Barriers and Factors Influencing Cosmetic Surgery Desire Among Saudi College Students: A Cross-sectional Study on Perception and Knowledge

Abstract

Background:

Plastic surgery is a constantly evolving field that is poorly understood by a major section of the populace. Despite a growth in cosmetic operations in Saudi Arabia, expertise is lacking. The study examines college students’ perceptions of cosmetic surgery and the factors that influence their interest in it.

Methods:

A cross-sectional study was done in Riyadh in January and March 2023, using an online self-administered questionnaire for college students. Students’ views and motivations for considering or avoiding cosmetic surgery were assessed in the poll.

Results:

Of 1028 students questioned, 52.3% were female. Forty-eight percent of participants were 21–23 years old, and 97.4% knew about cosmetic surgery. Estimates suggest that 30% of people want cosmetic surgery. Due to religious doubts, 48.2% of individuals avoided cosmetic surgery. Apprehension regarding consequences (40.9%), lack of resource knowledge (19.9%), and inability to persuade family (17.1%) were further worries.

Conclusions:

This study indicates that 33% of students are considering cosmetic surgery in the future. Scars and deformity seem to prevent cosmetic surgery. To better understand cosmetic surgery, students should learn about its pros and cons.

Takeaways

Question: What do Saudi college students know about plastic surgery?

Findings: Plastic surgery, especially rhinoplasty, was well-known by 1028 Imam Muhammad Ibn Saud Islamic University students. Over half knew someone who had surgery, but only one-third wanted it. Deformity, scars, and celebrity surgery failures were major issues. Social media provided most information. Women, older people, and low-income people considered surgery more.

Meaning: A mere 30% of students displayed an inclination for cosmetic surgery, primarily due to religious reservations and apprehensions about the outcomes.

INTRODUCTION

Cosmetic surgery improves attractiveness through surgical or nonsurgical methods. Plastic surgery repairs, restores, or enhances damaged, lost, sick, defective, or deformed body parts. Tissue may be transferred, reshaped, and reduced in the afflicted area. These goals can be attained with blepharoplasty, rhinoplasty, breast augmentation, chemical peels, and botulinum toxin injections.¹ The American Society of Plastic Surgeons reported 17.5 million cosmetic procedures in 2017, with rhinoplasty and blepharoplasty among the top five.² Cosmetic operations for both genders were expected to expand to 65.2% from 2012 to 2017.³ Cosmetic surgery, which uses surgical and nonsurgical treatments to improve appearance, is rising in popularity. New goods and technology have contributed to the constant rise in US cosmetic surgery rates.² The International Society for Aesthetic Plastic Surgery found that higher income, lower costs, media attention, and a positive outlook on cosmetic treatments contribute to the annual rise in cosmetic operations.⁴ The International Society for Aesthetic Plastic Surgery report ranks Saudi Arabia 29th of 30 nations with the highest cosmetic surgery rates.⁵

The cosmetic surgery market has grown due to medical advancements, patient preferences, and media coverage.⁶ The media’s influence on people’s self-image and cosmetic surgery decisions is well-known. Publications, television, and movies may affect body image satisfaction and self-worth, according to multiple studies.^6,7

Previous Saudi Arabian studies on cosmetic surgery understanding and attitudes among the general community and medical students found contradictory results. Almarghoub et al⁸ found that plastic surgeons and the media should do more to educate the public about cosmetic and reconstructive surgery. Mortada et al⁹ found that medical students lacked plastic surgery knowledge. However, early exposure to this discipline may improve their knowledge.⁹ These findings suggest that further research is needed to understand Riyadh college students’ awareness, barriers, and attitudes concerning aesthetic plastic surgery.

Plastic surgery has advanced, yet the public still lacks understanding, especially about cosmetic surgery. Despite the rising incidence of procedures in Saudi Arabia, there are little data and research on this topic. This study examines college students’ views and attitudes on cosmetic surgery and the barriers and fears that prevent them from getting it. The study examines college students’ cosmetic surgery decisions, their perceptions of the pros and cons, and their views of cosmetic surgery as a way to achieve physical beauty and social approval. The study also seeks to identify factors that dissuade college students from cosmetic surgery.

