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Attitudes Towards Cosmetic Surgery:
A Cross-Cultural Analysis of South Korean and United States Female College Students
Christine Cha
University of California, Santa Barbara
Department of Communication
Despite the increasing prevalence of media attention and national cases of cosmetic surgery, little
scientific research has focused on a cross-cultural examination of attitudes towards cosmetic
surgery in the United States versus South Korea. My cross-cultural analysis research specifically
aims to assess the difference in attitude and perception towards plastic surgery in the United
States and South Korea, and determine whether prevailing cultural perceptions toward plastic
surgery are founded on inherent collectivistic versus individualistic attitudes. Through a cross-
cultural analysis of female South Korean and American college undergraduates, the present
research will demonstrate how attitudes towards cosmetic surgery differs in the two countries,
and whether beliefs and attitudes are cultivated and emphasized through mainstream television.
These findings will have important implications on how to approach future solutions to
effectively communicate risks associated with cosmetic surgery.
Introduction
As an relatively unregulated industry, plastic surgery does not record or assimilate
procedure statistics properly, including situations in which clinics “carry out surgery without the
recommended qualifications and lack of formal training” which can result in a client’s permanent
body disfigurement (Suissa, 2008, p. 622). As a result, the analysis of how United States and
South Korea (henceforth simply regarded as ‘Korea’ throughout the paper) socializes and
cultivates women’s attitudes and beliefs towards cosmetic surgery is important to analyze to
address future problems that may arise due to the escalating popularity of the procedure.
According to the American Academy of Cosmetic Surgery (AACS), cosmetic surgery is the
“unique discipline of medicine focused on enhancing appearance through surgical techniques,
while plastic surgery is defined as a surgical specialty dedicated to the reconstruction of facial
and body defects.” However, like most previous research examining cosmetic surgery, I have
used the terms plastic surgery and cosmetic surgery interchangeably as the contemporary
surgical procedure for aesthetic enhancements.
Ideal Beauty Standards and the Rise of Cosmetic Surgery
Past association of cosmetic surgery as a reconstructive post-war operation following an
accident or disfigurement in combat is defunct as the procedure is now viewed as a common
pursuit to attain ideal beauty standards (Gimlin, 2007). With the modernized “prevailing view
that [cosmetic surgery] no longer epitomizes vanity but personal repair,” cultural expectations
and messages cultivate self-evaluations and socialized perceptions of idealized attractiveness,
which may impel the standardization and personal desire to seek surgical aesthetic enhancement
(King & King, 2005, p. 141). Previous studies found common predictor variables of cosmetic
surgery acceptance, motivation and desire to undergo the procedure included “different
interpersonal factors such as body image dissatisfaction, and internalization of sociocultural
messages from media” (Park, Calogero, Young, & Diraddo, 2010, p. 491). Although cultural
values and beliefs undoubtedly reinforce beauty ideals, a cross-cultural analysis of attitudes
towards cosmetic surgery is important to review because cultural norms shape different
trajectories and perceptions regarding the practice. In particular, the majority of existing research
observing popular attitudes towards cosmetic surgery focuses on women in the United States and
South Korea. According to the International Society of Aesthetic Plastic Surgery, in 2009, South
Korea ranked as number one as the country with citizens who have undergone cosmetic
procedures on a per capita basis, while the same survey recorded United States as the country
with the highest population of total cosmetic surgeries performed (Davies & Han, 2011).
The most common and popular procedures in the United States were body surgeries,
while the most frequent procedure in South Korea were facial surgeries. This phenomenon may
be explained by the different cultural emphasis of ideal beauty and female attractiveness. For
example, Frith, Shaw, and Cheng’s study (2005) found that Koreans magazines had a greater
number of ads showing only the model’s face, while US magazines had higher levels of nudity
and a greater emphasis on body and sexuality (Jung & Lee, 2009). Although various factors such
as lowered procedure costs and improved medical practices contribute to the increasing
popularity of cosmetic surgery, it is important to research the different ideal beauty standards in
the United States versus Korea in order to recognize social dependent and predictor variables of
“this hybrid practice of altering biologically inherited bodies through surgery [that] thrives as a
widely commonplace practice in contemporary medicine” (Suissa, 2008, p. 622).
