ERN
INT ATI
IBUTION
TR
AL CON
ON
Research
Factor Structure and Correlates of the
Acceptance of Cosmetic Surgery Scale Among
South Korean University Students
Aesthetic Surgery Journal
32(2) 220­–229
© 2012 The American Society for
Aesthetic Plastic Surgery, Inc.
Reprints and permission:
http://www​.sagepub.com/
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DOI: 10.1177/1090820X11431577
www.aestheticsurgeryjournal.com
Viren Swami, PhD; Choon-Sup Hwang, PhD;
and Jaehee Jung, PhD
Abstract
Background: Research on the acceptance of cosmetic surgery has focused on relatively affluent Western samples, to the exclusion of non-Western
samples and any potential cross-cultural differences. While rates of cosmetic surgery in South Korea have risen sharply in the past decade, mirroring rates
in other East Asian nations, little is known about attitudes toward cosmetic surgery in the Korean population.
Objectives: To examine the factor structure and correlates of a Korean adaptation of the previously-published Acceptance of Cosmetic Surgery Scale
(ACSS).
Methods: South Korean university students (N = 267) completed the ACSS, as well as included Korean translations of measures for actual vs. ideal
body weight discrepancy, body appreciation, sociocultural attitudes toward appearance, and demographics.
Results: The Korean ACSS reduced to a two-factor solution, mirroring results among other non-Western samples, although a one-factor solution was
deemed more plausible. Compared to men, women had significantly higher total scores, suggesting that they were more accepting of cosmetic surgery.
A multiple regression showed that, after controlling for the effects of participant sex, the only significant predictor of acceptance of cosmetic surgery was
general body appreciation, suggesting that some may view cosmetic surgery as a means of enhancing their body image.
Conclusions: The results reveal important global information for plastic surgeons—not only on the treatment of non-Western patients but on the
South Korean market, in which the cosmetic surgery industry remains unregulated. Given the popularity and acceptance of cosmetic surgery in South
Korea, there is an urgent need for regulatory intervention to ensure patient safety and satisfaction.
Keywords
acceptance of cosmetic surgery scale, research, psychology, culture
Accepted for publication May 5, 2011.
It has been acknowledged, in the popular media and in
scholarly studies, that rates of cosmetic surgery have
increased dramatically over the past decade, at least in
North America and Europe.1,2 For instance, the American
Society for Aesthetic Plastic Surgery3 reported a 155%
increase in the number of cosmetic surgery procedures
performed in the United States between 1997 and 2010.
This trend raises many important questions for aesthetic
surgeons, including their role in shaping standards of
appearance, the allocation of health care funding and practitioner time, and the potential for social stratification as
wealthier patients use cosmetic surgery to enhance their
appearance. In addition, aesthetic surgeons must be
increasingly mindful of the psychosocial ramifications
associated with aesthetic surgery, specifically with regard
to elective enhancement procedures versus those that
address legitimate medical conditions.4
To that end, researchers have sought to understand the
motivations that lead some individuals (but not others) to
consider undergoing cosmetic procedures. For instance,
Dr. Swami is a Reader in the Department of Psychology, University of
Westminster, London, United Kingdom, and an Adjunct Reader in the
Department of Psychology, HELP University College, Kuala Lumpur,
Malaysia. Professor Hwang is a Professor of Fashion Merchandising in
the Department of Clothing and Textiles, Kyung Hee University, Seoul,
South Korea. Dr. Jung is an Associate Professor in the Department
of Fashion and Apparel Studies, University of Delaware, Newark,
Delaware.
Corresponding Author:
Dr. Viren Swami, Department of Psychology, University of
Westminster, 309 Regent Street, London W1B 2UW, United Kingdom.
