Discussion
Of the women between 18 and 60 years of age who took part in the survey, 17 % had undergone cosmetic surgery. When combined with another recent but smaller study, the findings indicate a considerable increase in the use of cosmetic surgery in Norway, compared to 7.7 % in a study from 2003 which asked the same questions (7, 10).
The findings also suggest an increase in social acceptance of cosmetic surgery over the same period. As many as 74 % of respondents reported that they knew someone who had undergone cosmetic surgery, a rise from 56 % in 2003 (7). Over the same period, the share of women who had been recommended cosmetic surgery by people they knew rose from 6 % to 18 %. The results also showed an increase in the share of women who desired cosmetic surgery, from 23 % to 52 %, although this question was phrased slightly differently.
An interesting finding is that as many as 78 % of the women who had undergone cosmetic surgery considered it likely that they would undergo another procedure, compared to approximately half the women who had never had cosmetic surgery. Most women report that they are satisfied with the results of cosmetic surgery (14), which may explain their positive attitude towards further procedures. Alternatively, this finding may suggest that a subset of women who desire repeat cosmetic procedures suffer from body dysmorphic disorder (1).
Changes in the interest for and the prevalence of various types of cosmetic procedures may be a reflection of medical and technological developments, as well as shifts in marketing and body ideals. Cosmetic breast surgery was the most common surgical procedure at both reference points: 49 % in 2003 (7) and 43 % in 2022. About a third of the women who stated that they were somewhat to highly likely to undergo procedures, desired cosmetic eye surgery. This interest can potentially be explained by the increased use of video meetings, which has led to a greater focus on the face (1, 2), and a wish to counteract signs of ageing, like drooping eye lids, for cosmetic and/or medical reasons. Although genital cosmetic surgery accounted for 5 % of the desired procedures, only 2 % of all procedures performed were of this type. This may suggest that genital surgery remains uncommon, despite media posts suggesting the opposite (15).
Several of the factors that were associated with having undergone cosmetic surgery procedures or desiring such procedures in 2003 (7, 10), were also key in 2022, such as social acceptance of cosmetic surgery and a negative body image. In addition to these factors, we found a correlation between regular use of appearance-focused media, irrespective of age, and having undergone or desiring cosmetic surgery. Overall, the findings underpin the importance of social norms and media influence. The media and social networks play a role in conveying prevailing body ideals and provide examples of ways to attain these ideals for those who are dissatisfied with their body. Talking about cosmetic surgery with acquaintances and engaging with social media can normalise the decision to undergo such procedures, lessen perceived risks and spread information about new cosmetic procedures (1, 2, 11).
In terms of body image and social media use, there were few differences between women who had undergone cosmetic surgery and those who desired such surgery. However, there were differences between the two groups when it came to social acceptance. This may suggest that knowing other people who have undergone cosmetic surgery and receiving recommendations for cosmetic surgery could be contributing factors in the decision to have surgery.
In this study, women who had undergone or desired cosmetic surgery were older, and had lower levels of education, than those who did not desire surgery. A lower level of education was also found by Margraf et al. (16), and has been associated with reduced health literacy, i.e. the capacity to obtain and understand health information, and being more easily influenced by marketing (17). Somewhat surprisingly, no differences were found in the use of cosmetic surgery in relation to partner status, despite this having been found in other studies (1, 2, 16).
It is a weakness of the study that the sample was recruited from a research panel, as this makes it difficult to assess how the use of cosmetic surgery has changed over time. This recruitment pool differs from the two earlier Norwegian studies, which recruited their sample from the National Population Register (7) and Statistics Norway's population database (8). Self-selection can contribute to over-estimation in studies about cosmetic surgery (7–9), and systematic differences in such samples involving other characteristics and variables cannot be ruled out. For example, it is possible that telephone interviewing made it difficult for some participants to answer questions about genital surgery. Furthermore, the response rate was lower for questions about body weight and income, as we have found in other surveys.
Another limitation of the study was that cosmetic surgery was categorised by areas of the body rather than by type of procedure, such as liposuction. Participants were also not asked whether procedures were performed on medical or aesthetic grounds, or both, or if the procedure was performed in the private or public sector.
Increasing exposure to virtually unachievable body ideals in social media, particularly in younger cohorts, combined with normalisation and fiercer marketing of cosmetic surgery (18, 19), suggest a greater need for further research as well as preventive measures. Measures that boost the capacity to resist media influences have proved promising in preventing body dissatisfaction, withstanding body-image pressures, and reducing young women's desire to alter their appearance (20).