The possibility of feminist cosmetic surgery. Journal of Clinical Ethics, 7, 151–159.

    PubMed  Google Scholar 

  • Klassen, A., Jenkinson, C., Fitzpatrick, R., et al. (1996). Patients’ health related quality of life before and after aesthetic surgery. British Journal of Plastic Surgery, 49, 433–445.

    Article  PubMed  Google Scholar 

  • Laneader, A. M., & Wolpe, P. R. (2006). Ethical considerations in cosmetic surgery. In D. B. Sarwer, T. Pruzinsky, T. F. Cash, R. M. Goldwyn, J. A. Persing, & L. A. Whitaker (Eds.), Psychological aspects of reconstructive and cosmetic plastic surgery: Clinical, empirical, and ethical perspectives (pp. 301–313). Philadelpha: Lippincott Williams & Wilkins.

    Google Scholar 

  • Lochner, K., Pamuk, E., Makuc, D., Kennedy, B. P., & Kawachi, I. (2001). State-level income inequality and individual mortality risk: A prospective, multilevel study. American Journal of Public Health, 91, 385–391.

    Article  PubMed  Google Scholar 

  • Macdonald, N. E., Ebert, P. D., & Mason, S. E. (1987). Marital status and age as related to masculine and feminine personality dimensions and self-esteem. Journal of Social Psychology, 127, 289–298.

    Article  Google Scholar 

  • Markey, C. N., & Markey, P. M. (2009). Correlates of young women’s interest in obtaining cosmetic surgery. Sex Roles, 61, 158–166.

    Article  Google Scholar 

  • Markey, C. N., & Markey, P. M. (2010). A correlational and experimental examination of reality television viewing and interest in cosmetic surgery. Body Image, 7, 165–171.

    Article  PubMed  Google Scholar 

  • Morgan, K. (1991). Women and the knife: Cosmetic surgery and the colonization of women’s bodies. Hypatia, 6(3), 25–53.

    Article  Google Scholar 

  • Murnen, S., & Smolak, L. (2009). Are feminist women protected from body image problems? A meta analytic review of relevant research. Sex Roles, 60, 186–197.

    Article  Google Scholar 

  • Padmore, C. (1998). Significant flesh: cosmetic surgery, physiognomy, and the erasure of visual difference(s). Lateral: A Journal of Textual and Cultural Studies. Retrieved from http://pandora.nla.gov.au/nph-arch/1999/01999-Jul-2/http://www.latrobe.edu.au/www.english/lateral/simple_cp1.htm

  • Park, L. E., Calogero, R. M., Harwin, M. J., & DiRaddo, A. M. (2009). Predicting interest in cosmetic surgery: Interactive effects of appearance-based rejection sensitivity and negative appearance comments. Body Image, 6, 186–193.

    Article  PubMed  Google Scholar 

  • Robins, R. W., & Trzesniewski, K. H. (2005). Self-esteem development across the lifespan. Current Directions in Psychological Science, 14, 158–162.

    Article  Google Scholar 

  • Rosenberg, M. (1987). Rosenberg self-esteem scale. In K. Corcoran & J. Fischer (Eds.), Measures for clinical practice (pp. 408–409). New York: Free.

    Google Scholar 

  • Sarwer, D. B., & Magee, L. (2006). Physical appearance in society. In D. B. Sarwer, T. Pruzinsky, T. F. Cash, R. M. Goldwyn, J. A. Persing, & L. A. Whitaker (Eds.), Pychological aspects of reconstructive and cosmetic plastic surgery: Clinical, empirical, and ethical perspectives (pp. 23–36). Philadelpha: Lippincott Williams & Wilkins.

    Google Scholar 

  • Sarwer, D., Wadden, T., Pertschuk, M., & Whitaker, L. (1998). The psychology of cosmetic surgery: A review and reconceptualization. Clinical Psychology Review, 18, 1–22.

    Article  PubMed  Google Scholar 

  • Sarwer, D. B., Wadden, T. A., & Whitaker, L. A. (2002). An investigation of changes in body image following cosmetic surgery. Plastic and Reconstructive Surgery, 109, 363–369.

    Article  PubMed  Google Scholar 

  • Sarwer, D., LaRossa, D., Bartlett, S., Low, D., Bucky, L., & Whitaker, L. (2003). Body image concerns of breast augmentation patients. Plastic & Reconstructive Surgery, 112, 83–90.

    Article  Google Scholar 

  • Sarwer, D., Cash, T., Magee, L., Williams, E., Thompson, J. K., Roehrig, M., et al. (2005a). Female college students and cosmetic surgery: An investigation of experiences, attitudes, and body image. Plastic and Reconstructive Surgery, 115, 931–938.

