Beauty on YouTube:
Applying Social Cognitive Theory to Explore the Relationship between Beauty Vlog Consumption and Interest in Cosmetic Surgery in Women
Graduate School of Communication Master’s Thesis
Name: Leonie Anna Sophie Görke Student ID: 12362328
Master’s Program: Entertainment Communication Supervisor: dhr. prof. dr. J. Peter
Date of Completion: 30.01.2020 6418 words
Abstract
With rising numbers in performed procedures (American Society of Plastic Surgeons, 2018), cosmetic surgery is a growing trend in appearance enhancement. In recent years, several studies have identified cosmetic surgery reality TV consumption as a predictor of females’ cosmetic surgery intentions. However, as a rather novel format, little is known about the effects of YouTube beauty vlog consumption in this context. Thus, in a first attempt to investigate the relationship between beauty vlog consumption and interest in cosmetic surgery, a survey-based study among 167 adult women (aged 19 to 65) was conducted. Due to beauty vlogs’ explicit depictions of beauty-related behavior, social cognitive theory (Bandura, 1986) was applied to explore mechanisms of observational learning; specifically, the online questionnaire assessed respondents’ identification with YouTube beauty vloggers, positive outcome expectancies, cosmetic surgery self-efficacy, and appearance satisfaction. No correlation between beauty vlog consumption and interest in cosmetic surgery remained when including control variables. Further, contrary to the hypothesized conceptual model, regression analyses did not identify principles of social cognitive theory as moderators or mediators of this relationship. The findings are discussed in light of this study’s limitations and implications for future research.
Introduction
In its 2018 annual report, the cosmetics giant L’Oréal ascribes the steady growth of the worldwide cosmetics market over the past decade not only to the “continuous increase in online beauty spending” (L’Oréal, 2018, para. 4) but moreover to the “expansion of social networks” (L’Oréal, 2018, para. 4). Whereas detrimental effects on body image and appearance satisfaction of idealized images in traditional media on susceptible - primarily female - individuals are rather well established (e.g., López-Guimerà, Levine, Sánchez-Carracedo, & Fauquet, 2010), scholarly attention has increasingly turned to social media in recent years (Holland & Tiggemann, 2016; Fardouly & Vartanian, 2016). With its high usage among young adults (Perrin & Anderson, 2019) and concerning social media’s interactivity, high level of self-disclosure and emphasis on
visuality (Perloff, 2014), users might face even more extensive appearance pressures due to the ubiquity of attractive peers online (de Vries, Peter, Nikken, & de Graaf, 2014). Moreover, with the rise of social media influencers, this immensely popular “new type of third party endorser” (Freberg, Graham, McGaughey, & Freberg, 2011, p. 90) is presumed to impact audience attitudes, acquire a peer-like status and even assume a sisterly role among followers (Enke & Borchers, 2019; Berryman & Kavka, 2018; Freberg et. al., 2011).
The magnitude of this phenomenon becomes particularly evident on the video-sharing platform YouTube: Bianca Heinicke, for instance, who runs one of the most famous German beauty and lifestyle channels, namely BibisBeautyPalace, has assembled an impressive viewer base of 5.84 million subscribers (as of January 2020) and routinely promotes the commercial products showcased in her videos (Schwemmer & Ziewiecki, 2018; Gerhards, 2019). Within the YouTube beauty and cosmetic sphere in general, total views increased by approximately 50% between 2017 and 2018 alone, accumulating to almost 350 billion total views by 2018 (Pixability, 2018). More specifically, YouTube vlogs within the beauty and cosmetic domain showed a 3.04%
growth in average views between 2017 and 2018, resulting in 5 million views on average (Pixability, 2018). Vlogs generally comprise user-generated content that can be characterized as “personal online diaries” (Molyneaux, Gibson, O’Donnell, & Singer, 2008, p. 2) demonstrating “ordinariness, intimacy, and equality” (Hou, 2019, p. 536). Accordingly, beauty vloggers commonly share personal make-up routines, detailed tutorials describing the usage of make-up, and even expand on personal experiences with cosmetic procedures or surgical enhancement on YouTube. In this context, it seems plausible that audiences may acquire skills related to make-up and cosmetics as beauty vloggers convey their expertise and disclose personal experiences (Hou, 2019; Ko & Wu, 2017).
Gaining knowledge about, and potentially adopting appearance-enhancing behaviors portrayed in beauty vlogs seems especially timely considering the drastic upswing in cosmetic surgery (e.g., breast augmentation procedures increased by 48 % between 2000 and 2018 in the U.S.; see American Society of Plastic Surgeons, 2018) and empirical evidence pointing towards the media as a contributing factor in overall consideration and approval of surgical cosmetic procedures (Slevec & Tiggemann, 2010; Swami, 2009; Delinksy, 2005). In other words, if conventional mass media can be described as “potential resources for ‘learning’ about plastic surgery” (Darisi, Thorne, & Iacobelli, 2005, p. 907) within patients’ decision-making, this prompts the question whether said function might be even more applicable for beauty vlog exposure. Despite the prevalence of appearance-focused content on social media and YouTube’s role as an increasingly important source of information on cosmetic surgery (Wen, Chia, & Hao, 2015), associations of specific content (i.e. beauty vlogs) and viewers’ interest in pursuing cosmetic surgery have been examined rather scarcely. Thus, the present study aims to investigate potential correlations between the consumption of YouTube beauty vlogs and female viewers’ expressed interest in undergoing cosmetic surgery. In this sense, it is important to note that
cosmetic surgery is understood as solely including procedures that are performed without medical necessity – e.g., due to a physical injury – but with the objective to meet the patient’s desired aesthetic appearance standards (Calogero, Pina, & Sutton, 2014).
Theoretical Framework Social Cognitive Theory
As mentioned before, due to beauty vlog’s distinct demonstrations of beauty-related behavior, it can be assumed that such content serves as a template of conduct. Therefore, social cognitive theory (Bandura, 1986) will be utilized as a theoretical framework to unravel potential associations between viewers’ consideration of undergoing cosmetic surgery and the consumption of YouTube beauty vlogs. According to Bandura (1986), “virtually all learning phenomena, resulting from direct experience, can occur vicariously by observing other people’s behavior and its consequences for them” (p. 19). Correspondingly, by witnessing behaviors and attitudes others exhibit and the consequences they entail, observers can – consciously or unwittingly – adopt values and behavioral patterns to re-enact in the future (Bandura, 1986). Based on this premise, social cognitive theory has been widely used in body image research, for instance, to explain why individuals adjust eating and exercise behavior in response to thin media ideals (Harrison, 2009). Nabi (2009) further noted that principles of social cognitive theory explained most variance in cosmetic surgery makeover program viewers’ expressed interest in cosmetic surgery as compared to alternate, popularly used theoretical approaches (e.g., social comparison theory; Festinger, 1954). Arguably, such reality TV programs’ straightforward depictions of related behaviors and associated consequences might explain this finding (Nabi, 2009). In this sense, beauty vlogs follow a similar schema as vloggers demonstrate expertise, similarity, and approachability in sharing their personal stories, experienced outcomes, and advice (Ko & Wu, 2017; Lee & Watkins, 2016).