Plastic Surgery Phenomenon in South Korea
Previous research examining the plastic surgery phenomenon in South Korea often
framed cosmetic surgery as the western cultural influence of beauty ideals or as a feminist issue
of women’s social subjection under the country’s traditional patriarchal system. Plastic surgery is
inarguably extremely prevalent in South Korea among males and females, but the narrow focus
of altering appearances fail to understand the following:
“The influence in Korea of national identity discourses and traditional Korean beliefs and practices, and meanings and practices of aesthetic surgery represent a process of negotiation between multiple discourses concerning national identity, globalized and regionalized standards of beauty, traditional beliefs and practices, as well as the symbolic practices of coming of age, caring for the self, marking social status and seeking success” (Holliday & Hwang, 2012, p. 72).
Korean surgical pursuits do reflect a desire for Caucasian facials such as a thinly sculpted chin, a
prominent nose, and double eyelids (Davies & Han, 2011). However, although these idealized
features reflect the influence of Western beauty standards, plastic surgery phenomenon in South
Korea cannot be simplified as a globalization effect. While Western features are desired by
Korean female prospective customers, “unsuccessful surgeries are often defined as producing an
unnaturally ‘Western’ appearance,’” emphasizing the desire to attain a ‘natural’ Korean look,
such as thin rather than thick double eyelids (Bissel & Chung, 2009, p. 235).
The increasing societal pressure to obtain the “right face” for employment and economic
success can also explain the soaring rates of cosmetic surgery in South Korea. Through the social
norms conveyed through South Korean media culture and the pressure where attractiveness is
perceived as a determining factor in economic success and gaining employment in an extremely
competitive job market. Almost all job applications require a photo attachment, and these
societal pressures to conform to a common ideal standard of beauty normalizes cosmetic surgery
as an “investment to enhance one’s social and economic status” in a country with a high
population but a limited job market to support employment (Suissa, 2008, p. 622). With the high
level of social pressure to adhere to Western-influenced beauty ideals, South Korea epitomizes a
collectivistic culture that advocates conformity, not individuality (Kim, 2003).
U.S Women’s Perceived Attitudes Towards Cosmetic Surgery
Unlike South Korea’s collectivistic attitude and beliefs toward cosmetic surgery, the
United States’ culture of self-improvement and individualist ideals promotes the rise of plastic
surgery. In 2007, Gimlin analyzed post-surgery individual narratives of women in Great Britain
and the United State, and her study found that the U.S respondents frequently emphasized
“attitudes towards cosmetic surgery that emphasized empowerment—willingness to control their
own body to enhance beauty—and self-fulfillment ideals” (p. 279). Moreover, another survey
researching American women’s attitudes of cosmetic surgery acceptance, motivation and
decision to undergo aesthetic surgery found that U.S respondents consistently employed a similar
cultural repertoire that stressed individual choice and responsibility in participants’ decision-
making narratives (Leve, Rubin, & Pusic, 2012). In-depth interviews and narratives found U.S
women reflected a newfound attitude of ‘neoliberal ethos,’ an ideology that situates prospective
cosmetic surgery patients as free agents engaging in “consumer activity and individual risk-
benefit calculations of aesthetic surgery (Leve, Rubin, & Pusic, 2012, p. 133).
Despite U.S. women’s perceived attitudes towards cosmetic surgery, the underlying
cultural and social motivations and influence cannot be overlooked. In King & King’s research
(2005) of middle-aged women’s attitudes towards cosmetic surgery found favorable attitudes
towards the procedure, which may reflect the American ideals of youth as a key determinant of
female attractiveness. As a result, further examinations of cultural norms and beauty ideals in the
Western, individualist context is important to examine to demonstrate the interconnectedness of
social and personal motivations to predict attitudes towards cosmetic surgery in U.S women.
