COSMETIC

Outcomes Article

Psychosocial Characteristics of Young

Norwegian Women Interested in Liposuction,
Breast Augmentation, Rhinoplasty, and
Abdominoplasty: A Population-Based Study
Iiná Márjá Javo
Background: The present study investigated various psychosocial factors ex-
Tore Sørlie, M.D., Ph.D. pected to predict an interest in liposuction, breast augmentation, rhinoplasty,
Tromsø, Norway and abdominoplasty.
Methods: Questionnaire data were obtained from 1862 participants who re-
sponded to a survey distributed to a representative sample of 3500 women from
northern Norway aged 18 to 35 years.
Results: Liposuction was the most popular procedure (25 percent), followed by
breast augmentation (15 percent), rhinoplasty (7.0 percent), and abdomino-
plasty (5.6 percent). Most of the women interested in rhinoplasty and breast
augmentation reported interest in more than one procedure, whereas the vast
majority of women interested in abdominoplasty were not interested in any
other procedure. Multiple regression analyses showed that a low level of edu-
cation, indicators of social acceptance of cosmetic surgery, and negative ap-
pearance evaluation were predictors of an interest in all procedures. Body
dysmorphic disorder–like symptoms, appearance orientation, and teasing his-
tory were predictors of an interest in all procedures except for abdominoplasty,
whereas having children was a predictor of all procedures except for rhinoplasty.
Divorce rate and eating disorder were predictors of an interest in liposuction
only. Univariate regression analyses showed that the Big-Five personality traits
were associated with all procedures except abdominoplasty.
Conclusions: It appears that women interested in abdominoplasty may be mo-
tivated by a desire to repair the bodily changes occurring after childbirth,
whereas women interested in liposuction, breast augmentation, and rhinoplasty
may have more complex psychological factors associated with their interest in
cosmetic surgery. The findings of this study provide increased knowledge about
psychosocial factors characterizing women interested in liposuction, breast aug-
mentation, rhinoplasty, and abdominoplasty. (Plast. Reconstr. Surg. 125: 1536,
2010.)

I
t has been recommended that the assessment of
patients’ psychological suitability for cosmetic
surgery should focus on three areas: (1) iden-
tifying motivations for and expectations about sur-
gery; (2) assessing physical appearance and body
image; and (3) collecting psychiatric history and
evaluating current psychosocial functioning.1–3
From the Institute of Clinical Medicine, Faculty of Medicine,
University of Tromsø, and the Department of Specialized
Psychiatry, University Hospital of North Norway.
Received for publication August 17, 2009; accepted Decem-
ber 3, 2009.
Copyright ©2010 by the American Society of Plastic Surgeons
DOI: 10.1097/PRS.0b013e3181d5135a
Studies indicate that there are psychological dif-
ferences among women with an interest in the
different cosmetic procedures. Body dysmorphic
disorder is relatively frequently reported in rhi-
noplasty patients,4 whereas preoperative depres-
sive symptoms,5 psychiatric history,6 admissions to
psychiatric hospitals,7,8 use of psychotropic drugs,9
and an excess of suicide8,10 –15 are all reported more
frequently among breast augmentation patients
Disclosure: The authors have no financial interest
to declare in relation to the content of this article.

1536 www.PRSJournal.com
Volume 125, Number 5 • Psychosocial Characteristics
than among patients having other types of cos-
metic surgery. Furthermore, an interest in cos-
metic surgery in general has been found to be
related to various psychological constructs, such
as personality features, self-esteem, self-assessed
attractiveness,16 body dysmorphic disorder–like
symptoms,17 and body image17,18; and sociodemo-
graphic variables such as teasing history, knowing
someone who has had cosmetic surgery, having
been recommended cosmetic surgery,17,18 educa-
tion, having children, and quality of relationship
with parents.17 Given the disturbed body image in
patients with eating disorders, the assessment of
eating disorders has been considered central to
preoperative psychological evaluation of pa-
tients seeking cosmetic surgery.19 It has further
been suggested that an insecure style of inter-
personal attachment might be implicated in the
cause of body dissatisfaction20 and might there-
fore also be a motivation for cosmetic surgery.