E-mail: [email protected]
Swami et al
feminist scholars have attempted to deconstruct the dynamics of power in practices and representations of cosmetic
surgery, viewing it as a form of objectification,5-7 whereas
others have emphasized the potential of cosmetic surgery to
empower women against discrimination.8-10 More broadly,
greater cultural acceptance of cosmetic surgery in the West
has been attributed to factors ranging from media coverage
to greater affordability.1,2,11,12 In addition, scholars have
identified a number of demographic, individual, and interpersonal/social variables associated with greater willingness to consider cosmetic surgery. In terms of demographic
variables, the available research consistently points to
women being more likely than men to consider having cosmetic surgery,13-15 a finding that mirrors actual procedural
statistics.3 Other authors have reported that ethnic identity
is related to acceptance of cosmetic surgery, with Caucasian
women being more likely than African, Caribbean, and
South Asian women to consider cosmetic procedures, even
after controlling for body image, self-esteem, and weight.16
Finally, a higher body mass index (BMI) has been reliably
associated with greater acceptance of cosmetic surgery
among women.16-18 In terms of individual psychological differences, several studies have suggested reliable associations between consideration of cosmetic surgery and
negative body image.16-23 Other work has reported significant associations between consideration of cosmetic surgery and factors such as investment in appearance,11,24,25
social conformity,15 internalization of media messages about
appearance,17,18,20 celebrity worship,26 and materialist values.20 Finally, in terms of interpersonal and social variables,
a number of studies have shown that consideration of cosmetic surgery is associated with greater exposure to media
messages14,24,27,28 and with knowing others who have undergone cosmetic procedures.13,14,24 Along similar lines, consideration of cosmetic surgery has been associated with greater
appearance-related teasing,17,25 romantic relationship satisfaction,29 and paternal attitudes toward appearance.30
Although this research appears to be well established,
an important limitation is that most previous studies have
relied on relatively affluent Western samples. There continues to be a lack of studies on acceptance of cosmetic
surgery in non-Western settings. Such research is important because there may be cross-cultural differences in
attitudes toward or reasons for considering cosmetic surgery.23,31 That is, different cultural conceptions of the body
and body modification procedures may give rise to crosscultural differences in corporeal experiences in general and
acceptance of cosmetic surgery in particular. Understanding
these issues is also important for aesthetic surgeons, as
they may have relevant psychosocial outcomes in terms of
the delivery of medical care, patient satisfaction, and the
benefits of cosmetic surgery for patients (eg, self-esteem
and social functioning).
As a contribution to the existing literature, we examined acceptance of cosmetic surgery and its correlates
among university students in South Korea. Rates of cosmetic surgery in South Korea have risen sharply in the past
decade, mirroring rates in other East Asian nations32,33;
221
several factors may explain this increased popularity. First,
as discussed by Suissa,34 cultural values conveyed in
South Korean culture assert that cosmetic surgery ensures
access to wealthier romantic partners. The increase in
rates of cosmetic surgery among South Koreans may therefore be understood as an investment to enhance an individual’s social and economic position. In a similar vein,
Jung35 discussed the greater political, social, and economic
power of contemporary women in South Korea compared
to that of women in other East Asian nations, which may
offer them greater latitude in choosing to enhance their
appearance.