Media Portrayals of Cosmetic Surgery
“Mass media can reflect basic beliefs, attitudes, and values toward female beauty and can
even affect changes in cultures when others are exposed to images of ideal beauty and
attractiveness” (Bissel & Chung, 2009, p. 230). For example, in Harrison’s study (2003), college
students revealed television viewing was associated with views of the ideal female beauty and
approval of women’s use of surgical procedures to alter their bodies. For my research, I included
examining how cosmetic surgery is portrayed and normalized via television broadcasting in
Korea and the United States to examine whether television portrayals have strong implications
towards predicting attitudes, particularly the decision-making process, for individuals who
decide to undergo this procedure and evaluations of others who have undergone cosmetic
surgery.
U.S. Television Messages of Cosmetic Surgery
U.S. Cosmetic-surgery themed television programs have escalated in frequency and
popularity since the first reality program, ABC Extreme Makeover, aired in 2002. Remaining as
one of the strongest studies analyzing U.S plastic surgery programs, Lee’s 2009 study examined
a two-week recording of three plastic surgery programs (Extreme Makeover, Dr. 90210, and
Plastic Surgery Before and After). The research found a singular uniting theme throughout the
three programs—the notion that the ideal female body was a criterion for a woman’s economic
and romantic success. Another similarity was these programs consistently “characterized the
world of plastic surgery as a fountain of youth, an [alternate reality] that nurtures young,
energetic, and good-looking people” (Lee, 2009, p. 512). Such glamorization found these U.S.
plastic surgery television programs also portrayed a sanitized—almost invisible—atmosphere of
the possible risks or complications of these operations. Most importantly, the individualistic
message on these programs that “ugliness becomes our own choice and responsibility”
reinforced the cultural pressure for women to constantly strive to surgically ‘enhance’
themselves to fit unrealistic beauty ideals (Leve, Rubin, & Pusic, 2012, p. 130).
Media Portrayals of Cosmetic Surgery in South Korea
Television portrayals of cosmetic surgery in South Korea enforce a more extreme
message against a backdrop of a “Korean consumer culture that worships beautiful bodies”
(Park, 2007, p. 52). In particular, the celebrity culture of Korean entertainment media has helped
facilitate an increasing normalized perception of cosmetic surgery. For example, Korean popular
stars have become so popular as cultural icons that prospective customers request imitation of
facial features (Shoo, 2006). The role of celebrities in publicizing surgical procedures is
extremely important as celebrities themselves admit through various popular television programs
and interviews their own surgical modifications. Additionally, the digitally-active South Korean
population—also referred to as ‘netizens’—promote celebrity’s ‘enhancements’ through online
communities and social networking sites, as well as portraying a slew of ‘surgical success
stories’ (Davies & Han, 2011). As a result of televised marketing and pervasive exposure of ideal
female attractiveness, the mass media promotes cosmetic surgery as a means to achieve self-
improvement and attain a higher social and economic status. Despite the difference in cultural
messages reflected in television portrayals of cosmetic surgery in the United States versus South
Korea, “the media, in combination with other outside influences, help shape the world in which
these women and men feel they have to be attractive in order to be popular or successful” (Bissel
& Chung, 2009, p. 237). Because the socialization process of television exposure may increase
the acceptability and desirability of cosmetic surgery, my research hopes to find how televised
representation of plastic surgery is associated with evaluations of cosmetic surgery acceptance,
and motivation and decision to undergo cosmetic surgery themselves as an outcome variable.
Method
Design and Participants
Through a cross-cultural analysis of female South Korean and American college
undergraduates, my research design is to examine 50 non-randomly selected Caucasian women
attending the University of California, Santa Barbara. Volunteers for the study will indicate their
ethnicity during a pre-study questionnaire for those interested in being included for my research.
Also, 50 non-randomly selected South Korean women attending a university in Seoul will
receive the same questionnaire that was distributed to their American counterparts but the
questionnaire will be written in Korean and distributed by an aide. The following research
questions and hypotheses indicate the questions my research examines:
RQ1: Are collectivistic beliefs reflected in South Korean college women’s perception
towards cosmetic surgery? Individualistic beliefs reflected in U.S. college women’s
perception towards cosmetic surgery?
RQ2: How is cosmetic surgery portrayed and reflected in television?
H1: South Korean women are more likely to tell others if they have undergone the
cosmetic procedure than their U.S. female counterparts.
