Abstract
The pursuit of aesthetic enhancement through cosmetic dermatology has increased globally, influenced by societal beauty standards and social media. Self-esteem plays a pivotal role in shaping individuals’ choices for cosmetic dermatology procedures. To examine the relationship between self-esteem and preferences for cosmetic dermatologic procedures among the Saudi population, utilizing the Rosenberg Self-Esteem Scale. A cross-sectional survey was conducted among 919 participants in Saudi Arabia. The modified Arabic version of the Rosenberg Self-Esteem Scale assessed self-esteem levels. Demographic data, skincare habits, and cosmetic procedure preferences were analyzed using χ2 and multivariate regression tests. Low self-esteem was prevalent in 26% of participants and significantly associated with specific skincare habits (e.g., applying routines to hands and neck) and prior cosmetic procedures targeting visible body areas (P < .05). Participants without a history of cosmetic procedures were 1.72 times more likely to exhibit low self-esteem (adjusted odds ratio = 1.718; P = .002), whereas those not planning future procedures showed a decreased likelihood of low self-esteem (adjusted odds ratio = 0.501; P < .001). The study highlights a significant relationship between low self-esteem and increased engagement in cosmetic-seeking behaviors. Understanding these psychological factors can guide practitioners toward more patient-centered care.
Keywords: aesthetic dermatology, body image, cosmetic dermatologic procedures, cosmetic dermatology, cosmetic-seeking behaviors, psychosocial health, Rosenberg Self-Esteem Scale, self-esteem
1. Introduction
The pursuit of aesthetic enhancement, encompassing the use of cosmetics and various surgical and nonsurgical procedures, has witnessed remarkable growth globally. This trend is largely driven by the pervasive influence of social media, which continues to redefine societal beauty standards. With over half of the global population actively engaging with social media platforms, and this number steadily increasing,[1] image-centric platforms such as Instagram, Snapchat, and TikTok have amplified the pressure to present an idealized appearance.[1,2]
This growing emphasis on physical appearance has profound psychosocial implications, particularly concerning self-esteem. The American Psychological Association defines self-esteem as the degree to which an individual views their qualities and characteristics positively.[3] Studies have consistently highlighted the significant impact of physical appearance on self-esteem. Physical appearance, as a central component of self-image, significantly influences how individuals perceive their worth and confidence. This relationship often manifests in the desire to modify or enhance features to meet societal expectations or personal standards of beauty.[4] Cosmetic dermatology, offering an array of procedures from minimally invasive treatments to comprehensive interventions, plays a pivotal role in this dynamic. Choices in aesthetic treatments are not solely motivated by physical enhancement but are deeply intertwined with psychological factors such as self-esteem and self-image. Individuals with lower self-esteem may seek cosmetic procedures to address perceived inadequacies, while those with higher self-esteem might pursue such enhancements to maintain or elevate their appearance.[4] The motivations behind these decisions are complex, reflecting an interplay of internal self-perceptions and external societal pressures.
In light of these considerations, our study aimed to examine the relationship between self-esteem and individual choices and preferences for cosmetic and aesthetic dermatologic procedures. Using the Rosenberg Self-Esteem Scale (RSES), we focused on the public population of Saudi Arabia, a nation with over 35 million people, where ≈80% are active social media users.[5] This demographic provides a unique and relevant context for exploring how social influences and self-esteem intersect with cosmetic-seeking behavior. Understanding this relationship not only sheds light on the psychosocial dimensions of cosmetic dermatology but also informs practitioners about the psychological aspects influencing their patients’ choices, enabling more holistic and patient-centered care.
2. Materials and methods
2.1. Study design
This cross-sectional study employed an online survey distributed via Google Forms, targeting the general Saudi population. The survey was shared across multiple social media platforms, including X, WhatsApp, Instagram, TikTok, Snapchat, and LinkedIn. All adults were eligible to participate, and data collection was conducted from August to October 2024.
2.2. Sample size
Convenience sampling was used, with the sample size calculated to achieve a 95% confidence level and a 5% margin of error. A total of 919 participants were enrolled, satisfying the required sample size.