In a previous study conducted by Delinksy (2005), vicarious experiences through family and friends have been shown to increase female undergraduates’ approval and reported likelihood of pursuing cosmetic surgery, possibly due to higher familiarization with the issue and
availability of information. Similarly, Brown, Furnham, Glanville, and Swami (2007) found that, among a convenience sample of 208 adult participants, knowing people who had undergone cosmetic surgery predicted women’s likelihood of pursuing surgery, but not men’s. With this in mind, it seems conceivable that observing beauty vloggers – possibly perceived as virtual, “reliable, albeit somewhat superficial friends” (Rihl & Wegener, 2017, p. 10) – as well as the information and instructions they present may predict female viewers’ interest in cosmetic surgery.
With regards to beauty and cosmetics as the main thematic focus, it seems plausible that the frequency of exposure to beauty vlogs is furthermore paralleled by greater interest in pursuing surgical enhancement. For instance, on the basis of social cognitive theory and applying a daily diary approach, Miller, Kelly, and Stephen (2019) found that college women who more
frequently socially interacted with body-focused others reported lower body appreciation and greater dietary restraints. In addition, results from previous research conducted by Sperry, Thompson, Sarwer, and Cash (2009) among a sample of 2057 college women indicate that the frequency of cosmetic surgery makeover program consumption is, for instance, positively related to perceptions about the safety of cosmetic surgery. Thus, for the present study, frequently
encountering appearance-preoccupied beauty vlogs is expected to relate to higher interest in cosmetic surgery.
H1. Higher frequency of beauty vlog consumption will be associated with greater interest in pursuing cosmetic surgery.
Following Bandura (1986; 1997; 2001), viewers’ individual attributes, perceived self-efficacy in exerting control over their appearance (i.e. undergoing cosmetic surgery), and the potentially motivational effect of expected outcomes will be used to further specify the
hypothesized relationship between beauty vlog consumption and interest in cosmetic surgery. Individual Attributes. Behavior related to appearance-enhancement portrayed in the media can affect the standards that individuals define for their own appearance-related conduct (Willis & Knobloch-Westerwick, 2014). In this sense, however, an individual’s selective attention to a modeled behavior is one key sub-function in observational learning and subject to a distinct set of observer’s attributes as “[p]erceptions are guided by preconceptions” (Bandura, 1986, p. 53). General cognitive skills, value preferences, the ascribed meaning, and interpretation of observed actions can, for instance, impact potential future modeling (Bandura, 1986; 2001). With this study’s objective in mind, it seems plausible that appearance-related individual determinants might impact the degree to which attention is paid to depicted behavior in beauty vlogs, and to which processes of observational learning might occur in turn. Women who evaluate their own overall physical appearance negatively, for instance, might be more inclined to attentively consume beauty vlogs, and subsequently adopt depicted behaviors. Indeed, the frequency of watching cosmetic surgery makeover TV shows was shown to positively correlate with women’s body dissatisfaction as this specific format might be particularly appealing to those more
discontent with their appearance (Sperry, Thompson, Sarwer, & Cash, 2009). Numerous studies have further provided evidence for the contribution of appearance dissatisfaction to women’s willingness to pursue cosmetic surgery (e.g., Jung & Hwang, 2016; Slevec & Tiggemann, 2010; Markey & Markey, 2009; Brown, Furnham, Glanville, & Swami, 2007). Thus, as shown in Figure 1, appearance satisfaction is assumed to function as a moderator.
H2. The relationship between the frequency of beauty vlog consumption and interest in undergoing cosmetic surgery hypothesized in H1 is moderated by appearance satisfaction.
Self-Efficacy. Generally, self-efficacy can be described as the confidence in one’s own abilities to achieve a set goal (Bandura, 2001). The most influential source of such beliefs about one’s capabilities is repeated personal success; however, through vicarious experiences,
individuals can also raise their self-percepts of efficacy (Bandura, 1986) – primarily if the observed other is perceived as similar to oneself. Thus, “through social comparative inference, the attainments of others who are similar to oneself are judged to be diagnostic of one’s own capabilities” (Bandura, 1997, p. 87). For instance, previous research suggests that greater identification with cosmetic surgery reality TV candidates is associated with a higher reported desire to undergo cosmetic surgery among undergraduates (Nabi, 2009; Nabi & Keblusek, 2014). Through displays of intimacy and disclosure (García-Rapp, 2016), such identification processes could amplify beauty vlog viewers’ adoption of presented appearance-related behaviors: “The greater the assumed similarity, the more persuasive are the model’s successes and failures” (Bandura, 1997, p. 87).
H3a. Higher frequency of beauty vlog consumption will relate to greater identification with the beauty vlogger.
H3b. Identification with the beauty vlogger will relate to greater interest in pursuing cosmetic surgery.
H3c. The association between frequency of beauty vlog consumption and interest in undergoing cosmetic surgery will be mediated by identification with the beauty vlogger.
Following Bandura (1986; 1997), the level of perceived self-efficacy affects an
individual’s ability to perform personal change as beliefs in one’s own capabilities may initiate adopting new behaviors in the first place. Secondly, a strong sense of efficacy may elicit motivation and perseverance during personal transformation, and thirdly, self-efficacy might determine how successful mastered behaviors are maintained over time. Extended to the consumption of beauty-related YouTube videos and the portrayed appearance-optimizing
behaviors, observational learning might be more pronounced for viewers with greater confidence in their appearance-altering skills.
Previous research suggests, for instance, that beliefs in one’s personal ability to exercise control over physical appearance, low interpersonal self-efficacy, yet great confidence in the capability to achieve a desired shape- and weight-related ideal, predicts higher levels of dietary restraints in young women when confronted with interpersonal stress (Cain, Bardone-Cone, Abramson, Vohs, & Joiner, 2010). Yin et. al. (2016) have further examined beliefs about general self-efficacy among Chinese facial cosmetic surgery patients in comparison with a general population control group. Pre-operatively, cosmetic surgery patients showed significantly lower levels of self-efficacy, but experienced a meaningful improvement six months post-operatively, indicating that low general self-efficacy might instigate individuals to seek cosmetic surgery (Yin et. al., 2016). Contrary, however, other studies have concluded no or negative associations
between self-percepts of efficacy and appearance-related measures. In a survey conducted by Mowen, Longoria, and Sallee (2009), the hypothesized relation between trait self-efficacy and cosmetic surgery propensity – interpreted as a way of controlling one’s body – was not found. Correspondingly, Delforterie, Larsen, Bardone-Cone, and Scholte (2014) did not detect differences in appearance-related self-efficacy in their experimental research exploring the relationship between pro-ana website exposure and body satisfaction measures in young women.