Psychosocial factors found to be associated with
cosmetic surgery in general may be common or,
to a varying degree, may differ between the spe-
cific procedures.
It is important to study women at different
motivational stages of the process of having cos-
metic surgery, as women with a preliminary inter-
est in cosmetic surgery may differ from women
who are already scheduled to undergo and those
who have undergone surgery. The latter groups
have gone through the evaluation procedures of
the plastic surgeon, and a number of patients may
have been left out because of psychopathologic
characteristics or other reasons incompatible
with cosmetic surgery. The aim of the present
study was to identify psychosocial factors char-
acterizing women in the normal population
interested in the four most common cosmetic
procedures: liposuction, breast augmentation,
rhinoplasty, and abdominoplasty.
SUBJECTS AND METHODS
Samples and Procedure
This study is an elaboration of a previous study
published17 in Plastic and Reconstructive Surgery,
with an identical sample and procedure. The first
article focused on current attitudes in the society
toward cosmetic surgery in general, whereas the
present study is focused on specific procedures. By
studying women from the normal population
rather than from a clinic, we wanted to obtain a
representative sample of those interested in the
different procedures. A clinical sample from the
few cosmetic surgery clinics that exist in northern
Norway would have become strongly selective. We
restricted the sample to women aged between 18
and 35 years because the pure cosmetic motives
may be easier to detect among younger women,
who may be less inclined to change their appear-
ance because of concerns about aging. Three
thousand five hundred women were randomly
drawn by Statistics Norway from the female pop-
ulation of the two northernmost Norwegian coun-
ties, Troms and Finnmark. A questionnaire with
113 items was sent by mail in June of 2006, and a
reminder was given twice. The study was anony-
mous and approved by the Regional Medical Eth-
ics Committee and the Norwegian Social Science
Data Services. The informants consented by re-
turning the completed questionnaires.
Measures
Previous and Future Cosmetic Surgery
Cosmetic surgery was defined as surgery with-
out a recommendation and referral by a physician
because of deformities, trauma, or other medical
indications. We asked whether or not they would
consider having cosmetic surgery and, if so, which
type of procedure. Our main outcome variables
were an interest in liposuction, breast augmenta-
tion, rhinoplasty, and abdominoplasty. Finally, we
asked whether or not the respondents previously
had undergone cosmetic surgery.
Body Dysmorphic Disorder–Like Symptoms
Body dysmorphic disorder is defined as a pre-
occupation with an imagined defect in one’s ap-
pearance. Alternatively, where there is a slight
physical anomaly, the person’s concern is mark-
edly excessive. Similar to previous studies,21,22 we
used the Mini-International Neuropsychiatric In-
terview for the Diagnostic and Statistical Manual of
Mental Disorders (Fourth Edition) criteria for di-
agnosing body dysmorphic disorder,23 for self-rat-
ing of what we labeled as body dysmorphic disor-
der–like symptoms (yes/no questions): Are you
constantly thinking that there is something wrong
with your appearance? Has this concern contin-
ued despite the fact that people (including your
general practitioner) sincerely think that your dis-
satisfaction with your appearance is exaggerated?
Has this concern caused significant distress or im-
pairment in social functioning or in any other
area? A yes on all three questions was needed.
Personality
A 10-item version of the Big-Five personality
inventory was used.24 It has shown adequate levels
in terms of (1) convergence with the widely used
Big-Five measures in self, observer, and peer re-
1537

ports; (2) test-retest reliability; (3) patterns of ex-
ternal correlates; and (4) convergence between
self and observer ratings. Score range for each
subscale is 2 to 10. Cronbach ␣ values were as
follows: extraversion, 0.70; agreeability, 0.21; con-
scientiousness, 0.49; emotionally stable, 0.52; and
openness, 0.36. Cronbach ␣ is a measure of inter-
nal reliability of the items of a scale. When using
this instrument, relatively low Cronbach ␣ values
are expected.24
Interpersonal Attachment Security
The respondents were asked to define their
level of intimate interpersonal functioning within
one of three levels25:
1. I find it easy to have close relationships. I
like to depend on others and like that others
depend on me. I am seldom concerned that
others will leave me or come too close to me.