2.3. Study tool
The population’s self-esteem was assessed using the RSES.[6] The RSES measures self-esteem using 10 items answered on a 4-point Likert-type scale: from strongly agree to strongly disagree. For this study, we utilized the modified Arabic version of the RSES as developed by Oweis et al.[7] This version has been adapted to ensure cultural relevance and linguistic accuracy while retaining the psychometric integrity of the original scale, with a reported Cronbach α of 0.81 in their study sample.[7] The RSES is one of the most widely used measures of self-esteem. After reverse-scoring the negatively worded items, the scale can also be scored by totaling the individual 4-point items. The RSES demonstrates a Guttman scale coefficient of reproducibility of 0.92, indicating excellent internal consistency. Test–retest reliability over a period of 2 weeks reveals correlations of 0.85 and 0.88, indicating excellent stability. Low self-esteem was defined as a score below 15, following the cutoff used in the original RSES and in the validated Arabic version of the RSES.[6,7]
In this study, the term “cosmetic procedures” refers to participant-reported interventions aimed at enhancing physical appearance. These included both nonsurgical treatments (e.g., laser therapies, facial treatments like HydraFacial, chemical or cold peels, botulinum toxin, fillers, platelet rich plasma, radiofrequency, and high-intensity focused ultrasound) and cosmetic surgical procedures, as listed in the survey’s multiple-response items on prior and desired cosmetic interventions.
2.4. Demographic information
The demographic section comprised 9 questions addressing age, gender, region of residence, marital status, smoking status, employment status, monthly income, education level, and history of psychiatric diagnoses. Age was categorized as ≤30 and >30 years to simplify group comparisons and reflect general cosmetic usage patterns.
2.5. Ethical consideration
The study was approved by the institutional review board of the College of Medicine at King Saud University, Riyadh, Saudi Arabia. Participants provided informed consent through an online questionnaire after being briefed on the study’s objectives and assured of their right to withdraw at any time without obligation. To ensure anonymity, no identifying information was collected, and no incentives or rewards were offered for participation.
To minimize selection bias, participants were recruited from a diverse range of social media platforms to ensure a broad representation of the Saudi population. Also, to reduce response bias, the survey was designed to be anonymous, preventing social desirability effects.
2.6. Statistical data analysis
Categorical variables were summarized as frequencies and percentages (%). The χ2 test was used to assess the relationship between self-esteem levels, sociodemographic characteristics, and cosmetic dermatology choices. Significant findings were further analyzed using multivariate regression to identify independent predictors of low self-esteem. In addition, the χ2 test was applied to compare cosmetic/aesthetic dermatology choices by gender. A P value threshold of .05 was set to determine statistical significance. All survey questions were mandatory in the Google Forms platform, ensuring complete datasets with no missing responses for analysis. Data analysis was performed using IBM Statistical Package for the Social Sciences Statistics, version 26 (Armonk).
3. Results
This study enrolled 919 participants. As described in (Table 1), 45.2% were between 18 and 25 years old, with females being dominant (68.7%). Approximately half (50.1%) lived in the Central Region, and 58.8% were single. The prevalence of smokers in this study was 7.8%. Respondents who were earning <5000 Saudi Riyal per month constituted 21.3%. Participants who were bachelor’s degree holders were 55.4%. In addition, 12.5% had a previous diagnosis of psychiatric conditions.
Table 1.
Sociodemographic characteristics of participants (n = 919).
