Regression analyses were also performed with gender, age, practice type, ethnicity, and region of practice as predictors and buttock size preference as the outcome variable. Overall, the regression was significant (F5,577 = 3.352, p = 0.005), and the predictors accounted for 17 percent of the variance. Gender (b = −0.266, p = 0.046) and region of practice (b = 0.146, p = 0.019) emerged as significant predictors, controlling for age, practice type, and ethnicity. Considered together, these results show surgeons’ region of practice and gender impacted their attractiveness perceptions of buttock size (Table 4). Buttock size preferences did not differ significantly across plastic surgeons’ type of practice (academic versus private).
Buttock size preferences differed significantly across ages among the general public (F2,446 = 9.684, p < 0.001, η2 = 0.042). Younger people prefer larger buttocks (Table 3).
Buttock size preferences differed significantly across ethnicity among the general public (F1,447 = 4.592, p = 0.033, η2 = 0.010). Non-Caucasians prefer larger buttocks compared with Caucasians (Table 3).
Regression analyses were performed with gender, age, ethnicity, region, and income as predictors and buttock size preference as the outcome variable. Overall, the regression was significant (F5,443 = 5.583, p < 0.001), and the predictors accounted for 24 percent of the variance. Age (b = −0.030, p < 0.001) and ethnicity (b = −0.361, p = 0.025) emerged as significant predictors, controlling for gender, region, and income. These results show that age and ethnicity of the general public significantly influenced their buttock size preferences (Table 4). Buttock size preferences did not differ significantly across gender, region of origin, or yearly income among the general public.
Given the potential discordances regarding the definition and recognition of attractive buttocks, the presented study investigates the presence of such differences and how these are related to ethnic background and nationality, as well as, demographic factors including age, sex, social status (general public versus plastic surgeons), and type of surgical practice (academic versus private). Several interesting findings emerged from the analysis of the data.
Recently, Wong et al. evaluated buttock preferences among several ethnicities and concluded that new ideal waist-to-hip ratios of 0.6 and 0.65 update the previous standards and indicate a more curvy ideal, signaling a preference shift.19 The study, as the authors point out, was limited in that more than 90 percent of the respondents live in the United States and by the fact that there were highly disproportionate numbers of Caucasian respondents. Wong et al. consequently anticipated more culture-specific findings in future studies with a more proportionate number of respondents from other ethnic groups and geographic locations.19 We hope that the findings of apparently simultaneous data acquisition can address some of the outlined limitations and add valuable information to the interesting findings of our colleagues.
In the presented study and supporting our initial hypothesis, the majority of survey takers preferred the 0.7 waist-to-hip ratio as their ideal. Regarding buttock size, in the total survey population, size preferences differed significantly across participants’ ethnicity, showing that non-Caucasians prefer larger buttocks compared with Caucasians. After regression analysis, the results showed that regardless of profession (surgeon or lay people) and region, sex, age, and ethnicity impacted their attractiveness perceptions of buttock size. Specifically, men prefer larger buttocks controlling for other covariates (profession, age, ethnicity, region), younger people perceived larger buttocks to be more attractive, and non-Caucasians perceived larger buttocks to be more attractive compared with Caucasians. Furthermore, participants in non-European regions perceived larger buttocks to be more attractive compared with those in Europe, although this was only marginally significant.
Several distinct differences regarding the ratios and buttock sizes were further seen when taking demographic factors into consideration. Regarding the respondents’ age and buttock size preference, it appears that surgeons in their 40s and lay people in their 20s prefer significantly larger buttock sizes. This may be because current beauty and fashion trends emerge from the media and tend to manifest themselves among the younger age groups. Also, there are actually very few plastic surgeons younger than 30 years (n = 10 in this analysis), so one could postulate that, generally, younger people tend to prefer larger buttocks. However, the cohort of plastic surgeons between 40 and 50 years of age was also the second largest group, which might have influenced these findings. Overall, the data demonstrate transgenerational stability in use and meaning of waist-to-hip ratios, while strengthening the contention that female physical attractiveness is adaptive.
With respect to self-reported ethnicity, non-Caucasians preferred significantly larger buttocks independent of profession. Regarding region of practice, surgeons in Latin America (followed by Asia and North America/Europe) preferred the largest buttock size. This is in accordance with the current phenomenon of the “Brazilian buttock.”