2. I feel somewhat uncomfortable when having
others close to me. I find it difficult to trust
them completely and to depend on them. I
feel uneasy when others are coming too
close and my lovers wish more intimacy than
I do.
3. I feel that others are reluctant to be as close
as I want. I often feel worried that my part-
ner does not love me or does not want to
continue the relationship. I want to fuse to-
gether with another person. This wish often
frightens them away.
Self-Esteem
We used a Norwegian translation of Tafarodi
and Swann’s Self-Liking and Competence Scale to
measure global self-esteem,26 which constitutes
(1) a self-liking dimension, based on perception of
feedback from the social environment (score
range, 10 to 50; Cronbach ␣ ⫽ 0.91); and (2) a
self-competence dimension, based on internal
conceptions of success and failure in performing
tasks (score range, 10 to 50; Cronbach ␣ ⫽ 0.88).
Body Image
Body image was measured by two subscales of
the Multidimensional Body Self-Relations
Questionnaire27 as translated into Norwegian by
Loland.28 We used the seven-item appearance eval-
uation subscale measuring the overall satisfaction
with one’s appearance (score range, 7 to 35; Cron-
bach ␣ ⫽ 0.83) and the 12-item appearance ori-
entation subscale measuring the individual’s per-
ceived importance of her own appearance (score
range, 12 to 60; Cronbach ␣ ⫽ 0.90). In both
subscales, the difference of the mean value be-
tween women interested in cosmetic surgery in
general and those without such an interest was
1538
Plastic and Reconstructive Surgery • May 2010
approximately 5. To obtain clinical meaning to a
one-unit change in the logistic regression analyses,
both subscales were divided by 5.29
Satisfaction with Sexual Life
Satisfaction with sexual life was rated on a five-
point measure ranging from 1 (very dissatisfied) to
5 (very satisfied).
Eating Disorder
A five-item scale (Eating Disturbance Scale)
was used to measure disordered eating behavior
(score range, 5 to 25; Cronbach ␣ ⫽ 0.83). A cutoff
value of 16.0 was used, indicating pathologic val-
ues from 16.0 and above.30 Results suggest that the
Eating Disturbance Scale is sensitive to distorted
eating behavior and is suitable for screening pur-
poses in community samples.30
Emotional Distress
The Symptom Check List is a five-item version
of the anxiety and depression subscales of the
Hopkins Symptom Check List (score range, 5 to
25; Cronbach ␣ ⫽ 0.88). A cutoff value of 2.0 was
used, indicating pathologic scores from 2.0 and
above.31
Sociodemographic Variables
Educational level was defined as high (univer-
sity/college) or low (junior school/high school).
Relationship status was categorized as being in a
long-term relationship, married, divorced/sepa-
rated, or none of the above. Having children was
coded yes/no.
Perceived Quality of Social Network and
Family Relations
One yes/no question assessed whether or not
the respondent felt that she had enough good
friends. A five-point scaled measure assessed
whether the respondent wished a better relation-
ship with their father and their mother, which was
later unified into a single variable, quality of re-
lationship with parents.
Teasing History
One yes/no question recorded the respon-
dents’ experience with being repeatedly teased for
appearance.
Indicators of Social Acceptance of Cosmetic
Surgery
Two yes/no questions recorded whether or
not they knew someone who had undergone cos-
metic surgery, and whether or not they had been
recommended for cosmetic surgery18 (r s ⫽ 0.14).
Physical Exercise
One yes/no question recorded whether or not
the respondents exercised regularly. Height and
weight were also recorded and used to calculate
body mass index.