| Study data | N (%) |
|---|---|
| Age group (yr) | |
| • 18–25 | 415 (45.2%) |
| • 26–35 | 185 (20.1%) |
| • 36–50 | 256 (27.9%) |
| • >50 | 63 (06.9%) |
| Gender | |
| • Male | 288 (31.3%) |
| • Female | 631 (68.7%) |
| Region of residence | |
| • Central Region | 460 (50.1%) |
| • Western Region | 265 (28.8%) |
| • Eastern Region | 87 (09.5%) |
| • Northern Region | 48 (05.2%) |
| • Southern Region | 59 (06.4%) |
| Marital status | |
| • Single | 540 (58.8%) |
| • Married | 341 (37.1%) |
| • Divorced | 31 (03.4%) |
| • Widowed | 07 (0.80%) |
| Smoking status | |
| • Smoker | 72 (07.8%) |
| • Nonsmoker | 825 (89.8%) |
| • Ex-smoker | 22 (02.4%) |
| Occupational status | |
| • Unemployed | 160 (17.4%) |
| • Student | 374 (40.7%) |
| • Health care field | 69 (07.5%) |
| • Nonhealth care field | 280 (30.5%) |
| • Retired | 36 (03.9%) |
| Monthly income (SAR) | |
| • No income | 350 (38.1%) |
| • <5000 | 196 (21.3%) |
| • 5000–10,000 | 135 (14.7%) |
| • 10,000–20,000 | 182 (19.8%) |
| • >20,000 | 56 (06.1%) |
| Educational level | |
| • High school or below | 217 (23.6%) |
| • Diploma | 63 (06.9%) |
| • Bachelor’s degree | 509 (55.4%) |
| • Master’s degree | 82 (08.9%) |
| • PhD | 48 (05.2%) |
| Previous diagnosis of any psychiatric conditions | |
| • No | 804 (87.5%) |
| • Yes | 115 (12.5%) |
SAR = Saudi Riyal.
Table 2 shows that respondents with low self-esteem were associated with applying a skincare routine in their hands (P = .023) and neck (P = .037). Regarding the type of skincare products, based on the multiple-response answers, it was observed that moisturizer was the most commonly used skincare product (low: 75.3% vs normal: 75%), followed by cleansers (low: 63.2% vs 65%) and sunscreen (low: 41.4% vs 47.1%). However, these differences in self-esteem did not reach statistical significance (P > .05). Also, no significant relationship was observed between self-esteem and makeup frequency (P = .234). Regarding previous treatment to body areas, it was shown that respondents with low self-esteem were associated with previous treatment on the neck (P = .021), while respondents without a previous history of body area enhancement were less likely to have experienced low self-esteem (P = .022).
Table 2.
Type and application areas of skin care products in relation to the level of self-esteem (n = 919).
| Variables | Low, N (%) (n = 239) |
Normal, N (%) (n = 680) |
P value* |
|---|---|---|---|
| What are the areas you apply a daily skincare routine† | |||
| Face | 174 (72.8%) | 530 (77.9%) | .107 |
| Hands | 118 (49.4%) | 278 (40.9%) | .023‡ |
| Body | 100 (41.8%) | 259 (38.1%) | .306 |
| Around eyes | 80 (33.5%) | 210 (30.9%) | .459 |
| Neck | 76 (31.8%) | 169 (24.9%) | .037‡ |
| None | 42 (17.6%) | 108 (15.9%) | .543 |
| Type of skin care products† | |||
| Moisturizer | 180 (75.3%) | 510 (75.0%) | .923 |
| Cleansers | 151 (63.2%) | 442 (65.0%) | .613 |
| Sunscreen | 99 (41.4%) | 320 (47.1%) | .132 |
| Makeup remover | 91 (38.1%) | 244 (35.9%) | .545 |
| Antiaging products | 54 (22.6%) | 172 (25.3%) | .404 |
| Toners | 44 (18.4%) | 130 (19.1%) | .810 |
| Anticellulite creams | 07 (02.9%) | 14 (02.1%) | .439 |
| Others | 04 (01.7%) | 09 (01.3%) | .751 |
| None | 34 (14.2%) | 81 (11.9%) | .352 |
| Makeup frequency | |||
| Every day | 19 (07.9%) | 79 (11.6%) | .234 |
| A few times a week | 67 (28.0%) | 170 (25.0%) | |
| A few times a month | 40 (16.7%) | 124 (18.2%) | |
| A few time a year | 33 (13.8%) | 68 (10.0%) | |
| Never | 80 (33.5%) | 239 (35.1%) | |
| The body area you have treated/enhanced before† | |||
| Face | 150 (62.8%) | 394 (57.9%) | .192 |
| Body | 92 (38.5%) | 219 (32.2%) | .077 |
| Around eyes | 86 (36.0%) | 215 (31.6%) | .216 |
| Hands | 51 (21.3%) | 108 (15.9%) | .055 |
| Neck | 46 (19.2%) | 89 (13.1%) | .021‡ |
| None | 39 (16.3%) | 159 (23.4%) | .022‡ |
P value has been calculated using χ2 test.