Additionally, particularly since the liberalization of
mass media in the 1990s, Korean beauty concepts have
shifted from mild plumpness with a round face to a thin
body with Western facial features.36 South Koreans, especially women of marriageable age, may experience pressure to conform to Western standards of beauty achievable
only through cosmetic surgery (eg, double-eyelid procedures).32 Indeed, the incidence of cosmetic surgery is high
in Korea,37 a nation described as having “plastic surgery
fever.”38 Some scholars have similarly noted that the influence of Western media, alongside changes in socioeconomic conditions, may mean that South Korean women
are at greater risk of developing appearance dissatisfaction.39 Finally, cosmetic surgery in South Korea is not
regulated as it is in most Western countries, with many
procedures being carried out at lower cost by surgeons
without the recommended qualifications.34
Despite the evidence that cosmetic surgery has become
increasingly popular in South Korea, much of the available
research continues to document cross-cultural differences
only in terms of the rates of specific procedures.33 The first
aim of the present study was to examine attitudes toward
cosmetic surgery in general among South Korean university students. Specifically, we examined the factor structure of the most widely-used scale for measuring attitudes
toward cosmetic surgery—namely, the Acceptance of
Cosmetic Surgery Scale (ACSS).20 This was an important
first step because the factor structure of the ACSS has three
subscales among Western samples20,31 and two among one
non-Western sample, meaning that it may not be crossculturally invariant.23 The second aim of the current work
was to examine correlates of cosmetic surgery acceptance
in the South Korean context. Specifically, we analyzed the
associations between acceptance of cosmetic surgery and
known predictors among Western samples—namely, actual
vs. ideal body weight discrepancy (women only), body
appreciation, internalization of media messages about
appearance, sociocultural attitudes toward appearance,
and demographics (including weight, operationalized as
self-reported BMI). Note that the first three factors have
not, to our knowledge, been adapted for a Korean population; as such, an initial task for us was to prepare translations of the Photographic Figure Rating Scale,40 the Body
Appreciation Scale (BAS),41 and the Sociocultural Attitude
Toward Appearance Questionnaire-3 (SATAQ-3)42 for use
in the present study.
222
Methods
Participants
The participants in this study were 267 students from a
university in Seoul, South Korea, of whom 200 were
women and 67 were men.
Measures
Acceptance of cosmetic surgery. To measure acceptance of
cosmetic surgery, we relied on the 15-item ACSS,20 the
most widely used scale for the measurement of attitudes
toward cosmetic surgery. Among Western samples, it has
been reduced into three subscales—namely, Intrapersonal
(five items measuring attitudes related to the self-oriented
benefits of cosmetic surgery), Social (five items measuring
social motivations for cosmetic surgery), and Consider
(five items measuring the likelihood that a participant
would consider having cosmetic surgery).20,31 Among a
Malaysian sample, however, Swami23 reported that the
ACSS was best reduced to two factors, consisting of the
Consider subscale and an amalgamation of the Intrapersonal and Social subscales. Items in the ACSS are rated on
a seven-point scale (1 = strongly disagree, 7 = strongly
agree), and it has high internal consistency, good testretest reliability after three weeks, and good convergent
and divergent reliability among Western samples.20
Actual vs. ideal body weight discrepancy. The Photographic
Figure Rating Scale40 measures the discrepancy between
actual and ideal body weight. It consists of 10 grayscale
photographic images of real women representing the full
range of BMI categories. Only women were asked to complete the scale, with each rating the figure that most
closely matched her body and the one that she would
most like to possess (1 = figure with the lowest BMI, 10
= figure with the highest BMI). A measure of ideal-actual
weight discrepancy was computed as the difference
between unsigned (absolute) current and ideal ratings.
Previous work has shown that the Photographic Figure
Rating Scale retains cross-cultural validity43 and that
scores derived from the scale have high construct validity,
good test-retest reliability after three weeks, and good
construct validity.40,44
Body appreciation. The BAS41 is a 13-item measure of posi-
tive body image, in which items are rated on a five-point
scale (1 = never, 5 = always). Among Western samples,
the BAS has been shown to have a one-dimensional structure,41 but work with a non-Western sample has suggested
that it may consist of two subscales measuring general body
appreciation and body image investment.45 Among Western
samples, the BAS has been shown to have good discriminant, construct, and incremental validities.41,46
Impact of sociocultural influences on body image. The SATAQ342 is a 30-item scale measuring the multidimensional
Aesthetic Surgery Journal 32(2)
impact of sociocultural influences on body image. Items are
rated on a five-point scale (1 = strongly disagree, 5 =
strongly agree), and among Western samples, the scale consists of four factors measuring (1) the degree to which
various media are considered an important source of information about being attractive (Information), (2) feeling
pressured by various media to strive for cultural ideals of
beauty (Pressure), (3) endorsement and acceptance of
media messages touting unrealistic ideals for female beauty
and the striving toward these ideals (InternalizationGeneral), and (4) endorsement and acceptance of an athletic and toned body ideal (Internalization-Athlete).42
However, cross-cultural work with the scale has suggested
that it may reduce to three, rather than four, subscales—
namely, Information, Internalization-Athlete, and an
amalgamation of Pressure and General Internalization.47
Among Western samples, the scale is internally reliable and
has good discriminant and convergent validity.42
Demographics. Participants provided their demographic
details, including sex, age, religion, and self-reported
height and weight. The latter two variables were used to
calculate participants’ BMI (kg/m2).