The ambivalence and scarcity in scholarly findings call for further investigation. Thus, for the objective of the present study and in line with Bandura (1997), the association between beauty vlog consumption and appearance-altering measures is expected to be stronger among women with higher beliefs in domain-specific self-efficacy (i.e. appearance-altering and cosmetic surgery self-efficacy), as illustrated in Figure 1.
H4. The relationship between the frequency of beauty vlog consumption and interest in undergoing cosmetic surgery hypothesized in H1 is moderated by cosmetic surgery self-efficacy.
Outcome Expectancies. User-generated cosmetic surgery YouTube content
predominantly highlights the positive outcomes of surgical experiences whilst neglecting risks (Wen et. al., 2015). Indeed, many beauty vloggers who document their cosmetic surgery journey appear to underline its life-changing effect and seem to equate their “new” appearance with happiness. Similarly, fitness-promoting messages in magazines (Willis & Knobloch-Westerwick, 2014) and “fitspiration” YouTube vlogs (Ratwatte & Mattacola, 2019) use this narrative to link weight loss or exercising outcomes as an achievement of unrealistic aesthetic goals to emotional benefits. Such emphasis on positive outcomes can perform as a vicarious motivator: “Seeing others gain desired outcomes by their actions can create outcome expectancies that function as positive incentives” (Bandura, 2001, p. 276). Hence, observing a beauty vlogger engaging in appearance-enhancing activities (e.g., applying make-up or undergoing surgical enhancement) and consequently attaining a desired attractive appearance, potentially rewarded by others, could facilitate viewers’ motivation to imitate said behaviors.
H5a. Higher frequency of beauty vlog consumption will relate to more positive outcome expectancies of undergoing cosmetic surgery.
H5b. Positive outcome expectancies of pursuing cosmetic surgery will relate to greater interest in pursuing cosmetic surgery.
H5c. The association between frequency of beauty vlog consumption and interest in undergoing cosmetic surgery will be mediated by positive outcome expectancies of undergoing cosmetic surgery.
Figure 1. Conceptual Diagram adapted from Hayes (2013) illustrating the relationship between beauty vlog consumption and interest in cosmetic surgery, moderated by appearance satisfaction and cosmetic surgery self-efficacy, and mediated through identification with the vlogger and positive outcome expectancies of undergoing surgical enhancement.
Methodology Participants and Procedures
After receiving ethical permission, the online questionnaire was distributed using the online survey software Qualtrics and shared across various social media platforms. Conducting an online survey offered several advantages. In particular, the anonymity and convenience provided for respondents in light of the somewhat sensitive issue (i.e. willingness to pursue
cosmetic surgery) seemed compelling (Alessi & Martin, 2010; Evans & Mathur, 2005).
Additionally, the distribution of, and data collection via online surveys is fairly inexpensive and time-efficient as compared to pen-and-pencil approaches (van Selm & Jankowski, 2006). Moreover, concerning the limited research available on beauty vlog consumption, correlational research seemed appropriate to explore associations with women’s interest in pursuing cosmetic surgery and to further potentially provide preliminary evidence for this link (Fardouly &
Vartanian, 2016).
Data were collected over four weeks between December 2019 and January 2020. In total, 224 participants started filling out the survey. Initially, participants were asked to indicate their age and gender. Only female participants aged 18 and above were directed to fill out the questionnaire; all others were thanked for their interest in this research and explained that they were not eligible for participation. With a completion rate of 75%, 167 female participants between the ages of 19 and 65, M = 27.41, SD = 9.43, completed the online questionnaire after giving their informed consent and agreement to participate in the study. After completing the survey, all participants were thanked for their participation, debriefed about the research’s
interest, and provided information and a helpline number to turn to for appearance-related mental issues, such as body dysmorphic disorder.
Measures
Consumption Frequency of YouTube Beauty Content. Respondents were asked to indicate how often they consumed beauty-related YouTube content, pointing out that solely beauty-related videos uploaded by individual vloggers (i.e. not by cosmetics companies or media outlets) were of interest. Responses were measured on a scale from 1 (“never”) to 5 (“very often”), M = 2.34, SD = 1.19. Participants reporting that they never consumed any beauty-related
content on YouTube (n = 54; 32.5 %) were not displayed the question assessing identification, and redirected to the cosmetic surgery items.
Unless noted otherwise, all following variables were measured based on a 5-point Likert scale, ranging from 1 (“strongly disagree”) to 5 (“strongly agree”).
Identification. Five items adapted from Cohen (2001) were used following a previous study conducted by Nabi and Keblusek (2014). Items were altered to match the domain of interest, and contained statements that address states of emphasizing with the beauty vlogger (e.g., “While viewing the videos, I can feel the emotions he/she is going through.”) and percepts of similarity (e.g., “Watching his/her YouTube videos, I feel like I am watching a person like myself.”). After conducting principal component analysis, the scale proved to be unidimensional, explaining 63.29 % of the variance. Cronbach’s alpha further indicated good reliability (α = .85). Thus, the five items were combined into a means scale (M = 2.82, SD = .83).
Outcome Expectancies of Cosmetic Surgery. Inspired by Klassen et. al. (2016), six items from a measurement assessing cosmetic surgery patients’ pre-surgical expectations were used (M = 3.05, SD = .84). Items were chosen due to thematic fit and relevance for the present research. Respondents were asked what they would expect if they ever decided to undergo cosmetic surgery, e.g., “If I pursued cosmetic surgery in the future, I expect that people will tell me I look great.” Items further included “I expect to look fantastic,” “I expect to feel fantastic,” “I expect that good things will happen to me,” “I expect that close relationships will improve,” and “I expect that new people will want to get to know me.” Explaining 64.64% of the variance, the scale proved to be unidimensional and showed high internal consistency (α = .89).
Appearance Satisfaction. Assessing general feelings about one’s appearance, the Appearance subscale of the Body-Esteem Scale for Adolescents and Adults (BE-Appearance; Mendelson, Mendelson, & White, 2001) was included in the questionnaire (M = 3.25, SD = .72).
