We thank Dr. Thorne for providing some interesting arguments to the Discussion1 of our article “Psychosocial Predictors of an Interest in Cosmetic Surgery among Young Norwegian Women: A Population-Based Study” (Plast Reconstr Surg. 2009;124:2142–2148). However, we feel the need to clarify a couple of issues brought up by Dr. Thorne.1
In his introduction, he summarizes well the main goal and methods of our study, but some significant parts of our results were unfortunately omitted. We performed a population-based study hypothesizing that body dysmorphic disorder–like symptoms, personality, interpersonal attachment insecurity, low self-esteem, poor body image, dissatisfaction with sexual life, distorted eating behavior, emotional distress, low education, poor relationship with parents and friends, teasing history, social acceptance of cosmetic surgery, and low level of physical activity would relate to an interest in cosmetic surgery. Dr. Thorne states that our analysis revealed a correlation between five of these factors (body dysmorphic disorder–like symptoms, poor body image, history of teasing, low education, and poor relationship with parents) and a “yes” answer to the question “Would you consider cosmetic surgery?” In fact, our analysis showed correlation between all of the above-mentioned factors and the determinant variable. However, to minimize the disturbance of intercorrelations between the predictors, we performed a multiple regression analysis, revealing the independent contribution of each predictor in the final equation, which in addition to those already mentioned by Dr. Thorne, also included indices of personality and social acceptance of cosmetic surgery.
Those variables significant in the univariate analysis only were shown in Table 1 in the article. The strong odds ratios of these variables together with the lack of significance in the multivariate analysis indicate that there was a certain level of intercorrelation between the predictors, which is also shown in Table 3. It is therefore incorrect to conclude that those variables, including distorted eating behavior, were not at all correlated with an interest in cosmetic surgery.
In our study, 49 percent of the respondents indicated an interest in cosmetic surgery. Dr. Thorne interprets this finding in the following way: “normal” people answered “yes” to an interest in cosmetic surgery more often than those with demonstrable psychological issues.
The methods used in the study do not allow for interpretations on an individual level. Our hypothesis that there might be psychosocial differences on a group level between those with and without an interest in cosmetic surgery was, however, confirmed.
Dr. Thorne questions the relevance of including body dysmorphic disorder in our study. However, it is well documented in the literature that there is a higher prevalence of this disorder among people seeking cosmetic surgery than in normal populations, and that this disorder is generally considered to be a contraindication to performing cosmetic surgery. Body dysmorphic disorder might not be a problem to the average woman “seeking a tummy tuck after delivering a baby,” but not including body dysmorphic disorder when studying predictors of an interest in cosmetic surgery in general would be a great blunder.
He further claims that the question, “Would you consider cosmetic surgery?” might just as well be rephrased, “Would you like to be more attractive?” Dr. Thorne asserts that it is obvious that people who do not think they are attractive would like to be more attractive. This might be true, but not necessarily by means of cosmetic surgery. This study was based on an idea that most women to a certain degree are dissatisfied with their appearance, but although some would be interested in a surgical fix, others would aim at different and perhaps more healthy solutions to their dissatisfaction, such as developing strategies to accept their appearance as it is or to change their body through physical exercise. To include also those with economic, geographic, or other potential limitations to actually seek cosmetic surgery, we stated the question, “Would you consider cosmetic surgery?” instead of “Have you decided to have cosmetic surgery?” which of course would be less vague, but at the same time more excluding. We have emphasized this by using the phrase “interest in cosmetic surgery” and have not, as Dr. Thorne claims, equated this with a “desire for cosmetic surgery.”
To explain the relatively low level of education among those interested in cosmetic surgery in our study, Dr. Thorne suggests that “educated people were perhaps offended by a questionnaire trying to link a desire for cosmetic surgery with psychological imbalance and therefore might have falsely indicated that they were not interested in cosmetic surgery.” If Dr. Thorne is right, it would have weakened the effects of education in our study. However, when we compared the level of education among the respondents to our study with the normal female population with the same age span from the same geographic area, we found that it was even higher (Statistics Norway). This implicates that there was no selection bias toward less educated responders in our study.
It is important to interpret the findings of this study on a population level and not on the level of the individual cosmetic surgery patient. However, the findings may also contribute to a better understanding of the potential psychosocial background of the large number of young women who are seeking cosmetic surgery today.
Iinà M. Javo
Institute of Clinical Medicine
Tore Sørlie, M.D., Ph.D.
Department of Clinical Psychiatry
University of Tromsø
1. Thorne CH. Discussion: Psychosocial predictors of an interest in cosmetic surgery among young Norwegian women: A population-based study. Plast Reconstr Surg.
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