Procedure
The study questionnaire was constructed in English and
translated into the Korean version by one of the researchers (JJ), who is a Korean bilingual scholar in the United
States. Another bilingual scholar in South Korea then
translated the questionnaire into English, from which the
bilingual scholar in the United States made minor adjustments for the Korean version. All participants were volunteers recruited from undergraduate courses throughout a
university campus. After ensuring anonymity, participants
were asked to complete the scales relevant to appearance
and were debriefed upon completion. All statistics were
calculated with PASW 17 (formerly, SPSS 17).
Results
Participant Demographics
Participants had a mean age of 22.35 ± 2.04 years (range,
18-29 years) and a mean self-reported BMI of 20.27 ± 2.72
kg/m2 (range, 15.43-36.20 kg/m2). The majority of participants self-reported as atheists (58.2%), while others were
Christians (23.4%), Buddhists (9.8%), or of some other
religious affiliation (8.6%).
Acceptance of Cosmetic Surgery
The 15 items on the Korean ACSS were subjected to an
exploratory factor analysis (EFA). The significance of
the Bartlett test of sphericity (χ2105 = 2943.23, P < .001)
and the size of the measure of sampling adequacy
(Kaiser-Meyer-Olkin [KMO] = 0.93) showed that the 15
Swami et al
223
Table 1. Factor Loadings for Items Meeting Inclusion Criteria for the Korean Acceptance of Cosmetic Surgery Scalea
Item
Factor 1
Factor 2
3. In the future, I could end up having some kind of cosmetic surgery.
.82
.17
8. I have sometimes thought about having cosmetic surgery.
.82
.21
13. I would seriously consider having cosmetic surgery if I thought my partner would find me more attractive.
.91
.33
9. I would seriously consider having cosmetic surgery if my partner thought it was a good idea.
.79
.26
7. If I knew there would be no negative side effects or pain, I would like to try cosmetic surgery.
.78
.39
10. I would never have any kind of plastic surgery.b
.75
.17
15. If a simple cosmetic surgery procedure would make me more attractive to others, I would think about trying it.
.74
.47
12. If it would benefit my career, I would think about having cosmetic surgery.
.69
.45
11. I would think about having cosmetic surgery in order to keep looking young.
.63
.25
6. If I could have a surgical procedure done for free, I would consider trying cosmetic surgery.
.60
.29
4. People who are very unhappy with their physical appearance should consider cosmetic surgery as one option.
.40
.87
5. If cosmetic surgery can make someone happier with the way they look, then they should try it.
.32
.85
1. It makes sense to have minor cosmetic surgery rather than spending years feeling bad about the way you look.
.40
.68
14. Cosmetic surgery can be a big benefit to people’s self-image.
.43
.66
2. Cosmetic surgery is a good thing because it can help people feel better about themselves.
.53
.61
a
Factors 1 and 2 are nonspecified because they were collapsed into a general acceptance score.
Reverse-coded.
b
items had adequate common variance for factor analysis. We therefore conducted an EFA based on Varimax
rotation. The number of factors to be extracted was
determined by eigenvalues greater than one (λ > 1.0),
inspection of the scree plot,48 and an extraction criteria
of 0.40.49 Based on these criteria, two factors emerged
with λ > 1.0 after three iterations, with a slight decline
between the rotated factors of the solution (λ = 6.25
and 3.73, with 41.7% and 24.9% of the variance
explained, respectively).
Table 1 reports the factor loadings of all 15 items of the
ACSS, a number of which cross-loaded onto both factors.