Participants were asked for their agreement with ten appearance-related statements, such as “I wish I looked better,” (reverse coded) or “I like what I see when I look in the mirror.” As expected, the scale proved to be unidimensional based on principal component analysis and showed high reliability (α = .91).
Cosmetic Surgery Self-Efficacy. According to Bandura (1997), domain-specific self-efficacy should be measured as distinct and concise as possible to accurately identify individuals’ capability percepts. Thus, participants were asked to indicate their confidence in accomplishing a list of four potential tasks when pursuing cosmetic surgery, regardless of financial costs: “I am confident that I could find a qualified surgeon,” “I am confident that I could manage pain and follow-up examinations during recovery,” “I am confident that I could take time off
school/university/work for recovery,” and “I am confident that I could cope with potentially negative reactions from people close to me.” Using principal component analysis, the items accounted for 59.35 % of variance, representing unidimensionality and acceptable internal
consistency (α = .76). Thus, they were included in a composite means scale (M = 3.19, SD = .84). Interest in Cosmetic Surgery. The five-item Consider subscale of Henderson-King and Henderson-King’s (2005) Acceptance of Cosmetic Surgery Scale (ACSS) was used to assess participants’ interest in pursuing cosmetic surgery (M = 3.02, SD = 1.15). The ACSS has been successfully used in previous studies (e.g., Arnocky & Piché, 2014; Maltby & Day, 2011; Slevec & Tiggemann, 2010). Its Consider subscale (ACSS-Consider) includes items such as “If I could have a surgical procedure done for free, I would consider trying cosmetic surgery.” To ensure consistency, the term “plastic surgery” used in one item from the original scale was replaced by “cosmetic surgery” for the present questionnaire. The scale showed unidimensionality, with the five items accounting for 78.04 % of variance and high internal consistency (α = .93).
Covariates. Participants’ body-image-related media consumption, body mass index, and experience with cosmetic surgery were assessed as potential confounding variables.
Social Media Use. Participants were asked to report how often they used the following visuality-focused social media on a typical weekday. Social media use items were measured on a 5-point Likert scale, ranging from 1 (“never”) to 5 (“very often”): Instagram (M = 3.87, SD = 1.42), Snapchat (M = 2.11, SD = 1.40), and Facebook (M = 2.94, SD = 1.25).
Viewership of Appearance-Preoccupied Reality TV. Following Nabi (2009), participants were asked about their viewing frequency of specific reality TV formats. Reality TV formats were summarized into five categories (e.g., Topmodel TV shows; Weight loss TV shows) and substantiated with respective examples (e.g., America’s Next Topmodel; The Biggest Loser). Responses were assessed using a 5-point Likert scale ranging from 1 (“never”) to 5 (“very often”). Conducting principal component analysis, the scale showed to be unidimensional, accounting for 52.27 % of variance and acceptable reliability (α = .76).Thus, the items were combined in a means scale (M = 1.81, SD = .75).
Women’s Magazines Readership. Participants were asked to report how often they read women’s magazines, with higher scores representing higher consumption frequency on a 5-point Likert scale ranging from 1 (“never”) to 5 (“very often”), M = 2.07, SD = .87.
Body Mass Index. In accordance with previous research (Frederick, Lever, & Peplau, 2007; Nabi, 2009), each participants’ body mass index (BMI) was calculated using the formula: BMI = weight (kg)/ [height (m)]2. Participants’ mean BMI, M = 21.86, SD = 3.88, is considered a normal, healthy weight status (Nuttall, 2015).
Personal Experience of Cosmetic Surgery. Based on previous research (Maltby & Day, 2011), participants were asked to indicate if they had or had not pursued any kind of cosmetic
surgery in the past (1 = “No”, 2 = “Yes”). In total, 23 participants reported they had pursued cosmetic surgery before (13.7 %).
Vicarious Experience of Cosmetic Surgery. Following Matlby and Day (2011), participants were asked how many of their friends had previously pursued cosmetic surgery. Response scores ranged from 1 (“None”) to 5 (“All”), M = 1.61, SD = .65. Almost half of the participants reported not having any friends who had undergone cosmetic surgery (46.4 %; n = 78), followed by participants who indicated that less than half of their friends had pursued surgery thus far (44.0 %, n = 74).
Results Descriptive Analysis
Regarding the viewership of beauty vlogs on YouTube, the majority of participants reported to either never (32.5 %; n = 54) or rarely (24.7 %; n = 41) consume such content. Further, 23.5 % of participants indicated to sometimes watch beauty vlogs (n = 39). Only 15.7 % reported to consume beauty content often (n = 26), and 3.6 % indicated high frequency of beauty vlog consumption (5 = “very often”; n = 6). Considering participants’ interest in cosmetic surgery in the future, approximately half agreed (38.7 %; n = 63) or strongly agreed (12 %; n = 20) to have thought about pursuing a procedure, whilst 35.6 % either disagreed (n = 30) or strongly disagreed (n = 28) with this statement. Generally, almost a third of participants reported that they would never have any kind of cosmetic surgery (28.8 %; n = 47).
Identification of relevant control variables
Bivariate correlations showed that viewership of appearance-preoccupied reality TV (r = .24, p = .002), Instagram use (r = .17, p = .03), women’s magazines readership (r = .17, p = .03), and vicarious experience of cosmetic surgery (r = .43, p = .000) correlated with interest in cosmetic surgery. Moreover, having personal experience with cosmetic surgery was associated
with consideration of cosmetic surgery (r = .34, p = .000), indicating that participants who had pursued cosmetic surgery in the past were more interested in future procedures. The remaining proposed covariates – namely BMI, Facebook use, and Snapchat use – did not show significant correlations with interest in cosmetic surgery, and were thus not controlled for in further analysis. Unless otherwise stated, viewership of appearance-preoccupied reality TV, Instagram use,
women’s magazines readership, vicarious as well as personal experiences of cosmetic surgery will be included as control variables in all following analyses.
Main Analysis
Using Andrew F. Hayes’ PROCESS v3.4 macro for SPSS, two separate regression analyses were conducted for each moderator (Conditional Process Model 5; Hayes, 2013) with 5000 bootstrap samples, i.e. appearance satisfaction, as shown in Table 1, and cosmetic surgery self-efficacy, presented in Table 2.
Beauty Vlog Consumption and Interest in Cosmetic Surgery. H1 suggested that higher frequency of beauty-related YouTube content consumption would be related to greater interest in pursuing cosmetic surgery. Consistent with this hypothesis, zero-order correlations provided support for H1, as the consumption frequency of YouTube beauty content significantly correlated with interest in cosmetic surgery (r = .26, p = .001). However, once entered into regression analysis using Conditional Process Model 5 (Hayes, 2013), this main effect does not remain significant, b = -.74, SE = .38, t (99) = -1.95, p = .054, 95% CI = [-1.49, .01] (Table 1), b = -.05, SE = .34, t (99) = -.16, p = .872, 95% CI = [-.73, .62] respectively (Table 2).
