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Self Confidence, Body Image and Social Pressure in Cosmetic Rhinoplasty Surgery Candidates


1 Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, IR Iran
2 Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, IR Iran
3 University of Applied Science and Technology, Qazvin, IR Iran
*Corresponding author: Kazem Hosseinzadeh, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, IR Iran. Tel: +98-9112325786, E-mail: khz@qums.ac.ir.
Biotechnology and Health Sciences. 3(3): e35481 , DOI: 10.17795/bhs-35481
Article Type: Research Article; Received: Dec 13, 2015; Revised: Feb 6, 2016; Accepted: Mar 2, 2016; epub: Jun 28, 2016; collection: Aug 2016

Abstract


Background: In Iran, rhinoplasty has seemingly become the most favorite cosmetic surgery in the recent years, yet, there are limited reports about its psychosocial aspects

Objectives: The main goal of this study was to assess self-confidence, body image and social pressure in cosmetic rhinoplasty surgery candidates.

Patients and Methods: Using convenience sampling, 210 participants over the age of 20 years were enrolled in this study. The only inclusion criterion was agreement to participate in the study. A standard Likert-type questionnaire was used for gathering related data. This study was ap¬proved by the Qazvin University of Medical Sciences. All gathered data were analyzed using the SPSS software with 95% Confidence Interval (CI).

Results: Mean and standard deviation of self confidence, body image and social pressure were lower than the normal community. Statistical analyses showed a significant difference between genders only for mean self-confidence (P ≤ 0.05).

Conclusions: Cosmetic rhinoplasty candidates are in lower psychosocial status than the normal population. Researchers proposed a randomized clinical trial with at least a 12-month follow-up, to assess the effects of surgery on psychosocial dimensions of clients.

Keywords: Self-Confidence; Body Image; Social Pressure; Rhinoplasty

1. Background


The main reason why people seek aesthetic surgery is dissatisfaction with their appearance, which may or may not be caused by body dysmorphic disorders (BDDs) (1). body dysmorphic disorders, according to the diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5), is defined as a “preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others” (2). Increased risk of body dissatisfaction is found in people who feel that their physical appearance does not meet the ideals of beauty. This dissatisfaction reaches extreme levels in patients with BDDs (1). It is important to distinguish between BDDs and normal concerns about physical defects. As BDD patients have underlying psychiatric or psychological problems, they tend to exaggerate slight physical deformities, and are delusional about their physical features (1). Therefore, today, plastic and maxillofacial surgeons tend to evaluate the psychological status of individuals before cosmetic rhinoplasty, however technical results seem to be more important according to their views (1, 3). In Iran, rhinoplasty has seemingly become the most favorite cosmetic surgery in the recent years (3, 4). Yet, it seems necessary to understand the psychosocial motivations of patients; self-confidence, body image and social pressure, before the surgery is done. These three variables are related to each other and affect the patients’ demands for cosmetic rhinoplasty surgery.


Self-confidence is one’s belief and perception about his/her potential ability to do certain tasks. Low self-confidence results in unhealthy behavioral outcomes; seeking for surgical treatment and cosmetic surgery is one. On the other hand, body image is defined as one’s thoughts, feelings and behavior related to their physical features (5, 6). People’s behavior is affected by social pressure, as well. Social pressure is due to the social climate in which people obey social norms (6-8).


In spite of the importance of pre-surgical psychosocial assessment in cosmetic rhinoplasty surgery candidates, limited reports have been concerned with this subject. Therefore, this paper explores the situation of self-confidence, body image and social pressure in candidates of cosmetic rhinoplasty surgery.

2. Objectives


The main goal of this study was to assess self-confidence, body image and social pressure in cosmetic rhinoplasty surgery candidates. The research questions in this study were concerned with means and standard deviations of self-confidence, body image and social pressure in candidates of cosmetic rhinoplasty surgery.

3. Patients and Methods


3.1. Sampling

This was a descriptive cross-sectional study that aimed to explore the status of self-confidence, body image and social pressure in cosmetic rhinoplasty surgery candidates, prior to their surgery. This article was part of a thesis for a doctorate degree in dentistry and was approved by the Qazvin University of Medical Sciences. Using simple randomized sampling method, two hundreds and ten participants over than 20 years of age, were enrolled in the study from aesthetic rhinoplasty surgery centers of Qazvin city, Iran. The sample size was calculated with 95% confidence interval and 5% error with the following formula: N= Z2 pq/d2. Written informed consent was obtained from the participants and memorized them to maintain the special data in safe and private states. The only inclusion criterion was agreement to participate in the study.