METHODS

Research Methods and Subjects

This observational cross-sectional survey used an electronic validated questionnaire to poll college students at Al Imam Mohammad Ibn Saud University in Riyadh, Saudi Arabia. Saudi and non-Saudi college students 18 years or older at Al Imam Mohammad Ibn Saud University were studied. The single proportion equation in Roasoft was used to calculate the sample size of 1028 students with a 95% confidence interval and 5% margin of error.

Tool for Data Collection

A pilot study verified the questionnaire’s reliability. Age, college, academic year, and family income were obtained on the automated questionnaire. This investigation included additional parts on participants’ cosmetic surgery knowledge, attitudes, and habits. The questionnaire had multiple-choice and open-ended questions. Participants had 10 minutes to complete the electronic survey, which was then automatically collected.

Ethical Consideration

Before starting the research, Al Imam Mohammad Ibn Saud University’s Research Ethics Committee approved it and received a full description of its goals. Each participant gave verbal agreement before participating in the study. All data were kept secret throughout the study. This study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist for complete and transparent reporting. The STROBE checklist is popular for observational research. The checklist includes 22 elements researchers should include in their papers.¹⁰

Data Analysis

To assure data accuracy, data were thoroughly examined before being entered into the computer. The study team thoroughly corrected data errors and omissions. IBM SPSS Statistics version 26 was used for data input and analysis. The data were summarized using percentages, mean, range, and SD. To determine categorical variable correlation or disparity, the chi-square test was performed. The Fisher exact test was used when one or more contingency table cells had a frequency less than 5. The study removed incomplete items and recorded the number and reasons for questionnaire rejections. The datasets were checked for completeness before analysis to ensure each participant had all necessary data.

RESULTS

Demographics of Participants

This study included 1028 people, 52.3% of whom were female. Forty-eight percent of the sample was 21–23 years old, whereas 35.6% was 18–20 years old. The Economics and Administrative College had 22.1% of participants, followed by Medicine College with 19.2%. Additionally, 35% of individuals reported a 4.5 or higher grade point average in the most recent trimester. In addition, 37.1% of interviewees indicated a monthly household income more than 20,000 riyals, whereas 28.3% reported a monthly income between 10,000 and 20,000. A total of 93.6% of participants were single, and 97.4% of students knew about cosmetic surgery. All participants confirmed their Saudi citizenship and Riyadh residency. Table 1 summarizes the research participants’ basic traits.

Table 1.

Demographic Factors of the Participants (N = 1028)

	Count	Column N %
Gender
Male	490	47.7
Female	538	52.3
Age, y
18–20	366	35.6
21–23	493	48.0
24–26	124	12.1
>26	45	4.4
College
Computer Science	148	14.4
Engineering	87	8.5
Medicine	197	19.2
Economic and Administrative	227	22.1
Social Science	39	3.8
Faculty of Sharia and Law	84	8.2
Faculty of Languages and Translation	69	6.7
College of Science	53	5.2
Media and Communication	65	6.3
Faculty of Fundamentals of Religion	11	1.1
Social Psychology	15	1.5
Other	33	3.2
Year of study
Preparatory year	66	6.4
1st year	212	20.6
2nd year	250	24.3
3rd year	196	19.1
4th year	138	13.4
5th year	166	16.1
Academic GPA
<2.5	19	1.8
2.5–2.99	41	4.0
3–3.49	78	7.6
3.5–3.99	205	19.9
4–4.49	325	31.6
4.5–5	360	35.0
Family income
<5000	143	13.9
5000–10,000	213	20.7
10,000–20,000	291	28.3
>20,000	381	37.1
Marital status
Single	962	93.6
Married	52	5.1
Divorced	11	1.1
Widow	3	0.3
Have you heard that there are plastic surgical operations to enhance the appearance?
No	27	2.6
Yes	1001	97.4

GPA, grade point average.

Knowledge of Plastic Surgery Procedures

Most participants (97.4%) were aware of cosmetic surgery to improve looks. As shown in Figure 1, rhinoplasty was the most popular plastic surgery method among experts, with 93.2% citing it. Hair transplant (81.6%) and liposuction (80.3%) followed. Famous operations include breast augmentation/reduction (76.4%) and abdominoplasty (75.8%). Most participants (57.3%) knew somebody who had cosmetic surgery, with cousins being the most common (51.4%). However, only 33% wanted cosmetic surgery. Rhinoplasty was the most popular procedure, with 42.5% of respondents. Following it were hair transplant and liposuction at 17.3% each (Table 2).