H2: South Korean college students are more likely to emphasize stronger attitudes
towards importance of beauty and positive evaluations of cosmetic surgery than their US
female student counterparts.
To indicate whether prevailing social perception towards plastic surgery is founded on a
cultural concept (collectivism versus individualism), my research will demonstrate attitudes and
beliefs towards cosmetic surgery within female college students in the US versus Korea, and
whether social attitudes are cultivated and emphasized through mainstream television.
Procedure
To assess attitudes towards cosmetic surgery, my measures of cosmetic surgery
acceptance, motivation, and desire to undergo the procedure will be based on answers from a 50-
60 questions survey that asks for different demographic data such as ideal weight versus current
weight and height. Both the Korean and American subject pool will receive the questionnaire
that will include Likert-scale items and questions related to standardized instruments such as
Appearance Schemas Inventory, Appearance evaluation, Body Area Satisfaction Scale, Body-
Image Ideal questionnaire, and Rosenberg’s Self-Esteem Inventory. These questions will be
coded to research whether these variables are associated with cosmetic surgery motivation and
decision and undergo plastic surgery, as well as peer and self-evaluations of surgically enhanced
beauty.
However, because of acceptance of cosmetic surgery based on social and cultural values
and norms does not necessarily indicate one’s desire to undergo surgery directly, the Korean
subject pool will also evaluate before/after pictures of celebrities who have undergo aesthetic
surgery. To demonstrate whether media increases likelihood of surgery, the Korean subject pool
will rate acceptability and desire/motivation to undergo plastic surgery in the previous
questionnaire measures, and I will look at whether the positive or negative evaluations of the
before-after pictures also indicate socialized ideals of body image ideals based on cultural beauty
standards.
References
Bissel, K. L., & Chung, J. Y. (2009). Americanized beauty? Predictors of perceived attractiveness from US and South Korean participants based on media exposure, ethnicity, and socio-cultural attitudes toward ideal beauty. Asian Journal of Communication 19(2), 227-247.
Davies, G. & Han, G.S. (2011). Korean cosmetic surgery and digital publicity: Beauty by Korean design. Media International Australia, 146-156.
Gimlin, D. (2007). Accounting for cosmetic surgery in the USA and Great Britain: A cross-cultural analysis of women’s narratives. Sage Publications, 13, 41-60.
Holliday, R. & Hwang, J. E. (2012). Gender, globalization, and aesthetic surgery in South Korea. Body & Society 18(2), 58-81.
Jung, J. & Lee, Y. J. (2009). Cross-cultural examination of women’s fashion and beauty magazine advertisements in the United States and South Korea. Clothes & Textiles Research Journal 27(4), 274-286.
Kim, T. (2003). Neo-Confucian body techniques: Women’s bodies in Korea’s consumer society. Body & Society 9(2), 97-113.
King, D. H. & King, E. H. (2005). Acceptance of cosmetic surgery: Scale development and validation. Body Image, 2, 137-149.
Lee, S. Y. (2009). The power of beauty in reality plastic surgery shows: Romance, career, and happiness. Communication, Culture & Critique, 2, 503-519.
Leve, M., Rubin, L., & Pusic, A. (2012). Cosmetic surgery and neoliberalism. Managing risk and responsibility. Feminism & Psychology 22(1), 121-141.
Park, L. E., Calogero, R. M., Young, A.F., & Diraddo, A. M. (2010). Appearance-based rejection sensitivity predicts body dysmorphic disorder symptoms and cosmetic surgery acceptance. Journal of Social and Clinical Psyhcology 29(5), 489-509.
Park, S. U. (2007). Beauty will save you: The myth and ritual of dieting in korean society. Korea Journal, 41-71.
Shoo, D. (2006). Hybridity and the rise of Korean popular culture in Asia. Media, Culture, & Society 28(1), 25-44.
Soest, T. V., Kvalem, I. L., Skolleborg, K. C., & Roald, H. E. (2006). Psychosocial factors predicting the motivation to undergo cosmetic surgery. Plastic and Reconstructive Surgery, 51-62.
Suissa, A. J. (2008). Addiction to cosmetic surgery: Representations and medicalization of the body. Int J Ment Health Addiction, 6, 619-630.
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