3.2. Data Gathering and Analyzing Method:

A researcher-made checklist with the following four separate sections was used for related data gathering: a) Demographic section (with six items), b) Self confidence assessment (with eight items), c) Body image assessment (with five items) and d) Social pressure (with four items). The responses in sections b to d were classified in a five point Likert scale; from definitely agree (score: +2) to definitely disagree (score: -2). In order to obtain the psychometric criteria (validity and reliability), content validity and reliability were assessed. For content validity, ten experts from the faculty viewed the checklist in qualitative assessment. The Cronbach’s alpha for test-retest reliability in 15 participants was 0.79. Data gathering was done with four trained staff; all checklists were assessed for completion. All of the gathered data were coded and later entered in the SPSS software. Using descriptive analyzing methods, means and standard deviations of variables were calculated, and the differences between genders were analyzed with the χ2 parameter.

4. Results


Demographic characteristics of the sample are shown in Table 1. Mean and standard deviation of age in males and females was 20.2 ± 1.1 and 18.3 ± 3.4 years, respectively. More than 75% of the samples were females. Mean and standard deviation of self-confidence, body image and social pressure are shown in Table 2, based on the gender classification. Distribution of self-confidence, body image and social pressure items are shown in Tables 3-5. Statistical analyses showed a significant difference between genders only in mean self-confidence (P ≤ 0.05).


Table 1.
Demographic Characteristics of the Patients

Table 2.
Mean and Standard Deviation of Self Confidence, Body Image and Social Pressure

Table 3.
Distribution of Items in Self Confidence Self Record Checklista

Table 4.
Distribution of Items in Body Image Self Record Checklista

Table 5.
Distribution of Items in Social Pressure Self Record Checklista

5. Discussion


There is no doubt about the importance of psychosocial assessment of patients prior to cosmetic rhinoplasty surgeries. This study clarified that patients seeking for cosmetic rhinoplasty, suffer from low self-confidence, decreased body image, and are in social pressure to undergo the surgery. Some other studies (1, 3, 4) have manifested these results. Austin J (2015), in the study of “body dysmorphic disorder: prevalence and outcomes in an oculofacial Plastic Surgery Practice”, claimed that the prevalence of body dysmorphic disorder in an oculofacial surgical setting matches reports from other surgical specialties, and is significantly higher than the general population. Austin emphasized on psychological assessments before surgery (7). Previously, these findings were presented in Guy’s (2006) paper. According to the importance of psychological aspects of aesthetic surgeries, Guy and Kanata discussed that patients overwhelmingly tend to feel better about their body image after surgery. They suggest that self esteem and body image levels become high after surgery (8, 9).


The other finding in our study was the existence of gender differences in self-confidence. Females had a lower self-confidence level than male patients. This may be because of the aesthetic aspect of the face, due to the Islamic dressing pattern of women in Iran. Based on Islamic advices, women should cover themselves, yet the only manifestation is the face. This may cause a lower self-confidence in women, if they are not satisfied with the appearance of their nose (4, 10).


Also, there were some limitations in our study. We did not follow the patients’ self-confidence, body image and social pressure after surgery. This was because of their unwillingness to cooperate in a longitudinal study; most of them got married, and some travelled abroad. However, the researchers propose a randomized clinical trial with at least 12 months of follow up.

Acknowledgments

We would like to thank all the participants of this study

Footnotes

Authors’ Contribution: Kazem Hosseinzadeh: study design, data collection and analysis. Hamid Hamadzadeh: academic writing. Neda Montazeri: data gathering.
Funding/Support: All financial support was provided by the research deputy of Qazvin University of Medical Sciences (QUMS).

References


  • 1. Felix GA, de Brito MJ, Nahas FX, Tavares H, Cordas TA, Dini GM, et al. Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty. J Plast Reconstr Aesthet Surg. 2014;67(5):646-54. [DOI] [PubMed]
  • 2. American Psychiatric Association. Obsessive-compulsive and related disorders. In: Diagnostic and statistical manual of mental disorders. 5 ed. Arlington: American Psychiatric Association; 2013.
  • 3. Meningaud JP, Benadiba L, Servant JM, Herve C, Bertrand JC, Pelicier Y. Depression, anxiety and quality of life: outcome 9 months after facial cosmetic surgery. J Craniomaxillofac Surg. 2003;31(1):46-50. [PubMed]
  • 4. Zojaji R, Javanbakht M, Ghanadan A, Hosien H, Sadeghi H. High prevalence of personality abnormalities in patients seeking rhinoplasty. Otolaryngol Head Neck Surg. 2007;137(1):83-7. [DOI] [PubMed]
  • 5. Byrne M, Chan JC, O'Broin E. Perceptions and satisfaction of aesthetic outcome following secondary cleft rhinoplasty: evaluation by patients versus health professionals. J Craniomaxillofac Surg. 2014;42(7):1062-70. [DOI] [PubMed]
  • 6. Javo IM, Pettersen G, Rosenvinge JH, Sorlie T. Predicting interest in liposuction among women with eating problems: a population-based study. Body Image. 2012;9(1):131-6. [DOI] [PubMed]
  • 7. Woolley AJ, Perry JD. Body dysmorphic disorder: prevalence and outcomes in an oculofacial plastic surgery practice. Am J Ophthalmol. 2015;159(6):1058-1064 e1. [DOI] [PubMed]
  • 8. Stofman GM, Neavin TS, Ramineni PM, Alford A. Better sex from the knife? An intimate look at the effects of cosmetic surgery on sexual practices. Aesthet Surg J. 2006;26(1):12-7. [DOI] [PubMed]
  • 9. Kanatas AN, Rogers SN. A systematic review of patient self-completed questionnaires suitable for oral and maxillofacial surgery. Br J Oral Maxillofac Surg. 2010;48(8):579-90. [DOI] [PubMed]
  • 10. Ghassemi A, Rubben A, Bohluli B, Holzle F, Ghassemi M. Use of aesthetic rhinoplasty procedures in reconstructive nasal surgery. Br J Oral Maxillofac Surg. 2015;53(1):44-8. [DOI] [PubMed]