Beauty Vlog Consumption, Interest in Cosmetic Surgery, and Appearance Satisfaction. As hypothesized in H2, the relationship between beauty vlog consumption and interest in cosmetic surgery is assumed to be moderated by appearance satisfaction. However, no
significant interaction effect was found, b = .23, SE = .12, t (99) = 1.97, p = .051, 95% CI = [-.00, .47]. Thus, H2 was not supported.
Table 1
Regression analysis for the dependent variable interest in cosmetic surgery (ACSS-Consider) Coefficient SE t df 95% CI Consumption frequency of YouTube
beauty content
-.74 .38 -1.95 99 -1.49, .01
Identification -.11 .11 -1.00 99 -.33, .11
Positive outcome expectancies*** .66 .11 6.15 99 .45, .87 Interaction Effect
BE-Appearance x Consumption frequency
.23 .12 1.97 99 -.00, .47
Note. Moderation of the direct effect through appearance satisfaction (BE-Appearance). Model Summary: F (10, 99) = 9.62, p < .001, R2 = .49
*p < .05. **p < .01. ***p < .001.
Beauty Vlog Consumption, Interest in Cosmetic Surgery, and Identification. H3a suggested that higher frequency of beauty vlog consumption would relate to greater identification with the beauty vlogger. No significant effect was found, b = .13, SE = .08, t (103) = 1.59, p = .116, 95% CI = [-.03, .29]. Thus, H3a was not supported. H3b predicted, in turn, that identification with the beauty vlogger would relate to greater interest in pursuing cosmetic surgery. As shown in Table 1, no significant association was found. Hence, H3b was not
supported. H3c suggested that the association between beauty vlog consumption frequency and interest in pursuing cosmetic surgery would be mediated by identification with the beauty vlogger. As expected, since neither the link between vlog consumption and identification nor between identification and interest in cosmetic surgery proved to be statistically significant, identification with the YouTube vlogger did not function as a mediator (Hayes, 2013).
Additionally, as the confidence interval contains 0, b = -.01, SE = .02, 95% CI = [-.07, .02], no indirect effect was found. H3c was not supported.
Beauty Vlog Consumption, Interest in Cosmetic Surgery, and Cosmetic Surgery Self-Efficacy. As hypothesized in H4, the association of beauty vlog consumption and consideration of cosmetic surgery was assumed to be moderated by cosmetic surgery self-efficacy. In contrast to this hypothesis, the interaction effect was not significant, as illustrated in Table 2. Thus, H4 was not supported.
Beauty Vlog Consumption, Interest in Cosmetic Surgery, and Positive Outcome Expectancies. H5a predicted a positive association between the consumption frequency of YouTube beauty vlogs and perceived positive outcomes. However, this relationship was not significant, b = .17, SE = .09, t (103) = 1.98, p = .051, 95% CI = [-.00, .34]. Hence, H5a was not supported. Accordingly, positive outcome expectancies were assumed to relate to greater interest in pursuing cosmetic surgery in H5b. Consistent with this assumption, findings indicate a
significant relationship between positive outcome expectancies and interest in cosmetic surgery, b = .66, SE = .11, t (99) = 6.15, p = .000, 95% CI = [.45, .87], providing support for H5b.
Therefore, expecting cosmetic surgery to have positive effects seems to be associated with a greater consideration of such procedures among participants. H5c proposed an indirect effect of beauty vlog consumption and interest in cosmetic surgery, mediated by positive outcome
expectancies. As expected, this effect was not significant, b = .11, SE = .06, 95% CI = [.00, .23], since no significant association between beauty vlog consumption and positive outcome
Table 2
Regression analysis for the dependent variable interest in cosmetic surgery (ACSS-Consider)
Coefficient SE t df 95% CI
Consumption frequency of YouTube
beauty content -.05 .34 -.16 99 -.73, .62
Identification -.08 .11 -.75 99 -.31, .14
Positive outcome expectancies*** .56 .12 4.83 99 .33, .80 Interaction Effect
Cosmetic surgery self-efficacy x Consumption frequency
.03 .10 .33 99 -.17, .23
Note. Moderation of the direct effect through cosmetic surgery self-efficacy. Model Summary: F (10, 99) = 9.21, p < .001, R2 = .48
*p < .05. **p < .01. ***p < .001.
Discussion
This study aimed to investigate the relationship between beauty vlog consumption and interest in pursuing cosmetic surgery among adult women. To the author’s knowledge, this research is the first to investigate this relationship. To illuminate potential associations, social cognitive theory (Bandura, 1986) was applied; more precisely, processes of observational learning were expected to specify potential correlations between the frequency of watching beauty vlogs and reported interest in undergoing appearance-enhancing surgical procedures. Contrary to the hypotheses, neither mediating nor moderating effects were identified. Conducting zero-order correlations, general support for the proposed main effect – higher consumption frequency of beauty vlogs correlating with higher interest in cosmetic surgery – emerged. However, once entered into the regression model, this association did not remain significant, implying that confounding variables account for this correlation. In sum, underlying components of social cognitive theory (Bandura, 1986; 1997; 2001) did not substantiate the relationship between beauty vlog consumption and interest in cosmetic surgery. This outcome will be delineated in respect of previous scholarly approaches, and this study’s several limitations.
The lack of evidence for the proposed model (Fig. 1) is in contrast to prior research. For instance, findings from a cross-sectional study conducted by Nabi (2009) indicated that both, identifying with candidates and perceiving positive outcomes, are associated with greater expressed likelihood of pursuing surgical enhancement for viewers of cosmetic surgery reality TV shows. Surprisingly, beauty vlog consumption frequency did not associate with the composite identification measure, which, in turn, did not relate to interest in cosmetic surgery in the present study. One could speculate that not only the sample’s demographics but moreover situational beauty vlog consumption motives play a role here. Firstly, according to Bandura (1986),
identification processes are intensified through congruence between an observer’s self-image and perceptions of the model. Previous research suggests that bonds with YouTube vloggers decrease with age, as individuals “in age-groups that no longer correspond to those targeted by the media formats form weaker parasocial relationships” (Rihl & Wegener, 2017, p. 10). As a concept closely related to identification (Cohen, 2001), this tendency could explain the missing link for identification processes in the present study. Since the sample consisted of adult women ranged in age from 19 to 65 (M = 27.41, SD = 9.43), YouTube vloggers might, in fact, not evoke feelings of similarity, empathy, or relatedness in participants as the perceived discrepancy between the self and the vlogger might be too broad. Secondly, more distinct insights into participants’ viewing motives and habits could be of relevance. For instance, as participants were asked to keep their favorite beauty vlogger in mind (or the last one they watched, respectively), having a better understanding of whether participants prefer and follow one specific beauty vlogger, or instead search for appealing content based on make-up-related keywords could reveal the intensity of a potential bond. In this sense, participants might consume beauty vlogs primarily in order to gain superficial knowledge about cosmetics products or make-up instructions, whereas entertainment
or relationship-building motives may facilitate a perceived connection with the vlogger (Liu, Liu, & Zhang, 2019) and perhaps impact behavioral imitation.