Indeed, based on Kline’s criterion,49 all except one of the
items loaded onto the first extracted factor. In their original study, Henderson-King and Henderson-King20 suggested that it was permissible to compute a total acceptance
score by calculating the mean of all 15 items. This was
deemed to be a more acceptable solution than computing
two distinct factors, especially given that the two extracted
factors were significantly correlated (r = 0.57). We therefore computed the mean of all 15 items of the ACSS and
used this total acceptance score in all further analyses.
Cronbach α for this total score was 0.95. An independent
samples t-test showed that women had total scores
significantly higher than those of men on the ACSS
(women, 4.55 ± 3.81; men, 3.81 ± 1.36; t265 = 4.10, P <
.001, d = 0.50).
Body Appreciation
Next, the 13 items on the Korean BAS were subjected to
an EFA. The significance of Bartlett’s test of sphericity
(χ278 = 2246.31, P < .001) and the size of the measure of
sampling adequacy (KMO = 0.92) showed that the items
on the BAS had adequate common variance for factor
analysis. We therefore conducted an EFA based on
Varimax rotation where the number of extracted factors
was determined on the basis of the criteria noted above.
According to these criteria, it was possible to extract two
factors with λ > 1.0 after three iterations, with a steep
decline between the rotated factors of the solution (λ =
6.04 and 2.06, with 46.4% and 15.9% of the variance
explained, respectively).
In a previous study of a non-Western sample, Swami
and Chamorro-Premuzic45 reported that the BAS reduced
into two factors, which they named General Body
Appreciation and Body Image Investment, following the
removal of two items (Items 7 and 11). The results of the
present study mirror those findings, with the exception
that Items 7 and 11 loaded onto the General Body
Appreciation factor (see Table 2). As such, we followed
the general guidelines reported by Swami and ChamorroPremuzic45 in extracting two factors, the first of which
related to General Body Appreciation and contained 10
items. Cronbach α for this subscale was 0.93, whereas
224
Aesthetic Surgery Journal 32(2)
Table 2. Factor Loadings for Items Meeting Inclusion Criteria for the Korean Body Appreciation Scalea
Factor
Item
General Body Appreciation
Body Image Investment
5. I feel that my body has at least some good qualities.
.86
.20
10. My feelings toward my body are positive, for the most part.
.84
.36
2. I feel good about my body.
.83
.21
6. I take a positive attitude towards my body.
.83
.23
13. Despite its imperfections, I still like my body.
.80
.36
3. On the whole, I am satisfied with my body.
.79
.35
4. Despite its flaws, I accept my body for what it is.
.77
.34
1. I respect my body.
.71
.15
11. I engage in healthy behaviors to take care of my body.
.66
.12
7. I am attentive to my body’s needs.
.56
.20
9. I focus a lot of energy being concerned with my body shape or weight.b
.15
.78
12. I allow unrealistically thin images of women (♂) / unrealistically muscular images of men (♀) to affect my attitudes toward
my body.b,c
.27
.63
8. My self worth is independent of my body shape or weight.
.02
.60
a
Bold font indicates item loaded onto a particular factor.
Reverse-coded.
c
Contains sex-specific content for women and men.
b
that of the Body Image Investment subscale was 0.55.
Given these results, we retained only the General
Body Appreciation factor for further analyses. An independent samples t-test showed that men had a general
body appreciation significantly higher than that of women
(women, 3.44 ± 0.78; men, 3.74 ± 0.82; t265 = 2.64, P =
.009, d = 0.32).
Sociocultural Attitudes Toward
Appearance
The 30 items on the Korean SATAQ-3 were similarly subjected to an EFA based on varimax rotation, as the significance of Bartlett’s test of sphericity (χ2435 = 4658.53, P <
.001) and the size of the measure of sampling adequacy
(KMO = 0.92) showed that these items had adequate common variance for factor analysis. According to the extraction criteria denoted above, we extracted four factors with
λ > 1.0 after five iterations. There was major decline
between the rotated factors of the solution (λ = 8.13, 4.79,
2.34, and 2.03, explaining 27.1%, 16.0%, 7.8%, 6.8% of
the variance, respectively). As shown in Table 3, none of
the items cross-loaded, and items were reduced into the
four factors originally delineated by Thompson et al.42
Cronbach α values for these four factors were as follows:
Information, 0.93; Internalization-General, 0.91; Pressures,
0.91, and; Internalization-Athlete, 0.87.