Fig. 1.

Percentage of participants who have heard about various cosmetic surgical operations.

Table 2.

Prevalence and Attitude of the Participants to Undergo Cosmetic Surgery

	Count	Column N %
Do you know anyone personally who has undergone cosmetic surgery?
No	439	42.7
Yes	589	57.3
If yes, whom
Parents	57	9.4
Cousins	312	51.4
Siblings	78	12.9
Friends	160	26.4
If yes, what procedure
Hair transplant	117	19.3
Rhinoplasty	256	42.2
Liposuction	124	20.5
Abdominoplasty	65	10.7
Breast augmentation/reduction	20	3.3
Facelift surgery	24	4.0
Do you desire or plan to undergo any such operation?
No	695	67.6
Yes	333	32.4
if yes, what operation would you like to do?
Hair transplant	69	17.3
Rhinoplasty	170	42.5
Liposuction	69	17.3
Abdominoplasty	47	11.8
Breast augmentation/reduction	33	8.3
Facelift surgery	12	3.0

Plastic Surgery Challenges and Fears

The majority of individuals (70%) worried about cosmetic surgery scars and deformity. For 43.4% of individuals, loss of function was the second most common worry, followed by mortality for 28.5%. Table 3 shows that 60.4% of participants worried about plastic surgery owing to celebrity failures. Religion was the second most feared factor (48.7%). The majority of individuals (54.5%) believed cosmetic surgery scars were temporary, whereas 30.4% believed they were permanent. Only 7.9% of participants believed cosmetic surgery would not cause scars.

Table 3.

Fears about Plastic Surgical Operations and Source of These Fears

	Count	Percentage
Fears about plastic surgical operations
Disfigurement and Scars	685	70.0
Infections	255	26.1
Loss of function	424	43.4
Death	279	28.5
Not sure if allowed in religion	50	5.1
None	44	4.5
Sources of fears about plastic surgical operation
YouTube videos	374	37.6
Celebrities with failed surgery	601	60.4
Witness to failure among family/friends	265	26.6
Newspaper reports	209	21.0
Religious reasons	485	48.7

Personal Views on Cosmetic Surgery

In addition, 47.8% of participants were aware of Riyadh’s cosmetic surgery facilities. When asked about cosmetic surgery, 41.1% said it was useful if it satisfied patients. A total of 18.5% of respondents said that cosmetic surgery was a waste of time and money, whereas 13.8% thought it was immoral. A significant 76.4% of participants believed media, advertising, and social media influenced patients’ cosmetic surgery decisions. Social media was the main source of information on these procedures for 89.6% of participants (Table 4).

Table 4.

Thoughts About Surgery and Attitude Toward Patients Who Underwent Surgery

	Count	Column N %
What is your idea about scar after having a plastic surgery operation?
Temporary scar after the surgery	560	54.5
Permanent scar after the surgery	312	30.4
No resulting scar after the surgery	81	7.9
Not know	38	3.7
Depending on different factors as surgeon or operation	37	3.6
Are you aware of the availability of appearance enhancing cosmetic surgical facilities in Riyadh?
No	537	52.2
Yes	491	47.8
What is your opinion about people who undergo cosmetic surgery?
Sinful	142	13.8
Wastage of time and money	190	18.5
No opinion	273	26.6
Good if it makes them happy	423	41.1
Does mass media/advertisement/social media influence decision making?
No	100	9.7
Yes	785	76.4
Not sure	143	13.9
Sources of information
Social media	921	89.6
Friends and family	652	63.4
Television	269	26.2
Radio	83	8.1
Print media	204	19.8

Cosmetic Surgery Desire Variables

Women were more likely than men to plan or undergo cosmetic operations (38.8% versus 25.3%, P = 0.000). Age was also associated with a higher desire for cosmetic procedures (P = 0.001). Lower family wealth was associated with a higher desire for cosmetic operations (P = 0.014). Single people wanted cosmetic surgery less, although not much (Table 5).

Table 5.