Variables with multiple-response answers.
Significant at P < .05 level.
In Figure 1, the prevalence of participants with low self-esteem was 26%, while the rest were normal (74%). The overall mean score of the RSE scale was 15.5 (SD: 1.88). In Figure 2, based on multiple-response answers, the most common cosmetic procedure previously performed among respondents was laser (low: 29.3% vs normal: 35.3%), followed by facial, for example, hydra facial (low: 18% vs normal: 19.1%), and dermal filler (low: 14.6% vs normal: 19.1%). However, respondents who did not have a history of cosmetic procedures were less likely to be diagnosed with lower self-esteem (P = .030). In Figure 3), the most common cosmetic procedure that participants wished to undergo was facial, for example, hydra facial (low: 31.4% vs normal: 24.6%; P = .039), followed by laser (low: 28% vs 21.3%; P = .034) and chemical/cold peel (low: 18.8% vs 17.6%; P = .682).
Figure 1.
Level of self-esteem according to Rosenberg Self-Esteem Scale. PRP = platelet rich plasma.
Figure 2.
Type of cosmetic procedure previously undertaken in regard to the level of self-esteem.
Figure 3.
Type of cosmetic procedure wishes to undergo according to the level of self-esteem. PRP = platelet rich plasma.
Table 3 shows inverse significant correlations between total self-esteem score in terms of the number of treated/enhanced body areas (r = −0.094, P = .004) and the number of cosmetic procedures wished to be taken (r = −0.082, P = .013). No significant correlations were observed between the total self-esteem score in relation to the total number of areas applied daily skincare, the total number of skincare products, and the number of cosmetic procedures being undertaken (P > .05). Measuring the relationship between self-esteem among the sociodemographic characteristics and the cosmetic dermatology choices of participants found that younger age group (P = .007), decreasing monthly income (P = .021), no previous history of cosmetic procedure (P = .018) and planned to undergo cosmetic procedure (P = .022) were associated with low self-esteem. No significant relationships were observed between the level of self-esteem in terms of gender, marital status, education, employment status, makeup frequency, total number of areas applied daily skincare, and total number of skincare products (all P > .05) (Table 4).
Table 3.
Correlation between self-esteem score among the number of body areas and the number of cosmetic surgeries being undertaken and planned to undertake (n = 919).
| Variables | Self-esteem score | |
|---|---|---|
| R value | P value* | |
| Total number of areas applied daily skincare | −0.065 | .051 |
| Total number of skincare products | 0.013 | .695 |
| Number of treated/enhanced body areas | −0.094 | .004† |
| Number of cosmetic procedures being taken | 0.036 | .275 |
| Number of cosmetic procedures wished to be taken | −0.082 | .013† |
P value has been calculated using Pearson correlation test.
Significant at P < .05 level.
Table 4.
Relationship between self-esteem among the sociodemographic characteristics and the cosmetic dermatology choices (n = 919).