We also examined whether there were significant sex
differences on any of these subscales. Results of a series of
independent samples t-tests showed that women had
higher scores on the Pressures subscale (women, 3.21 ±
0.97; men, 2.52 ± 0.97; t265 = 5.10, P < .001, d = 0.63)
and the Internalization-General subscale (women, 3.40 ±
0.84; men, 3.01 ± 0.81; t265 = 3.31, P = .001, d = 0.41).
Men had significantly higher scores on the InternalizationAthlete subscale (women, 2.65 ± 0.66; men, 3.12 ± 0.64;
t265 = 5.08, P < .001, d = 0.62) . Finally, there were no
significant differences between the sexes on the Information
subscale (women, 3.07 ± 0.50; men, 2.97 ± 0.54; t265 =
1.40, P = .163, d = 0.17).
Interscale Correlations and Multiple
Regression
To examine the correlates of acceptance of cosmetic surgery
in Korea, we computed bivariate correlations among the total
ACSS score, General Body Appreciation, actual-ideal body
weight discrepancy (women only, 1.43 ± 1.08), the four
SATAQ-3 subscales, participant age, and BMI, separately for
women and men. As shown in Table 4, among women,
higher acceptance of cosmetic surgery scores were significantly correlated with all four SATAQ-3 subscales and lower
General Body Appreciation but none of the other variables. Among men, higher ACSS scores were significantly
Swami et al
225
Table 3. Factor Loadings for Items Meeting Inclusion Criteria for the Korean Sociocultural Attitudes Toward Appearance Questionnaire–3a