Table 1.

Demographic Characteristics of the Patients

Characteristic Value Range
Gender, No (%)
Female 47 (22.4)
Male 163 (77.6)
Age, y, mean ± SD 24.2 ± 4.8 22 - 26
Education, No (%)
Under diploma 33 (15.7)
High school or diploma 79 (37.3)
College degree 57 (30.1)
Employment, No (%)
Employed 95 (46)
Unemployed 115 (54)
Ethnicity, No (%)
Persian 146 (70)
Turkish 64 (30)

Table 2.

Mean and Standard Deviation of Self Confidence, Body Image and Social Pressure

Female Male P Value
Self confidence 27.2±2.5 25.3±3.3 0.039a
Body image 29.92±3.1 29.82±3.4 0.132
Social pressure 16.1±2.2 16.23±2.1 0.142
a T-test shows significant difference in self confidence between males and females.

Table 3.

Distribution of Items in Self Confidence Self Record Checklista

Items Definitely Agree Agree Neutral Disagree Definitely Disagree
I always feel sadness when I see myself in the mirror - 12 (5.7) 22 (10.5) 93 (44.5) 83 (39.5)
I feel ugly when I compare myself to others 5 (2.4) 40 (19) 95 (45.2) 59 (28.1) 11 (5.2)
My mind is occupied by thoughts about my face composition 10 (4.8) 35 (16.7) 61 (29) 78 (37.1) 26 (12.4)
I wish to have new strange duties after aesthetic rhinoplasty surgery 11 (5.2) 21 (10) 48 (22.9) 7.(33.3) 60 (28.6)
My self-confidence will be increased after rhinoplasty - 17 (8.1) 28 (13.3) 80 (38.1) 85 (45.5)
I feel to be attend in the public areas convenience after rhinoplasty 19 (9) 23 (11) - 116 (55) 52 (24.8)
I feel others are better than me 20 (9.5) 112 (53) 63 (30) 13 (6.2) 2 (1)
I feel ashamed when I speak with others who are more beautiful than me 18 (8.6) 127 (60) 45 (21.4) 15 (7.1) 5 (2.4)
a Data are expressed as No (%).

Table 5.

Distribution of Items in Social Pressure Self Record Checklista

Items Definitely Agree Agree Neutral Disagree Definitely Disagree
My nose structure is very important for others 12 (5.7) 21 (10) 19 (9) 123 (58) 35 (16.7)
People focus on my nose structure seriously 9 (4.3) 18 (8.6) 58 (27) 88 (41) 37 (17)
My family/wife tends to see my nose in better structure 9 (4.3) 17 (8.1) 149 (71) 20 (9.5) 15 (7.1)
All those who have an ugly nose are in social pressure 124 (59) 41 (19.5) 30 (14) 11 (5.2) 4 (1.9)
a Data are expressed as No (%).

Table 4.

Distribution of Items in Body Image Self Record Checklista

Items Definitely Agree Agree Neutral Disagree Definitely Disagree
There is no proportion in my face compositions 2 (1) 9 (4.3) 13 (6.2) 79 (37.3) 107 (51)
My face composition is ugly compared to others 2 (1) 23 (11) 73 (35) 74 (35) 38 (18)
I feel hurt from my face dysmorphia - 2 (1) 38 (18) 77 (36) 97 (44)
Surgery changes others decisions about me 1 (5.2) 10 (4.8) 38 (18) 76 (36) 75 (35)
Surgery makes me have a better sense about myself 21 (10) 31 (14) 46 (21) 75 (35) 37 (17)
a Data are expressed as No (%).