    Article  Google Scholar 

  • Sarwer, D., Gibbons, L., Magee, L., Baker, J., Casas, L., Glat, P., et al. (2005b). A prospective, multi-site investigation of patient satisfaction and psychosocial status following cosmetic surgery. Aesthetic Surgery Journal, 25, 263–269.

    Article  Google Scholar 

  • Schieman, S., & Campbell, J. E. (2001). Age variations in personal agency and self-esteem: The contexts of physical disability. Journal of Aging & Health, 13, 155–182.

    Article  Google Scholar 

  • Sherwin, S. (1998). A relational approach to autonomy in health care. In S. Sherwin (Ed.), The politics of women’s health: Exploring agency and autonomy (pp. 19–47). Philadelphia: Temple.

    Google Scholar 

  • Sinclair, S. J., Blais, M. A., Gansler, D. A., Sandberg, E., Bistis, K., & LoCicero, A. (2010). Psychometric properties of the Rosenberg self-esteem scale: Overall and across demographic groups living within the United States. Evaluation & the Health Professions, 33, 56–80.

    Article  Google Scholar 

  • Slevec, J., & Tiggemann, M. (2010). Attitudes toward cosmetic surgery in middle-aged women: Body image, aging anxiety and the media. Psychology of Women Quarterly, 34, 65–74.

    Article  Google Scholar 

  • Sperry, S., Thompson, J. K., Sarwer, D. B., & Cash, T. F. (2009). Cosmetic surgery reality TV viewership: Relations with cosmetic surgery attitudes, body image and disordered eating. Annuals of Plastic Surgery, 62, 7–11.

    Article  Google Scholar 

  • Stice, E., Schupak-Neuberg, E., Shaw, H., & Stein, R. (1994). Relation of media exposure to eating disorder symptomatology: An examination of mediating mechanisms. Journal of Abnormal Psychology, 103, 836–840.

    Article  PubMed  Google Scholar 

  • Subramanian, S. V., Blakely, T., & Kawachi, I. (2003). Income inequality as a public health concern: Where do we stand? Commentary on “Is exposure to income inequality a public health concern? Health Services Research, 38, 153–167.

    Article  PubMed  Google Scholar 

  • Sullivan, D. A. (2001). Cosmetic surgery: The cutting edge of commercial medicine in America. New Brunswick: Rutgers University Press.

    Google Scholar 

  • Swami, V. (2007). The missing arms of Venus de Milo: Reflections on the science of physical attractiveness. Brighton: Book Guild.

    Google Scholar 

  • Swami, V., & Furnham, A. (2008). The psychology of physical attraction. London: Routledge.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Swim, J., & Cohen, L. (1997). Overt, covert, and subtle sexism. Psychology of Women Quarterly, 21, 103–118.

    Article  Google Scholar 

  • Swim, J., Aikin, K. J., Hall, W. S., & Hunter, B. A. (1995). Sexism and racism: Old-fashioned and modern prejudices. Journal of Personality and Social Psychology, 68, 199–214.

    Article  Google Scholar 

  • To Bolton, M., Pruzinsky, T., Cash, T., & Persing, J. (2003). Measuring outcomes in plastic surgery: Body image and quality of life in abdonminoplasty patients. Plastic and Reconstructive Surgery, 11, 619–625.

    Article  Google Scholar 

  • U.S. Census Bureau (2003). Census 2000 data for the state of California. Retrieved from http://www.census.gov/census2000/states/ca.html

  • Vespa, J. (2009). Gender ideology construction: A life course and intersectional approach. Gender &Society, 23, 363–387.

    Article  Google Scholar 

  • von Soest, T., Kvalem, I., Skolleborg, K., & Roald, H. (2006). Psychosocial factors predicting the motivation to undergo cosmetic surgery. Plastic and Reconstructive Surgery, 116, 51–62.

    Article  Google Scholar 

  • Yoder, J. D., & McDonald, T. W. (1997). The generalizability and construct validity of the Modern Sexism Scale: some cautionary notes. Sex Roles, 36, 655–663.

    Article  Google Scholar 

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Acknowledgement

Thanks to Margaret Hunter, Jackson Katz and Vickie Jensen for comments on earlier drafts of this manuscript, as well as to the two anonymous reviewers and the journal editor for their sound input and guidance.

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  1. Department of Human Development, California State University, Long Beach, 1250 Bellflower Blvd., Long Beach, CA, 90840, USA

    Shelley Eriksen

  2. Department of Sociology, California State University, Long Beach, 1250 Bellflower Blvd., Long Beach, CA, 90840, USA

    Shelley Eriksen

  3. Department of Philosophy, University of Washington, Seattle, Box 353350, Seattle, WA, 98195, USA

    Sara Goering

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Correspondence to Shelley Eriksen.

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Eriksen, S., Goering, S. A Test of the Agency Hypothesis in Women’s Cosmetic Surgery Usage. Sex Roles 64, 888–901 (2011). https://doi.org/10.1007/s11199-011-9952-1

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