Factor
Items
PRSS
INT-G
INF
INT-A
2. I’ve felt pressure from TV or magazines to lose weight.
.85
.15
.01
.05
10. I’ve felt pressure from TV or magazines to be thin (♂) / to be muscular (♀).
.84
.18
.15
.01
18. I’ve felt pressure from TV or magazines to diet.
.82
.22
.08
.06
14. I’ve felt pressure from TV or magazines to have a perfect body.
.81
.22
.12
.04
26. I’ve felt pressure from TV or magazines to change my appearance.
.76
.28
.05
.17
6. I’ve felt pressure from TV or magazines to look pretty (♂) / to look muscular (♀).
.67
.21
.06
.06
22. I’ve felt pressure from TV or magazines to exercise.
.50
.10
.13
.12
12. I compare my body to the bodies of people who appear in magazines.
.41
.80
.21
.03
3. I do care if my body looks like the body of people who are on TV.
.34
.80
.12
.11
16. I compare my appearance to the appearance of people in magazines.
.21
.75
.26
.17
4. I compare my body to the body of people who are on TV.
.21
.74
.12
.01
8. I compare my appearance to the appearance of TV and movie stars.
.16
.61
.15
.17
11. I would like my body to look like the people who are in movies.
.01
.61
.26
.21
7. I would like my body to look like the models who appear in magazines.
.43
.60
.28
.01
15. I wish I looked like the models in music videos.
.15
.56
.01
.08
27. I try to look like the people on TV.
.28
.50
.10
.03
17. Magazine articles are an important source of information about fashion and “being attractive.”
.28
.20
.80
.02
21. Pictures in magazines are an important source of information about “being attractive.”
.26
.18
.76
.19
28. Movie stars are an important source of information about fashion and “being attractive.”
.17
.26
.74
.22
13. Magazine articles are an important source of information about fashion and “being attractive.”
.16
.15
.72
.17
29. Famous people are an important source of information about fashion and “being attractive.”
.13
.29
.68
.04
25. Movies are an important source of information about fashion and “being attractive.”
.25
.28
.68
.10
5. TV commercials are an important source of information about fashion and “being attractive.”
.23
.16
.67
.07
9. Music videos on TV are an important source of information about fashion and “being attractive.”
.34
.12
.64
.13
1. TV programs are an important source of information about fashion and “being attractive.”
.49
.16
.58
.14
30. I try to look like sports athletes.
.04
.18
.19
.81
23. I wish I looked as athletic as sports stars.
.12
.15
.21
.80
24. I compare my body to that of people who are athletic.
.21
.21
.14
.78
19. I wish to look as athletic as the people in magazines.
.03
.02
.24
.74
20. I compare my body to that of people in “good shape.”
.01
.08
.36
.70
Abbreviations: PRSS, pressures; INT-G, internalization-general; INF, information; INT-A, internalization-athlete.
Bold font indicates item loaded onto a particular factor.
a
correlated with three of the four SATAQ-3 subscales and
lower General Body Appreciation but again showed no significant correlations with any of the other variables.
To examine the predictive power of these variables in
relation to acceptance of cosmetic surgery, we conducted
a multiple hierarchical regression (the Enter method on
226
Aesthetic Surgery Journal 32(2)
Table 4. Interscale Correlations Between the Overall ACSS Score and All Remaining Variablesa
1
1: Overall ACSS
2
−.36**
2: General body appreciation
−.38**
3: Weight discrepancy
−.01
3
4
5
6
7
.36**
.26**
.24*
.15*
.01
.12
−.25**
−.37**
−.39**
−.24*
−.36**
.02
.18*
.20*
.30**
−.03
.45**
−.10
.50**
.49**
.38**
.03
.09
.82**
.51**
.03
.01
.54**
.19*
.05
.13
.13
−.03
−.50**
−.58**
4: Information
.24*
−.31*
.25*
5: Internalization-general
.42**
−.23
.25*
.40**
6: Pressures
.29*
−.57**
.27*
.42**
.72**
7: Internalization-athlete
.11
−.19
.16
.55**
.75**
−.42**
.25*
.24*
−.09
.11
−.04
.04
.08
.03
.11
8: Body mass index
9: Age
−.16
.01
−.05
−.01
.56**
8
9
−.15*
−.11
Abbreviation: ACSS, Acceptance of Cosmetic Surgery Scale.
a
Correlations for women in the top diagonal. Women, n = 200; men, n = 67.
*P < .05. **P < .001.
PSAW/SPSS), with total ACSS scores as the dependent
variable; with sex entered on its own in a first block; and
with General Body Appreciation, the four SATAQ-3 subscales, body weight discrepancy, BMI, and age entered in
a second block. As shown in Table 5, in the second block
of the multiple regression, the only significant predictors
of cosmetic surgery acceptance were participant sex (with
women more likely to report higher scores) and General
Body Appreciation (with individuals with lower general
body appreciation reporting higher scores).
Table 5. Hierarchical Multiple Regression With Total Acceptance of
Cosmetic Surgery Scale Scores as the Dependent Variable
Standardized β
t
.27
4.19
< .001
.19
2.18
.030
−.15
−2.07
.040
Pressures
.07
0.60
.549
Internalization-general
.18
1.69
.092
Information
.03
0.41
.684
Internalization-athlete
.01
0.02
.985
Body weight discrepancy
.05
0.61
.541
Body mass index
.05
0.60
.543
Age
.05
0.75
.455
Items
Block 1
Sex
Block 2
Sex
General body appreciation
Discussion
The present study examined the factor structure of the
Korean ACSS because previous work has suggested that its
structure may not be cross-culturally invariant.23 In this
regard, the current results suggest that the Korean ACSS is
best reduced to two factors, a finding that generally mirrors previous work with the ACSS in non-Western settings.23 Unlike previous work, however, the original
Consider subscale did not emerge as a distinct subscale
but instead included a number of items from both the
Social subscale and the Intrapersonal subscale. Items associated with the original Intrapersonal subscale reduced
into a distinct factor in the present work.