| Factor | Level of self-esteem | P value* | |
|---|---|---|---|
| Low, N (%) (n = 239) |
Normal, N (%) (n = 680) |
||
| Age group (years) | |||
| ≤30 | 156 (65.3%) | 376 (55.3%) | .007† |
| >30 | 83 (34.7%) | 304 (44.7%) | |
| Gender | |||
| Male | 78 (32.6%) | 210 (30.9%) | .615 |
| Female | 161 (67.4%) | 470 (69.1%) | |
| Marital status | |||
| Never been married | 145 (60.7%) | 395 (58.1%) | .486 |
| Been married | 94 (39.3%) | 285 (41.9%) | |
| Educational level | |||
| Diploma or below | 75 (31.4%) | 205 (30.1%) | .722 |
| Bachelor or higher | 164 (68.6%) | 475 (69.9%) | |
| Employment status | |||
| Unemployed | 51 (21.3%) | 145 (21.3%) | .992 |
| Student | 98 (41.0%) | 276 (40.6%) | |
| Employed | 90 (37.7%) | 259 (38.1%) | |
| Monthly income (SAR) | |||
| No income | 96 (40.2%) | 254 (37.4%) | .021† |
| <10,000 | 97 (40.6%) | 234 (34.4%) | |
| ≥10,000 | 46 (19.2%) | 192 (28.2%) | |
| Makeup frequency | |||
| Every day | 19 (07.9%) | 79 (11.6%) | .234 |
| A few times a week | 67 (28.0%) | 170 (25.0%) | |
| A few times a month | 40 (16.7%) | 124 (18.2%) | |
| A few time a year | 33 (13.8%) | 68 (10.0%) | |
| Never | 80 (33.5%) | 239 (35.1%) | |
| Total number of areas applied daily skincare | |||
| ≤3 | 180 (75.3%) | 535 (78.7%) | .282 |
| >3 | 59 (24.7%) | 145 (21.3%) | |
| Total number of skincare products | |||
| ≤3 | 158 (66.1%) | 441 (64.9%) | .726 |
| >3 | 81 (33.9%) | 239 (35.1%) | |
| Any cosmetic procedure undertaken | |||
| Yes | 99 (41.4%) | 342 (50.3%) | .018† |
| No | 140 (58.6%) | 338 (49.7%) | |
| Any cosmetic procedure wished to be taken | |||
| Yes | 164 (68.6%) | 410 (60.3%) | .022† |
| No | 75 (31.4%) | 270 (39.7%) | |
SAR = Saudi Riyal.
P value has been calculated using the χ2 test.
Significant at P < .05 level.
On the basis of the significant results obtained from the cross-tabulation method, a multivariate regression analysis was subsequently performed to determine the significant independent predictors of low self-esteem. According to the results, compared with participants who had a previous history of cosmetic procedures, participants without a previous history of cosmetic procedures had an increased chance of having low self-esteem by at least 1.72 times higher (adjusted odds ratio [AOR] = 1.718, 95% confidence interval [CI] = 1.213–2.433, P = .002). In contrast, compared with participants who wished to undergo cosmetic procedures, participants who had no plans for cosmetic procedures had a decreased chance of low self-esteem by at least 50% (AOR = 0.501, 95% CI = 0.352–0.714, P < .001). No significant effects were observed between low self-esteem in terms of age and monthly income after adjustments to a regression model (P > .05) (Table 5).
Table 5.
Multivariate regression analysis to determine the significant independent predictor of low self-esteem (n = 919).
| Factor | AOR | 95% CI | P value |
|---|---|---|---|
| Age group (years) | |||
| ≤30 | Ref | ||
| >30 | 0.752 | 0.523–1.081 | .124 |
| Monthly income (SAR) | |||
| No income | Reference | ||
| <10,000 | 0.825 | 0.518–1.314 | .418 |
| ≥10,000 | 0.668 | 0.432–1.035 | .071 |
| Any cosmetic procedure undertaken | |||
| Yes | Ref | ||
| No | 1.718 | 1.213–2.433 | .002* |
| Any cosmetic procedure wished to be taken | |||
| Yes | Reference | ||
| No | 0.501 | 0.352–0.714 | <.001* |
AOR = adjusted odds ratio, CI = confidence interval, SAR = Saudi Riyal.
Significant at P < .05 level.
4. Discussion
4.1. Background and relevance
This study aimed to explore the relationship between self-esteem and cosmetic-seeking behavior among the public population in Saudi Arabia. The key findings indicate that individuals with low self-esteem are more likely to engage in specific skincare routines and express a desire for certain cosmetic procedures. Notably, low self-esteem was associated with applying skincare routines to the hands and neck, previous treatments on the neck, and a higher inclination toward procedures like facial treatments and laser therapies.