Volume 125, Number 5 • Psychosocial Characteristics
Statistical Analyses
Missing values ranged from 0 to 2 percent and
were replaced by series means. In all regression
analyses, the groups with an interest in the differ-
ent procedures were compared with women not
interested in cosmetic surgery. Those variables
that were significant (p ⬍ 0.01) in the univariate
logistic regression analyses were included in mul-
tiple logistic regression analyses by stepwise regres-
sions. Correlations involving dichotomous predic-
tors were tested by the Spearman r s, and those
between continuous predictors were tested using the
Pearson r. Except for the correlation between the
self-liking and self-competence scales (r ⫽ 0.72) and
between appearance evaluation and self-liking (r ⫽
0.69) and self-competence and appearance evalua-
tion (r ⫽ 0.56), all correlations between the different
predictor pairs were below 0.50.
The strength of the predictors was expressed
as odds ratios with 95 percent confidence limits.
For the continuous predictors, the odds ratio in-
dicates the effects of a one-unit change in the
predictor.29 All statistical tests were performed as
two-tailed tests, and the significance level in the
multiple regression analyses was set at p ⫽ 0.05.
SPSS for Windows 16.0 (SPSS, Inc., Chicago, Ill.)
was used for all statistical analyses.
RESULTS
Of 3500 questionnaires, 208 were returned
because of wrong address, giving a final sample of
3292 subjects. One thousand eight hundred eighty
subjects returned the questionnaire, of which 18
had to be removed because too many values were
missing. Thus, 1862 subjects represents a response
rate of 56 percent. The prevalence of an interest
in the listed procedures was as follows: liposuction,
25 percent (mean age, 28 ⫾ 5.0 years); breast
augmentation, 15 percent (mean age, 27 ⫾ 5.0
years); rhinoplasty, 7.0 percent (mean age, 27 ⫾
5.0 years); and abdominoplasty, 5.6 percent
(mean age, 30 ⫾ 4.0 years).
We found an interest in more than one type of
procedure among 69 percent of those interested
in rhinoplasty, 57 percent of those interested in
breast augmentation, 35 percent of those inter-
ested in liposuction, and 17 percent of those in-
terested in abdominoplasty. We further found that
4.8 percent of those interested in liposuction, 4.3
percent of those interested in breast augmenta-
tion, 3.8 percent of those interested in abdomi-
noplasty, and 2.3 percent of those interested in
rhinoplasty reported having undergone cosmetic
surgery previously.
As shown in Table 1, low educational level,
having been recommended cosmetic surgery, and
low appearance evaluation were significant pre-
dictors in the multivariate analyses of all four pro-
cedures. Low educational level had the strongest
association with an interest in breast augmenta-
tion, whereas having been recommended cos-
metic surgery had the strongest effect on an in-
terest in rhinoplasty. When predicting an interest
in abdominoplasty, the odds ratio of appearance
evaluation was twice the strength as compared
with predicting an interest in breast augmenta-
tion. Table 1 further shows that body dysmorphic
disorder–like symptoms, teasing history, and ap-
pearance orientation were predictors of an inter-
est in all procedures but abdominoplasty. The
odds ratio of body dysmorphic disorder–like symp-
toms was twice as high when predicting rhino-
plasty compared with liposuction. The effect of
appearance orientation was strongest in an inter-
est in breast augmentation, whereas the odds ra-
tios of teasing history had more even values. In-
terests in all of the procedures, except rhinoplasty,
were predicted by having children and knowing
someone who had undergone cosmetic surgery,
both of which were strongest in the abdomino-
plasty group. The odds ratio of having children
was five times greater for abdominoplasty than for
liposuction. Being divorced/separated and having
an eating disorder were significant predictors of
an interest in liposuction only. Agreeability and
exercising, in contrast, were significant predictors
of rhinoplasty only. The predictor variables sig-
nificant only in the univariate analyses and those
not significant at all are listed in Table 2.