Although user-generated YouTube content generally exhibits appearance-enhancement with a positive valence (e.g., Ratwatte & Mattacolla, 2019; Wen et. al., 2015), no link between beauty vlog consumption and positive outcome expectancies of undergoing cosmetic surgery surfaced. Notably, Nabi (2009) assessed participants’ evaluations of positive outcomes for reality TV show candidates, whilst the present study aimed to investigate how participants evaluate the expected result of pursuing cosmetic surgery for themselves. Thus, in line with Bandura (1986), perceiving a positive outcome for the observed behavior might impact participants’ adjustment of their own expectations in the first place – a mechanism that could be addressed by future
experimental research. Positive outcome expectancies did, however, prove to be linked to higher interest in cosmetic surgery. This finding is hardly surprising, as expectations of positive
consequences motivate behavioral intentions, whereas negative outcome expectancies function as disincentives (Bandura, 2001).
A considerable body of literature has emphasized the role of appearance satisfaction in women’s desire to pursue cosmetic surgery (e.g., Jung & Hwang, 2016; Slevec & Tiggemann, 2010; Markey & Markey, 2009; Brown et. al., 2007), substantiating that lower self-evaluations of attractiveness relate to greater interest in “improving” one’s physical appearance via cosmetic surgery. As no interaction between beauty vlog consumption and appearance satisfaction was found, low appearance satisfaction might, indeed, relate to women’s interest in cosmetic surgery, regardless, however, of women’s media consumption. Thus, appearance satisfaction did not influence the intensity of the relationship between beauty vlog consumption and female participants’ interest in cosmetic surgery.
One essential component of social cognitive theory (Bandura, 1986; 1997) entails
individual estimates of self-efficacy. Thus far, few studies have investigated self-efficacy in light of cosmetic surgery intentions. Yin et. al. (2016) have, for instance, found that low assessment of efficacy increased the likelihood of undergoing facial cosmetic surgery. In contrast, self-efficacy was not associated with cosmetic surgery propensity in a survey conducted by Mowen et. al. (2009). Similarly, this study did not identify cosmetic surgery self-efficacy as a moderator, implying that the confidence in one’s own ability to pursue cosmetic surgery does not affect the relationship between beauty vlog consumption and interest in future surgical enhancement. Apart from the current inconsistency in findings, the present study contributes to future methodological approaches to the assessment of individuals’ confidence in the ability to pursue cosmetic surgery. In this context, prior studies applied general self-efficacy measures (Yin et. al., 2016; Mowen, Longoria, and Sallee, 2009). However, following Bandura (1997), global assessments of self-efficacy are barely insightful; instead, self-self-efficacy measures “must be tailored to domains of functioning and must represent gradations of task demands within those domains” (p. 42). Thus, this study presented a first attempt to develop a self-efficacy scale targeted at exemplary personal challenges related to the pursuit of cosmetic surgery. Additional identification of tangible related tasks and further exploration of corresponding items could provide a useful tool for future research.
Limitations and Directions for Future Research
It seems noteworthy to mention additional limitations of this study and corresponding implications for prospective research. First and foremost, no distinction in content type was made within this study. As beauty vloggers feature a variety of video formats on their channels –
oftentimes combining straightforward beauty tutorials with more intimate ‘behind-the-scenes’-content (Berryman & Kavka, 2017) – such differentiation could allow more nuanced insights. For
instance, rather than assessing general viewership of beauty vlogs, it seems plausible that exposure to videos that specifically address a vlogger’s personal cosmetic surgery journey may enable processes of observational learning, potentially amplifying women’s desire to pursue surgery themselves. For this purpose, experimental empirical approaches could provide valuable contributions.
Secondly, regarding the scant research available, this study’s primary focus was to examine components of social cognitive theory (i.e. cosmetic surgery self-efficacy and positive outcome expectancies) as potential mediators and moderators of the direct effect between beauty vlog consumption and interest in pursuing cosmetic surgery. However, in line with Bandura (1986; 1997), it seems conceivable that these variables might as well operate in concert, suggesting that self-efficacy beliefs might moderate the indirect path through positive outcome expectancies. Thus, models of conditional mediation (Hayes, 2013) might be better suited to grasp a potential relationship between beauty vlog consumption and interest in cosmetic surgery.
Thirdly, methodological shortcomings limit this study’s findings. Although the size of the current sample is comparable to similar survey-based correlational studies investigating the desire for cosmetic surgery (e.g., Markey & Markey, 2009; Maltby & Day, 2011; Brown et. al., 2007), a larger sample would allow for more accuracy, generalization, and higher statistical power. As the results are restricted by the sample, no conclusions about the prevalence of beauty vlog
consumption or interest in cosmetic surgery among the general female population can be derived. Moreover, despite the statistical insignificance of the examined paths, the cross-sectional nature of this research does not permit causal inference. However, as this study presented a first attempt to examine correlations between beauty vlog consumption and women’s interest in cosmetic surgery, its findings deliver preliminary indications that this relationship may not exist.
A replication of this study with an adolescent sample could extend current findings. In 2018, 32 % of U.S. teens indicated that YouTube was the social media platform they used most often (Anderson & Jiang, 2018). Furthermore, YouTube vloggers are believed to be highly persuasive and influential on teens’ purchase decisions and even to excel in popularity as compared to traditional mainstream celebrities (Arnold, 2017). Moreover, findings from a previous study indicate that, regardless of gender, Dutch adolescents’ social media use predicts the desire to pursue cosmetic surgery through appearance investment (de Vries et. al., 2014). Thus, although the findings presented in the present study do not suggest an association between beauty vlog consumption and female adults’ interest in cosmetic surgery, this relationship might prevail among adolescents.