Importantly, all but one of the items from the second
extracted factor in the present work adequately loaded
onto the first factor. In their original work, HendersonKing and Henderson-King20 suggested that it was permissible to compute a total ACSS score by taking the mean of
all 15 items, representing overall acceptance of cosmetic
surgery. This was a preferable option in the present work,
given that the two extracted factors were significantly correlated. Moreover, the overall ACSS score showed good
internal consistency in the present work, suggesting that it
P
may be the best option for researchers wishing to employ
the ACSS in the South Korean context.
The present results also show that South Korean
women had a total ACSS score significantly higher than
that of men, with a relatively large effect size. This finding
corroborates previous work in the West, where women
reported being more likely than men to consider having
cosmetic surgery and to be more accepting of it.13-15
Suissa34 remarked that cosmetic surgery may be more
acceptable for women in the South Korean context because
it provides them with a premium that ensures greater
Swami et al
access to wealthier romantic partners. Similarly, Jung35
noted that South Korean women may have greater political, social, and economic power, which may result in
greater acceptance of appearance enhancement procedures, including cosmetic surgery.
Our results also show that after controlling for the
effects of participant sex, acceptance of cosmetic surgery
among South Koreans was significantly predicted by
General Body Appreciation only, and it was also significantly correlated with greater internalization of media
messages about appearance, which is consistent with
previous work.17,30 This result is intriguing because of the
poor predictive power of General Body Appreciation and
because of the lack of significant associations between
acceptance of cosmetic surgery and both actual-ideal body
weight discrepancy and self-reported BMI. The most likely
explanation for these findings is a cultural one: scholars
have noted that East Asian beauty standards are more
likely to emphasize facial features than bodily characteristics such as shape and weight.50 This may translate into
specific aesthetic priorities among East Asians when it
comes to cosmetic surgery51,52—namely, they may be more
interested in procedures focused on altering the appearance of the face rather than the body. An alternative possibility is that our translations of the scales were inadequate.
However, this seems unlikely; we followed established
protocols when preparing our questionnaire in Korean,
and participants did not report any difficulties in understanding the items.
Finally, our results provide initial support for the reliability of the Korean versions of the SATAQ-3 and the BAS.
Specifically, our results show that the Korean SATAQ-3
reduced into the four-factor structure originally delineated
by Thompson et al.42 The BAS reduced to a two-factor
structure, as reported among Malaysian and Brazilian
adults.31,45 In terms of the BAS, its factor structure may not
be cross-culturally invariant, and there may be crosscultural differences in understandings of positive body
image.45
The two main limitations of the present work are the
reliance on university students and the relatively small
sample of men, thereby limiting our ability to generalize
the present findings. In addition, the present work incorporated a limited number of scales that were initially
developed in the West and that, despite our translation
procedures, may not adequately capture constructs related
to body image among East Asians. Notwithstanding these
limitations, the present work contributes to the task of
understanding attitudes toward cosmetic surgery from a
cross-cultural perspective. We hope that the availability of
the Korean ACSS will stimulate further studies on acceptance of cosmetic surgery among East Asian populations.
Conclusions
The results of this study, which examined attitudes toward
cosmetic surgery in a South Korean university population,
have important implications for aesthetic surgeons wishing
227
to understand the growing interest in cosmetic surgery in
non-Western populations and the possible outcomes of such
interest. In the South Korean context, the cosmetic surgery
industry is unregulated, and surgeons without the recommended qualifications are carrying out many procedures.
This may have negative consequences for the industry as a
whole, particularly if it results in permanent physical and
psychological damage to patients. Given the popularity and
acceptance of cosmetic surgery in South Korea, there is an
urgent need for regulatory intervention to ensure patient
safety and satisfaction with cosmetic procedures.
Disclosures
The authors declared no potential conflicts of interest with
respect to the research, authorship, and publication of this
article.
Funding
The authors received no financial support for the research,
authorship, and publication of this article.
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