DISCUSSION
We found a relatively high interest in the dif-
ferent cosmetic procedures, with liposuction be-
ing the most popular (25 percent), followed by
breast augmentation (15 percent), rhinoplasty
(7.0 percent), and abdominoplasty (5.6 percent).
Many reported an interest in more than one pro-
cedure, especially among those interested in rhi-
noplasty and breast augmentation. Consequently,
many of the respondents were included in the
analysis of more than one group.
In the multiple regression analysis, we found
that low educational level was a strong predictor of
an interest in all of the procedures, and strongest
among women interested in breast augmentation,
which is in line with Brinton et al., who found that
women with breast implants had a lower educa-
tional level than women who had undergone
other types of cosmetic surgery.32 Similar to pre-
1539
 Table 1. Multiple Logistic Regression Analyses of Predictors of an Interest in Breast Augmentation, Rhinoplasty, Liposuction, and Abdominoplasty

1540
Breast Augmentation Rhinoplasty Liposuction Abdominoplasty
(n ⴝ 1221) (n ⴝ 1070) (n ⴝ 1407) (n ⴝ 1044)

95% CL 95% CL 95% CL 95% CL

OR Lower Upper p OR Lower Upper p OR Lower Upper p OR Lower Upper p

Education 0.31 0.22 0.43 ⬍0.001 0.38 0.24 0.59 ⬍0.001 0.61 0.45 0.81 ⬍0.01 0.45 0.27 0.74 ⬍0.01
Having been recommended
cosmetic surgery 2.80 1.43 5.49 ⬍0.01 3.82 1.75 8.38 ⬍0.001 2.46 1.34 4.50 ⬍0.01 2.96 1.26 6.95 ⬍0.02
Appearance evaluation* 0.80 0.68 0.93 ⬍0.01 0.75 0.62 0.92 ⬍0.01 0.56 0.49 0.65 ⬍0.001 0.39 0.31 0.48 ⬍0.001
BDD-like symptoms 3.09 1.64 5.83 ⬍0.001 3.83 1.90 7.71 ⬍0.001 1.91 1.08 3.38 ⬍0.03 NS
Knowing someone who has had
cosmetic surgery 2.07 1.44 2.96 ⬍0.001 NS 1.89 1.40 2.55 ⬍0.001 3.10 1.71 5.62 ⬍0.001
Having children 1.86 1.33 2.61 ⬍0.001 NS 1.49 1.11 2.00 ⬍0.01 7.92 4.08 15.4 ⬍0.001
Teasing history 1.83 1.07 3.12 ⬍0.03 2.00 1.08 3.70 ⬍0.01 1.92 1.22 3.01 ⬍0.01 NS
Appearance orientation* 1.47 1.31 1.65 ⬍0.001 1.42 1.23 1.65 ⬍0.001 1.34 1.22 1.48 ⬍0.001 NS
Divorced/separated NS NS 8.08 2.28 28.6 ⬍0.01 NS
Eating disorder NS NS 1.71 1.13 2.60 ⬍0.02 NS
Agreeability* NS 0.78 0.68 0.90 ⬍0.01 NS NS
Exercising NS 0.63 0.40 0.98 ⬍0.05 NS NS
CL, confidence limits; OR, odds ratio; BDD, body dysmorphic disorder; NS, nonsignificant.
*Continuous variable.

Table 2. Univariate Logistic Regression Analyses of Predictors of an Interest in Breast Augmentation, Rhinoplasty, Liposuction, and
Abdominoplasty
Breast Augmentation
(n ⴝ 1221)
Nonsignificant BMI, extraversion, agreeability,
having enough friends, being
married, in a long-term
relationship,
divorced/separated
Significant Emotional distress, eating
positive disorder
predictors
Significant Age, conscientiousness,
negative emotionally stable, openness,
predictors interpersonal attachment
security, self-liking, self-
competence, exercising,
satisfaction with sexual life,
quality of relationship with
parents
BMI, body mass index; BDD, body dysmorphic disorder.