4.2. Comparison with literature
Our study included 919 participants, with 45.2% aged between 18 and 25 years, and a majority being female (68.7%). Approximately half of the participants resided in the Central Region of Saudi Arabia (50.1%). In addition, 12.5% reported having a previous diagnosis of psychiatric conditions. Many studies addressed the relationship between self-esteem and cosmetic-seeking behavior such as botox injections, soft tissue fillers, and laser therapies; with middle-aged individuals as the primary target population.[8–10] However, children and adolescents were found to have lower self-esteem due to dermatological conditions such as acne vulgaris and hair loss.[11,12] The predominance of female gender in the study aligned with prior research that reported a statistically significant difference according to gender. They noted that women have a lower level of emotional well-being than men, as well as greater knowledge and a more positive attitude toward cosmetic dermatology.[9] Another study has found that higher engagement in cosmetic-seeking behaviors was attributed to greater exposure to beauty standards and access to media. Nevertheless, partners and peers had some associations with the utilization of cosmetic products and procedures.[13] The proportion of participants with psychiatric conditions mirrors findings that mental health issues are common among individuals interested in cosmetic enhancements. A study conducted in Mexico on women who underwent body-contouring cosmetic surgery showed that one-third of the population received psychological attention, as well as around half of them having an episode of depression during their lifetime.[8]
The study found that respondents with low self-esteem were significantly more likely to apply skincare routines to their hands (P = .023) and neck (P = .037) compared to those with normal self-esteem. These findings align with previous research suggesting that individuals may focus more on enhancing specific visible body areas, as antiaging supplements or vitamins and hair removal procedures were most frequently utilized.[13] On the other hand, a study stated that cosmetic surgery has a significant impact on self-esteem, where enhancing body image reduces appearance-related burdens and provides psychological benefits linked to self-esteem. In addition, cosmetic surgery has been shown to improve overall quality of life outcomes.[14] A recent study found an association between upper face dynamic wrinkles and self-esteem. Interestingly, it showed a statistically significant increase in the self-esteem of the participants who were observed 2 weeks after the injection of botulinum toxin. However, the beneficial effects on self-esteem were not presented 3 months following the injection.[15]
The study found no significant relationship between self-esteem and makeup frequency among participants (P = .234). This goes in contrast with prior research done in 2022 which concluded that higher self-esteem was related to higher makeup frequency.[16] The lack of a significant relationship in our study may be related to the fact that makeup usage is influenced by other factors other than self-esteem alone. Respondents with low self-esteem were significantly more likely to have previously received treatments on the neck (P = .021). The significant link between low self-esteem and previous treatments on the neck supports findings from studies indicating that individuals with lower self-esteem are more likely to pursue cosmetic procedures targeting specific body areas they perceive negatively.[17] In addition, participants without a history of body area enhancement were less likely to experience low self-esteem (P = .022). This finding is consistent with previous research that observed that individuals with greater body appreciation exhibited lower interest in cosmetic surgery, indicating a positive self-perception reduces the desire for aesthetic procedures.[18]
The study found that the most common cosmetic procedures previously performed among respondents were laser treatments (low self-esteem: 29.3% vs normal self-esteem: 35.3%), followed by facials such as hydra facials (low: 18% vs normal: 19.1%) and dermal fillers (low: 14.6% vs normal: 19.1%). Similar findings were reported by Alharethy[19] in a study done in 2017 to report the demographic trends in Saudi patients undergoing cosmetic procedures. Our findings align with the aforementioned research except for dermal fillers in which reported percentages were 5.8%. This may be implied due to the exponential growth of dermal fillers over the years. Importantly, respondents without a history of cosmetic procedures were less likely to have low self-esteem (P = .030). These findings resonate with prior research indicating a complex relationship between self-esteem and engagement in cosmetic procedures. A study has shown that the majority of the patients who received cosmetic enhancement reported a significant difference and an overall improvement in self-esteem; however, 2 patients did not show a significant difference in self-esteem. The data stated that the 2 patients had had previous cosmetic procedures which may have resulted in improved self-esteem to begin with, or repetitive engagement in cosmetic procedures may contribute to less satisfaction, and consequently less likely to have improvement in self-esteem.[10] A systematic review was done on the psychosocial outcomes following cosmetic surgery. The findings showed that most of the reviewed studies reported that patients are generally happy with the outcome of cosmetic procedures. Still, patients who were dissatisfied with cosmetic procedures had unrealistic expectations of outcomes or underwent more extensive procedures that required greater psychological adjustment.[20]
The study assessed participants’ self-esteem using the RSES and found that 26% of the participants exhibited low self-esteem, while the remaining 74% had normal self-esteem levels. The overall mean RSE score was 15.5 with a standard deviation of 1.88. The prevalence of low self-esteem among our participants (26%) is consistent with findings from similar populations. For instance, a study done in 2023 on 1099 Saudi university students reported a low self-esteem prevalence of 24.1%.[21] Moreover, a study done in Poland reported that over half of the sample (n = 798) had global low self-esteem.[22] These parallels suggest that low self-esteem is a prevalent concern not only in Saudi Arabia but also globally.