The Relation between Demographic Factors and Desire to Undergo Any Such Operation

	Do You Desire or Plan to Undergo Any Such Operation?
	No		Yes		P
	Count	Row N %	Count	Row N %
Gender					0.000*
Male	366	74.7	124	25.3
Female	329	61.2	209	38.8
Age, y
18–20	255	69.7	111	30.3	0.001*
21–23	348	70.6	145	29.4
24–26	70	56.5	54	43.5
>26	22	48.9	23	51.1
Year of study					0.039*
Preparatory year	40	60.6	26	39.4
1st year	156	73.6	56	26.4
2nd year	181	72.4	69	27.6
3rd year	122	62.2	74	37.8
4th year	87	63.0	51	37.0
5th year	109	65.7	57	34.3
Academic GPA					0.977
<2.5	14	73.7	5	26.3
2.5–2.99	29	70.7	12	29.3
3–3.49	51	65.4	27	34.6
3.5–3.99	140	68.3	65	31.7
4–4.49	220	67.7	105	32.3
4.5–5	241	66.9	119	33.1
Family income					0.014*
<5000	83	58.0	60	42.0
5000–10,000	149	70.0	64	30.0
10,000–20,000	189	64.9	102	35.1
>20,000	274	71.9	107	28.1
Marital status					0.088
Single	659	68.5	303	31.5
Married	28	53.8	24	46.2
Divorced	7	63.6	4	36.4
Widow	1	33.3	2	66.7

*P < 0.05

GPA, grade point average.

DISCUSSION

To meet society’s ever-changing technical and social standards, cosmetic surgery has become increasingly popular. The 2016 Annual Global Aesthetic Survey by the International Society of Aesthetic Plastic Surgery found a 9% increase in surgical and nonsurgical procedures.¹⁰ Plastic surgery is poorly understood in Saudi Arabia. Thus, this research seeks to assess university students’ attitudes on cosmetic surgery and identify the barriers to their participation.

Fifty-seven point three percent of respondents have friends who underwent cosmetic surgery. One-third of respondents said they wanted to have such surgery. Most interested parties chose rhinoplasty. Alamri et al¹¹ found that 12.6% of Jeddah Tertiary Care Center staff were willing to undergo face cosmetic surgery to correct facial abnormalities.

Another poll found 14.6% of respondents would have facial cosmetic surgery to remove wrinkles and neck fat. Face plastic surgery was contemplated by only 13% of respondents. Only 13% of interviewees considered face cosmetic surgery.¹² In 2012, a cross-sectional study¹³ examined Saudi bariatric surgery patients’ demand for body sculpting surgery. According to the poll, 78.1% wanted cosmetic surgery, including body sculpting. Only 14% of participants chose the operation. The research failed to explain why most people who want surgery do not have it.

Data show that women are more likely than men to have cosmetic surgery. Markey et al¹⁴ showed that women were more nervous about cosmetic surgery than men. Swami et al¹⁵ found that women can handle cosmetic surgery better. Brown et al⁷ suggest that women’s social pressure to comply with beauty standards and attract attention may explain the gender gap.

This study identified few single people accepting cosmetic surgery. Contrary to previous studies, 51.6% of women who had cosmetic surgery were not in a committed relationship.¹⁶ This study supports Schlessinger et al¹⁷ who found that most women who received these therapies were married. Women who spend a lot of time on social media are more likely to be interested in these therapies because they like to try new things. Their heavy social media use may explain this. It was also shown that persons with lower earnings were statistically more likely to want cosmetic surgery.

This study found a clear association between lower income and a higher desire for cosmetic surgery, supporting previous research.¹⁵ One may want to improve their appearance to improve their social status or job prospects.

This study examined why people skip cosmetic surgery. As shown in Figure 2, the most common reasons were religious reservations about cosmetic surgery, uncertainty about potential effects, limited understanding about available facilities, and difficulties persuading their families. A previous analysis found that cosmetic surgery was originally banned in Saudi Arabia due to its apparent contradiction with Islamic beliefs.¹⁸ The public disliked cosmetic surgery due to its health risks and negative connotations.¹⁸ A separate study found that religion, age, education, marital status, and other factors strongly influenced breast augmentation acceptance. Religious people had higher self-esteem, life satisfaction, less depression, less media intake, and a lower risk of breast surgery.¹⁹

Fig. 2.