Rhinoplasty (n ⴝ 1070)
BMI, age, having children,
having enough friends, being
married, in a long-term
relationship,
divorced/separated
Emotional distress, eating
disorder, knowing someone
who has had cosmetic surgery
Extraversion, conscientiousness,
emotionally stable, openness,
interpersonal attachment
security, self-liking, self-
competence, satisfaction with
sexual life, quality of
relationship with parents
Liposuction (n ⴝ 1407)
BMI, age, extraversion, being
married, in a long-term
relationship
Emotional distress
Agreeability, conscientiousness,
emotionally stable, openness,
interpersonal attachment
security, self-liking, self-
competence, exercising,
satisfaction with sexual life,
having enough friends, quality
of relationship with parents
Abdominoplasty (n ⴝ 1044)
BMI, extraversion, agreeability,
conscientiousness, emotionally stable,
openness, interpersonal attachment
security, appearance orientation,
having enough friends, in a long-
term relationship
Emotional distress, eating disorder,
BDD-like symptoms, teasing history,
being married, divorced/separated,
age
Self-liking, self-competence, exercising,
satisfaction with sexual life, quality of
relationship with parents
Plastic and Reconstructive Surgery • May 2010
Volume 125, Number 5 • Psychosocial Characteristics
vious studies with larger age spans,18,33 age was not
significant in any of the multivariate analyses, al-
though women interested in abdominoplasty were
older and women interested in breast augmenta-
tion were younger than their peers.
As predicted,18 we found that having been rec-
ommended cosmetic surgery and knowing some-
one who has had cosmetic surgery were significant
predictors of an interest in all of the procedures.
However, among those interested in rhinoplasty,
only having been recommended cosmetic surgery
was significant in the multivariate analysis.
Recent studies using validated measures of body
image together with satisfying comparison groups
have found that overall body image is a strong pre-
dictor of an interest in cosmetic surgery in
general.17,18 In the present study, appearance eval-
uation was a negative predictor of all of the proce-
dures and was strongest in abdominoplasty. Appear-
ance orientation, in contrast, was a significant
predictor in all procedures except abdominoplasty.
This is in concordance with Bolton et al., who stud-
ied a sample of abdominoplasty patients.34 It appears
that women interested in abdominoplasty have the
lowest satisfaction with appearance but at the same
time consider their own appearance less important
than women interested in other procedures. This is
further demonstrated by the fact that the presence
of body dysmorphic disorder–like symptoms was a
strong predictor of an interest in all of the proce-
dures except abdominoplasty.
The presence of body dysmorphic disorder–
like symptoms was the strongest predictor of an
interest in rhinoplasty, which is in concordance
with previous findings of the nose being the most
common preoccupation in body dysmorphic dis-
order patients.4,35 The presence of body dysmor-
phic disorder–like symptoms was based on the
same criteria that are used in the Mini-Interna-
tional Neuropsychiatric Interview for the Diagnos-
tic and Statistical Manual of Mental Disorders (Fourth
Edition) for diagnosing body dysmorphic disor-
der, but it is not designed for self-reporting and
our results must therefore be interpreted with cau-
tion. Having children was strongly associated with
an interest in abdominoplasty and moderately as-
sociated with an interest in liposuction and breast
augmentation, which can be explained by the
bodily changes occurring after pregnancy affect-
ing breasts, fat deposits, and the abdominal wall.
Previous studies suggest that teasing history is
associated with an interest in breast augmentation36
and in cosmetic surgery in general.17,18 However,
together with body image variables in the final
model, teasing history did not reach statistical sig-
nificance in two of the above-mentioned studies.18,36
In the present study, teasing history was a significant
predictor of an interest in all of the procedures,
except for abdominoplasty, even with body image
variables included in the model.
Studies from the earlier era of cosmetic sur-
gery revealed that women with breast implants had
a higher divorce rate than controls.37–39 In our
study, we found no such association, which may
partly be attributable to the age limit of 35 years
in the sample. However, women interested in li-
posuction had a remarkably higher divorce rate
than controls, which also turned out to be the
strongest predictor of an interest in liposuction.