The study found significant inverse correlations between total self-esteem scores and both the number of treated/enhanced body areas (r = −0.094, P = .004) and the number of cosmetic procedures participants wished to undertake (r = −0.082; P = .013). This means that lower self-esteem is associated with a higher number of body areas treated or enhanced and a greater desire for future cosmetic procedures. These findings align with prior research indicating that individuals with higher self-esteem were significantly associated with lower cosmetic usage.[23] Moreover, a recent study done in Saudi Arabia stated that >70% of the population who sought noninvasive cosmetic procedures reported that the primary motivation to undergo cosmetic procedures was to increase their perceived attractiveness level; consequently, they had high self-esteem.[24]
The analysis revealed that low self-esteem was significantly associated with being in the younger age group (P = .007), having a decreasing monthly income (P = .021), having no previous history of cosmetic procedures (P = .018), and planning to undergo a cosmetic procedure (P = .022). These findings align with prior research indicating that younger individuals often experience lower self-esteem and heightened body image concerns. The study found that higher age was significantly associated with higher self-esteem.[24] The association between lower income is also supported by existing literature. A study reported that socioeconomic status is associated with engagement in cosmetic procedures, with individuals from families with higher incomes having significantly higher possibilities of having cosmetic procedures.[25] Lower-income backgrounds tend to report lower self-esteem levels. Financial limitations may contribute to feelings of inadequacy or restrict access to means of enhancing appearance, thereby impacting self-esteem. The significant association between planning to undergo a cosmetic procedure and low self-esteem (P = .022) suggests that individuals reporting lower self-esteem more frequently express interest in cosmetic enhancements. This is consistent with prior literature, which found that one of the important factors for pursuing cosmetic procedures.[26]
The multivariate regression analysis identified significant independent predictors of low self-esteem among participants. Specifically, individuals without a previous history of cosmetic procedures were 1.72 times more likely to have low self-esteem compared to those who had undergone such procedures (AOR = 1.718, 95% CI = 1.213–2.433, P = .002). Conversely, participants who had no plans to undergo cosmetic procedures had a decreased likelihood of having low self-esteem compared to those who wished to undergo them (AOR = 0.501, 95% CI = 0.352–0.714, P < .001). These findings align with previous research exploring the relationship between self-esteem and cosmetic surgery. Studies have indicated that individuals with lower self-esteem are more likely to report interest in cosmetic procedures, possibly as a means to improve their self-image. For example, a systematic review was done to investigate the influence of surgical and minimally invasive facial cosmetic procedures on psychosocial outcomes, and 9 articles measuring self-esteem postprocedure and global improvement were reported.[27] In contrast to prior literature, multiple studies found that low self-esteem is not directly related. For instance, a cross-sectional study assessed the self-esteem and psychological profiles of individuals seeking cosmetic surgery compared with a control group of the general population, the study concluded that individuals seeking cosmetic surgery do not generally exhibit lower self-esteem than the general population.[28] However, associations between body image and other dimensions of self-esteem were significant for both groups, highlighting that the association is multifaceted. Also, the observation that participants without plans for cosmetic procedures had a decreased likelihood of low self-esteem is consistent with studies showing that higher self-esteem is associated with body satisfaction and less interest in altering one’s appearance. Al Ghadeer et al[29] noted a statistically insignificant weak positive correlation between high self-esteem and cosmetic procedures. It was reported that individuals with higher self-esteem are less likely to desire cosmetic procedures.