Another factor that seems to play a major role in influencing why certain procedures and body shapes are more popular in one region compared with another is the weather.20 In countries with warmer weather (e.g., Latin America), people tend to wear less clothing year round, which might lead to more body consciousness and increased demand for aesthetic procedures. Therefore, individual preferences and aesthetic perception depend not only on the individual’s cultural and ethnic background, but also on geographic factors.20 As recent studies have shown, the impact of ethnic characteristics on aesthetic preferences and the ethnic distribution within a certain region further factor into surgical decision-making.20,21
Regarding the sex of respondents, male surgeons prefer significantly larger buttocks compared with female surgeons, while there were no significant differences in the general public. However, this statement does not hold true for every country, as the opposite finding was observed in the group of plastic surgeons in Europe, where female surgeons preferred the larger buttock sizes.
In the cohort of plastic surgeons, regression analysis revealed that surgeons’ region of practice and gender impacted their attractiveness perceptions of buttock size the strongest. In the general public, lay people’s age and ethnicity were the most important factors regarding their buttock size preferences.
Overall, the analysis showed that ideal proportions are not universally applicable. Although most plastic surgeons will acknowledge these facts given their experience, it is very hard to prove it numerically.
The study certainly has several limitations. Arguably, throughout their career, each generation of plastic surgeons has been exposed to different sociocultural influences, including visual media, which might have influenced the findings. The same assumption might explain intercultural preferences in the general public. The media and suggested ideals in fashion and body habitus are different in every country and therefore undoubtedly impact beauty preferences. It is also important to note that the findings represent current trends in aesthetics, are therefore only a snapshot in time, and may as such be subject to change. Because this study was based on voluntary participation in an online survey, a certain degree of selection bias might also prevail. It may further be critiqued in that the survey displayed images of only one Caucasian model, which were altered artificially using digital software, a technique that may be less ideal than comparing different “real” models with different ethnicities and features. Furthermore, other body proportions that play a role when defining attractiveness were not included in this analysis.
Singh has already described that the linkage between waist-to-hip ratio and body fat distribution may largely influence the perception of female attractiveness.16 In three separate studies, the author found that body fat and its distribution are critical when judging female attractiveness and health, whereas a female figure of normal body weight and low waist-to-hip ratio were perceived as healthy, youthful, and of high reproductive potential. Singh further hypothesized that an attractive waist-to-hip ratio should be culturally invariant in its significance.16 Regarding cross-cultural validity, several studies exist that evaluated attractiveness on the basis of multiple body portraits that were of different ethnic background, and where the evaluators were asked to choose the most attractive appearance.22–24 However, by only using one model for the evaluation, many potential confounding factors such as skin color, age of the models/patients, and remaining habitus do not need to be taken into consideration. Using different models also means that the actual proportions of buttock size and shape would have to be calculated and changed each time. Using modern technology and changing only certain bodily features within an otherwise fixed body frame, and thereby actually changing proportions, golden ratios and ideal proportions are apparently not universally applicable and must be seen in context. Despite the artificial character of the model, the fact that all survey takers used the same images for their assessment increases the validity of the findings.
This is in concordance with findings from Perrett et al., where the authors had faces judged by observers and found that, contrary to the averageness hypothesis, highly attractive faces are systematically different in shape from average, a finding that prevailed across different cultures.25 In a subsequent study, where evaluators were asked to rate attractiveness of Caucasian and African faces, the authors found that there seems to be a cross-cultural agreement in facial attractiveness preferences, again a finding that supports our main hypothesis that certain body proportions and features appear most attractive across a very wide range of ethnicities and cultures.23
In summary, although golden ratios and ideal proportions are generally not universally applicable, the 0.7 waist-to-hip ratio can be considered most attractive across a wide range of people. This study may change a surgeon’s modi operandi because it sensitizes the aesthetic perception of plastic surgeons. It emphasizes that many factors need to be taken into consideration when evaluating body shapes, with the patient’s aesthetic desires remaining the ultimate gold standard, even if it may be different from the surgeon’s perceived ideal.
Future research should consider investigating whether surgeons’ opinions change behavior across different countries. For example, by having augmented many women’s buttocks, have plastic surgeons affected the way society thinks buttocks should appear and the way they are portrayed in the media?
Aesthetic perception is influenced by a wide range of factors. This study illustrated that intercultural and ethnic differences, in addition to the ethnic and geographic background of surgeons and the general public, play major roles in this regard. Particularly in the field of plastic and reconstructive surgery, globalization suggests more and more unified surgical goals, and, with respect to buttock aesthetics, apparently a waist-to-hip ratio of 0.7 is rated to be attractive by a wide range of people. However, the authors of this study urge all plastic surgeons to take all compounding factors into consideration when defining surgical goals with their patients, which will ultimately aid in achieving optimal aesthetic outcomes, satisfying both surgeon and patient alike.
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