Participants’ reasons for not undergoing cosmetic surgery to date.

In the recent poll, 70% of participants said deformity and scars were their biggest cosmetic surgery fears. The second most common concern was loss of function, cited by 43.4% of individuals. Death was the third most common worry at 28.5%. These findings support a previous study that found that 42.5% of cosmetic plastic surgery patients had scars. The data were acquired by analyzing participants’ plastic surgery knowledge and attitudes.¹¹ Another study found that operation costs hinder performance.²⁰ Please note that our study did not examine the procedure cost. The study also found that 75% of people believed surgery did not scar.²⁰

Alopecia affects all genders and ages, although teenagers who care about their appearance and social status may find it especially unpleasant.²¹ In recent years, young students have been more interested in hair transplantation, maybe due to cultural or sociological causes.²² Modern culture values beauty, which may explain why young people get hair transplants.²³ Social media and other media have created a culture that values appearance. Thus, many young people are pressured to conform to a beauty standard.²³ Hair loss might lower self-confidence and prevent social acceptance and personal success.²⁴ Technical advances and various treatment choices have made hair transplantation more accessible.²⁵ This may have increased the number of young people considering hair transplantation for hair loss. Younger people may also be more likely to undergo cosmetic operations like hair transplantation to improve their appearance and appeal to potential partners.²⁴ This is especially important for singles looking for love. The research also found that those with lower household earnings were more likely to seek cosmetic surgery, maybe because they believed it would improve their social status and job prospects. This supports a prior study on socioeconomic status and cosmetic surgery attitudes.²⁶

Media, marketing, and social media impact patients’ cosmetic surgery decisions, according to 76.4% of participants. The majority of responders (89.6%) used social media for information. These findings match a recent study²⁶ that revealed more than 70% of consumers deemed a cosmetic surgeon’s website quality the most essential element in their decision. Social media imagery, infographics on the surgeon’s website, and other patients’ experiences or testimonies might help patients comprehend or feel confident about a surgical operation. This does not mean the patient understands how the procedure applies to them or the risks.²⁷ However, if the treatment fails to meet the patient’s expectations, the patient feels betrayed by the plastic surgeon and the physician’s reputation, a phenomenon called “institutional betrayal.”^28,29 Walker et al²³ found that women’s social media posts of before and after photographs of cosmetic surgery affect the public’s willingness to do it. This was consistent throughout their investigation. A US study of 100 patients revealed that 50% preferred viewing photographs of before and after surgery over watching movies, reading reviews, or researching the medical practice.³⁰ The above-mentioned criteria demonstrate social media’s significant influence on cosmetic surgery motivation. However, providing participants with accurate information is not necessary; thus, all social media content must be checked and authenticated.

Although insightful, the research had significant limitations. The study initially included a small sample of university students, which may not accurately represent the population. The research was also limited to Saudi Arabia, limiting its applicability. The research also showed sample bias against some groups, specifically medical college graduates who may have higher skill due to their education. The research relied solely on participant data, which may be unreliable. Future research should include a wider and more diverse sample of Saudi Arabians to expand on this study’s findings. Researchers could improve such research by using observational studies or medical records to measure cosmetic surgery knowledge and attitudes. It would also be useful to study how sociocultural factors affect cosmetic surgery attitudes. Longitudinal research may reveal cosmetic surgery perspectives’ progression. During patient meetings, doctors should emphasize cosmetic surgery education.

CONCLUSIONS

This study reveals Saudi university students’ views on aesthetic surgery. The poll found that although many participants knew someone who had cosmetic surgery, few were interested in it. Women were more likely than men to want cosmetic surgery, possibly due to cultural pressures to look a certain way. This study provides valuable insights into Saudi cosmetic surgery, despite its limitations. It stresses the need for greater research to understand what influences people’s perspectives and attitudes toward cosmetic surgery. This study may help healthcare professionals improve patient consultations and create cosmetic surgery laws. Education about cosmetic surgery may help people make better decisions and have better results.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

PATIENT CONSENT

Verbal agreement was obtained from each participant before allowing them to voluntarily take part in the study.

ETHICAL APPROVAL

Before beginning the study, permission from the Research Ethics Committee at Al Imam Mohammad Ibn Saud University was obtained, and the committee was provided with a formal explanation of the study’s purpose.