Conclusion
To conclude, addressing the increasing numbers in cosmetic surgery procedures (American Society of Plastic Surgeons, 2018) and corresponding concerns about the media’s impact on women’s decision-making, this study’s objective was to explore potential correlations between YouTube beauty vlog consumption and interest in cosmetic surgery among female adults within the theoretical framework of social cognitive theory (Bandura, 1986; 1997; 2001). In contrast to several studies pinpointing the effects of cosmetic surgery reality TV shows on women’s
intentions to undergo surgical enhancement, no evidence for a corresponding relationship between the consumption of beauty vlogs and interest in cosmetic surgery emerged. Future research, and experimental studies in particular, could further contribute to confirm this finding.
References
Alessi, E. J., & Martin, J. I. (2010). Conducting and internet-based survey: benefits, pitfalls, and lessons learned. Social Work Research, 34(2), 122-128.
American Society of Plastic Surgeons (2018). 2018 Plastic Surgery Statistics Report. Retrieved from https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-full-report-2018.pdf
Anderson, M., & Jiang, J. (2018). Teens, social media & technology 2018. Retrieved from
https://www.pewresearch.org/internet/2018/05/31/teens-social-media-technology-2018/
Arnocky, S., & Piché, T. (2014). Cosmetic surgery as intrasexual competition: the mediating role of social comparison. Psychology, 5, 1197-1205. doi: 10.4236/psych.2014.510132
Arnold, A. (2017). Why YouTube stars influence millennials more than traditional celebrities. Retrieved from https://www.forbes.com/sites/under30network/2017/06/20/why-youtube-stars-influence-millennials-more-than-traditional-celebrities/#3e829a2848c6
Bandura, A. (1986). Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, N. J.: Prentice-Hall.
Bandura, A. (1997). Self-efficacy: the exercise of control. New York: W. H. Freeman and Company.
Bandura, A. (2001). Social cognitive theory of mass communication. Media Psychology, 3(3), 265-299. doi: 10.1207/S1532785XMEP0303_03
Berryman, R., & Kavka, M. (2017). ‘I guess a lot of people see me as a big sister or a friend’: the role of intimacy in the celebrification of beauty vloggers. Journal of Gender Studies, 26(3), 307-320. doi: 10.1080/09589236.2017.1288611
Brown, A., Furnham, A., Glanville, L., & Swami, V. (2007). Factors that affect the likelihood of undergoing cosmetic surgery. Aesthetic Surgery Journal, 27(5), 501-508. doi:
10.1016.j.asj.2007.06.004
Cain, A. S., Bardone-Cone, A. M., Abramson, L. Y., Vohs, K. D., & Joiner, T. E. (2010). Prospectively predicting dietary restraint: the role of interpersonal self-efficacy, weight/shape self-efficacy, and interpersonal stress. International Journal of Eating Disorders, 42(6), 505-512.
Calogero, R., Pina, A., & Sutton, R. (2014). Cutting words: Priming self-objectification increases women’s intention to pursue cosmetic surgery. Psychology of Women Quarterly, 38(2), 197-207. doi: 10.1177/0361684313506881
Cohen, J. (2001). Defining identification: a theoretical look at the identification of audiences with media characters. Mass Communication & Society, 4(3), 245-264.
Darisi, T., Thorne, S. & Iacobelli, C. (2005). Influences on decision-making for undergoing plastic surgery: a mental models and quantitative assessment. Plastic and Reconstructive Surgery, 116(3), 907-916. doi: 10.1097/01.PRS.0000177691.81162.e5
de Vries, D., Peter, J., Nikken, P., & de Graaf, H. (2014). The effect of social network site use on appearance investment and desire for cosmetic surgery among adolescent boys and girls. Sex Roles, 71, 283-295. doi: 10.1007/s11199-014-0412-6
Delforterie, M. J., Larsen, J. K., Bardone-Cone, A. M., & Scholte, R. H. J. (2014). Effects of viewing a pro-ana website: an experimental study on body satisfaction, and appearance self-efficacy. Eating Disorders, 22(4), 321-336. doi: 10.1080/10640266.2014.898982 Delinsky, S. S. (2005). Cosmetic surgery: a common and accepted form of self-improvement?.
Enke, N., & Borchers, N. S. (2019). Social media influencers in strategic communication: a conceptual framework for strategic social media influencer communication. International Journal of Strategic Communication, 13(4), 261-277. doi:
10.1080/1553118X.2019.1620234
Evans, J. R., & Mathur, A. (2005). The value of online surveys. Internet Research, 15(2), 195-219. doi: 10.1108/10662240510590360
Fardouly, J., & Vartanian, L. R. (2016). Social media and body image concerns: current research and future directions. Current Opinion in Psychology, 9, 1-5. doi:
10.1016/j.copsyc.2015.09.005
Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7, 117–140. Freberg, K., Graham, K., McGaughey, K., & Freberg, L. A. (2011). Who are the social media
influencers? A study of public perceptions of personality. Public Relations Review, 37, 90-92. doi: 10.1016/j.pubrev.2010.11.001
Frederick, D. A., Lever, J., & Peplau, L. A. (2007). Interest in cosmetic surgery and body image: views of men and women across the lifespan. Plastic and Reconstructive Surgery, 120(5), 1407-1415. doi: 10.1097/01.prs.0000279375.26157.64
García-Rapp, F. (2016). The digital media phenomenon of YouTube beauty gurus: the case of Bubzbeauty. International Journal of Web Based Communities, 12(4), 360-375. doi: 10.1504/IJWBC.2016.080810
Gerhards, C. (2019). Product placement on YouTube: an explorative study on YouTube creators’ experiences with advertisers. Convergence: The International Journal of Research into New Media Technologies, 25(3), 516-533. doi: 10.1177/1354856517736977
Harrison, K. (2009). Media and the Body. In R. L. Nabi & M. B. Oliver (Eds.), The SAGE Handbook of Media Processes and Effects (S. 393-407). Los Angeles: SAGE.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Press.