4.3. Strengths and limitations
A major strength of this study is the sizable sample size of 919 participants, enhancing the representativeness within the digitally active Saudi Arabian population. The use of a validated self-esteem instrument (RSES) adds psychometric reliability to the results. However, the cross-sectional design precludes causal inference, and associations observed should not be interpreted as directional. The reliance on self-reported data may introduce recall and social desirability biases. While anonymity was maintained to reduce such biases, objective validation (e.g., via clinical records) was not feasible given the anonymous, population-based nature of the survey. In addition, the use of convenience sampling through social media may have resulted in demographic overrepresentation – particularly of younger, female, and urban respondents – which may limit generalizability to other subgroups such as older adults, males, or those from rural areas. Lastly, unmeasured psychosocial variables such as cultural pressure, peer influence, and media exposure were not assessed and may serve as important confounders in the relationship between self-esteem and cosmetic behavior.
4.4. Recommendations for future research
Future studies should consider longitudinal designs to assess changes in self-esteem and cosmetic-seeking behavior over time. In the current study, factors such as media exposure, cultural expectations, and peer influence were not directly measured. However, they may serve as important confounders and moderators in the relationship between self-esteem and cosmetic preferences. Future research should aim to include and control for these psychosocial variables to provide a more comprehensive understanding of the underlying mechanisms driving interest in cosmetic procedures. In addition, studies should strive for more balanced gender representation and explore targeted interventions aimed at improving self-esteem, particularly among populations at greater risk for appearance-related distress.
5. Conclusion
The intersection of self-esteem and cosmetic dermatology is deeply rooted in societal beauty standards and the pervasive influence of social media, which have significantly shaped individual perceptions of attractiveness and self-worth. Globally, the pursuit of aesthetic enhancement has become increasingly common, with cosmetic dermatology offering various procedures to address perceived imperfections. This study highlights a significant association between low self-esteem and cosmetic-seeking behavior among the public population in Saudi Arabia. Individuals with lower self-esteem more frequently reported engaging in specific skincare routines and expressed interest in cosmetic procedures, particularly targeting visible body areas. These insights underscore the need for integrated approaches in healthcare that address both psychological well-being and aesthetic concerns. By acknowledging the underlying self-esteem issues, practitioners can offer more holistic care, and policymakers can develop targeted initiatives to promote mental health and healthy self-perception.
Author contributions
Conceptualization: Almuntsrbellah Almudimeegh, Eman Almukhadeb.
Methodology: Almuntsrbellah Almudimeegh, Eman Almukhadeb, Khalid Nabil Nagshabandi, Naif Alshehri, Ibrahim Aldakhil.
Project administration: Almuntsrbellah Almudimeegh, Khalid Nabil Nagshabandi.
Supervision: Almuntsrbellah Almudimeegh, Eman Almukhadeb.
Investigation: Eman Almukhadeb.
Data curation: Khalid Nabil Nagshabandi, Omar Aldosari, Ibrahim Aldakhil.
Formal analysis: Khalid Nabil Nagshabandi, Omar Aldosari.
Writing – review & editing: Khalid Nabil Nagshabandi, Naif Alshehri, Hala Abdullah Almusa.
Visualization: Naif Alshehri, Hala Abdullah Almusa, Omar Aldosari.
Writing – original draft: Naif Alshehri, Hala Abdullah Almusa, Ibrahim Aldakhil.
Validation: Omar Aldosari.
Resources: Ibrahim Aldakhil.
Abbreviations:
- AOR
- adjusted odds ratio
- CI
- confidence interval
- RSES
- Rosenberg Self-Esteem Scale
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are publicly available and are available from the corresponding author upon reasonable request.
How to cite this article: Almudimeegh A, Almukhadeb E, Nagshabandi KN, Alshehri N, Almusa HA, Aldosari O, Aldakhil I. The impact of individuals’ self-esteem on cosmetic dermatology preferences assessed using the Rosenberg Self-Esteem Scale: A cross-sectional study. Medicine 2025;104:26(e43109).
Contributor Information
Almuntsrbellah Almudimeegh, Email: almontaserbellah@hotmail.com.
Eman Almukhadeb, Email: ealmukhadeb@ksu.edu.sa.
Khalid Nabil Nagshabandi, Email: khaloed23@gmail.com.
Hala Abdullah Almusa, Email: hala.almussa@gmail.com.
Omar Aldosari, Email: omar.aldosari2015@gmail.com.
Ibrahim Aldakhil, Email: Ibrahimkd20@gmail.com.
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