Women with breast implants appear to have
below-average body weight,32,36,40 – 43 which has led
to the concern that there is an increased preva-
lence of eating disorders among these women.
Alagöz et al. found disordered eating behavior in
10.2 percent of a sample of 75 patients having
cosmetic surgery other than for body fat.44 In the
present study, body mass index was not a signifi-
cant predictor in any of the univariate analyses,
which is in line with Henderson-King and
Henderson-King45 but contrary to the findings of
Frederick et al.33 Nevertheless, eating disorder was
a significant predictor in the univariate analysis of
an interest in breast augmentation, but when in-
troducing body dysmorphic disorder–like symp-
toms into the final model, the effect of eating
disorder diminished. In the multiple regression
analysis of an interest in liposuction, eating dis-
order remained a significant predictor, even with
body dysmorphic disorder–like symptoms in-
cluded in the model.
Zojaji et al. studied rhinoplasty candidates and
found them to have certain personality dispositions.46
In the present study, all the Big-Five personality traits
were significant in the univariate analysis of an in-
terest in rhinoplasty, but only agreeability remained
significant when the presence of body dysmorphic
disorder–like symptoms was introduced into the
model. None of the Big-Five personality traits was
associated with any other procedure in the multi-
variate analysis. Abdominoplasty was the only pro-
cedure where none of the personality variables was
significant in the univariate analysis.
Exercising turned out to be negatively associ-
ated with all of the procedures, but lost signifi-
cance when introducing having children into the
model, except in rhinoplasty, where having chil-
dren was nonsignificant. These findings could
generate a hypothesis that people who are exer-
cising on a regular basis and thus doing something
actively to keep in shape are less inclined to seek
1541

more passive surgical solutions for their appear-
ance dissatisfaction.
Both self-esteem subscales (self-liking and self-
competence) were significant in the univariate
analysis of all the procedures, but none remained
significant in the end. This is in concordance with
previous studies where the significance of self-es-
teem variables has diminished when introducing
body image variables.17,18
Emotional distress and quality of relation-
ship with parents were associated with all of the
procedures in the univariate analyses, and in-
terpersonal attachment security was associated
with all procedures but abdominoplasty. How-
ever, when introducing other predictors, the
effect of these variables diminished in the mul-
tivariate analysis.
A weakness of the study is that the sample was
collected from a limited geographic area, with
cultural differences limiting generalization. The
large sample size, the great variety of potential
predictor variables included, and the use of vali-
dated instruments provide strength to the study.
Among the 43 percent that did not respond, there
was an overrepresentation among the youngest
women in Finnmark County. This may reflect the
fact that relatively many of these women migrate
from Finnmark to get an education and therefore
are not currently living at their official address.
Women with less interest in cosmetic surgery may
have been less inclined to respond.
The results of this study may lead to a better
understanding and increased awareness of psy-
chosocial factors characterizing women seeking
liposuction, breast augmentation, rhinoplasty,
and abdominoplasty. It appears that in contrast to
an interest in abdominoplasty, where having chil-
dren is a strong predictor, an interest in liposuc-
tion, breast augmentation, and rhinoplasty may be
relatively strongly associated with various psycho-
social factors. As proposed by Solvi et al.,47 this
suggests that there are differences between
women wanting to repair their body after having
children and women that simply want to create
or improve a physical feature. The associations
of divorce rate and eating disorder with an in-
terest in liposuction should be further tested in
future studies.
Tore Sørlie, M.D., Ph.D.
Institute of Clinical Medicine
Faculty of Medicine
University of Tromsø
N-9037 Tromsø, Norway
tore.sorlie@unn.no
1542
Plastic and Reconstructive Surgery • May 2010
ACKNOWLEDGMENT
This study received financial support from the In-
stitute of Clinical Medicine, Faculty of Medicine, Uni-
versity of Tromsø.
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