Henderson-King, D., & Henderson-King, E. (2005). Acceptance of cosmetic surgery: scale development and validation. Body Image, 2, 137-149. doi: 10.1016/j.bodyim.2005.03.003 Holland, G., & Tiggemann, M. (2016). A systematic review of the impact of the use of social
networking sites on body image and disordered eating outcomes. Body Image, 17, 100-110. doi: 10.1016/j.bodyim.2016.02.008
Hou, M. (2019). Social media celebrity and the institutionalization of YouTube. Convergence: The International Journal of Research into New Media Technologies, 25(3), 534-553. doi: 10.1177/1354856517750368
Jung, J., & Hwang, C. S. (2016). Associations between attitudes towards cosmetic surgery, celebrity worship, and body image among South Korean and US female college students. Fashion and Textiles, 3(17), 1-14. doi: 10.1186/s40691-016-0069-6
Klassen, A. F., Cano, S. J., Alderman, A., East, C., Badia, L., Baker, S. B., Robson, S., & Pusic, A. L. (2016). Self-reported scales to measure expectations and appearance-related psychosocial distress in patients seeking cosmetic treatments. Aesthetic Surgery Journal, 36(9), 1068-1078. doi: 10.1093/asj/sjw078
Ko, H.-C., & Wu, W.-N. (2017). Exploring the determinants of viewers‘ loyalty toward beauty YouTubers: a parasocial interaction perspective. Proceedings of the 2017 International Conference on Education and Multimedia Technology. ICEMT 2017: International Conference on Education and Multimedia Technology, Singapore (pp. 81-86). doi: 10.1145/3124116.3124130
L‘oréal (2018). Cosmetics market: L’Oréal confirmed its position as cosmetics market leader once again this year. Retrieved from https://www.loreal-finance.com/en/annual-report-2018/cosmetics-market-2-1/
Lee, J. E., & Watkins, B. (2016). YouTube vloggers’ influence on consumer luxury brand perceptions and intentions. Journal of Business Research, 69, 5753-5760. doi: j.jbusres.2016.04.171
Liu, M. T., Liu, Y., & Zhang, L. L. (2019). Vlog and brand evaluations: the influence of
parasocial interaction. Asia Pacific Journal of Marketing and Logistics, 31(2), 419-436. doi:10.1108/APJML-01-2018-0021
López-Guimera, G., Levine, M. P., Sánchez-Carracedo, D., & Fauquet, J. (2010). Influence of mass media on body image and eating disordered attitudes and behaviors in females: a review of effects and processes. Media Psychology, 13(4), 387-416. doi:
10.1080/15213269.2010.525737
Maltby, J., & Day, L. (2011). Celebrity worship and incidence of elective cosmetic surgery: evidence of a link among young adults. Journal of Adolescent Health, 49, 483-489. doi: 10.1016/j.jadohealth.2010.12.014
Markey, C. N., & Markey, P. M. (2009). Correlates of young women’s interest in obtaining cosmetic surgery. Sex Roles, 61, 158-166. doi: 10.1007/s11199-009-9625-5
Mendelson, B. K., Mendelson, M. J., & White, D. R. (2001). Body-Esteem scale for adolescents and adults. Journal of Personality Assessment, 76(1), 90-106.
Miller, K., Kelly, A., & Stephen, E. (2019). Exposure of body focused and non-body focused others over a week: a preliminary investigation of their unique contributions to college women’s eating and body image. Body Image, 28, 44-52. doi:
Molyneaux, H., O’Donnel, S., Gibson, K., & Singer, J. (2008). Exploring the gender divide on YouTube: an analysis of the creation and reception of vlogs. American Communication Journal, 10(1), 1-14.
Mowen, J. C., Longoria, A., & Sallee, A. (2009). Burning and cutting: identifying the traits of individuals with an enduring propensity to tan and to undergo cosmetic surgery. Journal of Consumer Behaviour, 8, 238-251. doi: 10.1002/cb.284
Nabi, R. L., & Keblusek, L. (2014). Inspired by hope, motivated by envy: comparing the effects of discrete emotions in the process of social comparison to media figures. Media
Psychology, 17(2), 208-234. doi: 10.1080/15213269.2013.878663
Nabi, R. L. (2009). Cosmetic surgery makeover programs and intentions to undergo Cosmetic enhancements: a consideration of three models of media effects. Human Communication Research, 35, 1-27. doi: 10.1111/j.1468-2958.2008.01336.x
Nuttall, F. Q. (2015). Body mass index: obesity, BMI, and health: a critical review. Nutrition Today, 50(3), 117-128. doi: 10.1097/NT.0000000000000092
Perloff, R. M. (2014). Social media effects on young women’s body image concerns: theoretical perspectives and agenda for research. Sex Roles, 71, 363-377. doi: 10.1007/s11199-014-0384-6
Perrin, A., & Anderson, M. (2019). Share of U.S. adults using social media, including Facebook, is mostly unchanged since 2018. Retrieved from https://www.pewresearch.org/fact- tank/2019/04/10/share-of-u-s-adults-using-social-media-including-facebook-is-mostly-unchanged-since-2018/
Pixability (2018). The digital beauty counter: how beauty marketers can connect with consumers through YouTube, Facebook, and Instagram video. Retrieved from
Ratwatte, P., & Mattacola, E. (2019). An exploration of ‘fitspiration’ content on YouTube and its impacts on consumers. Journal of Health Psychology. Advanced online publication. doi: 10.1177/1359105319854168
Rihl, A., & Wegener, C. (2017). YouTube celebrities and parasocial interaction: using feedback channels in mediatized relationships. Convergence: The International Journal of Research into New Media Technologies, 25(3), 554-556. doi: 10.1177/1354856517736976
Schwemmer, C., & Ziewiecki, S. (2018). Social media sellout: the increasing role of product promotion on YouTube. Social Media + Society, 4(3), 1-12. doi:
10.1177/2056305118786720
Slevec, J., & Tiggemann, M. (2010). Attitudes toward cosmetic surgery in in middle-aged women: body-image, aging anxiety, and the media. Psychology of Women Quarterly, 34(1), 65-74. doi: 10.1111/j.1471-6402.2009.01542.x
Sperry, S., Thompson, J. K., Sarwer, D. B., & Cash, T. F. (2009). Cosmetic surgery reality TV viewership: relations with cosmetic surgery attitudes, body image, and disordered eating. Annals of Plastic Surgery, 62(1), 7-11. doi: 10.1097/SAP.0b013e31817e2cb8
Swami, V. (2009). Body appreciation, media influence, and weight status predict consideration of cosmetic surgery among female undergraduates. Body Image, 6, 315-217. doi:
10.1016/j.bodyim.2009.07.001
van Selm, M., & Jankowski, N. W. (2006). Conducting online surveys. Quality & Quantity, 40, 435-456. doi: 10.1007/s11135-005-8081-8
Wen, N., Chia, S. C., & Hao, X. (2015). What do social media say about makeovers? A content analysis of cosmetic surgery videos and viewer’s responses on YouTube. Health
Willis, L. E., & Knobloch-Westerwick, S. (2014). Weighing women down: messages on weight loss and body shaping in editorial content in popular women’s health and fitness
magazines. Health Communication, 29(4), 323-331.
Yin, Z., Wang, D., Ma, Y., Hao, S., Ren, H., Zhang, T., Chen, W., & Fan, J. (2016). Self-esteem, self-efficacy, and appearance assessment of young female patients undergoing facial cosmetic surgery: a comparative study of the Chinese population. JAMA Facial Plastic Surgery, 18(1), 20-26. doi: 10.1001/jamafacial.2015.1381
