Cosmetic Surgeons and other professionals, who work in the field of medicine devoted to improving appearance, appear to have developed a particular understanding about how what they do helps their patients. This view has now been challenged by some new counterintuitive research by US psychologists, who argue that the field has neglected what it is that actually leads women to feel good about our bodies, and the answer is somewhat surprising.


It is undoubtedly true that when we are very upset by an aspect of our appearance, having it corrected or enhanced, can make a big difference to our sense of well being. So it’s understandable that aesthetic medical professionals should have evolved the straightforward view they have. About how what they do helps their patients.


This has also been found by psychologists to be particularly true of women compared to men. It seems that a much bigger proportion of personal happiness resides in feeling good about your looks for women, compared to men.


So the view of aesthetic medical professionals is along the lines of; we correct a problem or improve an aspect of appearance and the patient becomes happier as a result. This seems so obvious and straightforward it hardly bears repeating, but in fact new research by psychologists based at Ohio State University casts serious doubt on this model. In particular it raises the provocative possibility that merely fixing a problem, is unlikely on its own, to lead to overall sustained improvements in positive feelings about appearance and body.


This new view is that just as health is more than the mere absence of disease, feeling positive about your body is more than just not feeling negative about it.


Nichole Wood-Barcalow, Tracy Tylka and Casey Augustus-Horvath have published a study in the prestigious academic journal Body Image, of 15 young women and 5 experts in the field of body image. The survey was intended to establish the answer a little researched question – for those who start out feeling great about their bodies, from where originates the source of such positivity?


There has been a lot of research on why we feel bad about our bodies, and indeed the group who harbour particularly negative attitudes to their appearance, have been the focus of much research. Yet the sector of the general public who feel great about their physical selves, appears to have been somewhat neglected. In a sense this is entirely understandable as this group are unlikely to present to clinicians seeking help.


However, if we want to help our patients feel better about the way they look, unpacking how it is that some already feel marvelous about their bodies is key to that enterprise.


The study, entitled -‘‘But I Like My Body’’: Positive body image characteristics and a holistic model for young-adult women – points out that there are basically three groups of women – those who feel bad about their bodies, those who feel neutral or harbour what appear to be ‘normative’ attitudes or normal content or discontent, and a third unresearched group, who are incredibly positive about their bodies.


This sample was the focus of this new research, and it could be this paper represents one of the very first attempts to investigate in-depth why some of us experience such positivity about our bodies. If aesthetic medical professionals want to help their clients feel better about their appearance, they may want to consider what psychological processes are in action for this group, to assist their patients develop a better sense of well-being about their appearance following a procedure. This is because the research emphasises a positive attitude to your body is much more than merely the absence of negative feeling.


Cosmetic professionals take a ‘deficit’ view of our attitudes to our physical selves. Fix the problem and hey presto we must now feel good. But suppose it’s the case that being positive about our physical appearance, involves much more than simply not detecting a deficit?


The researchers found that those who were upbeat about their looks are engaged in several active psychological processes which are what is producing this amazingly constructive outcome. The mechanism appeared to have little to do with objective assessment of outward show.


The first process the authors uncovered was a huge amount of appreciation for their bodies, and what their bodies did for them. This positive admiration for their bodies appeared to help them understand the consequent psychological cost of a negative attitude to their appearance.


This group also appeared to be surrounded by a group of friends, relatives and intimates all of whom expressed unconditional positivity to their bodies. This could be a particularly important finding for cosmetic medical professionals to be aware of. There would be little point in objectively correcting a problem, if all that happened was the patient returned to a social environment where criticism or general negativity to their appearance was the norm. The procedure would be unlikely to be associated with a helpful result for the patient, if this social context to their own attitude to their looks was not addressed.   


The women who were positive about their appearance also looked after their bodies and this care for themselves seem to tie in with their deep appreciation of their figures. For example all the women studied made at least moderate attempts to eat healthily and exercise regularly. They also pampered their bodies with massages and various grooming rituals, as well as being keen to see the doctor at the earliest sign of any medical problems. This cluster of behaviours appeared to be all linked with a sense of responsibility for looking after their bodies and a feeling that if they did do this, their bodies would look after them as well.


Cosmetic medical professionals may want to consider how much education they give their patients about how to look after their bodies generally, as this would appear from this research to be crucial in assisting a shift to more optimism around physical appearance.


These women who were highly positive about their exteriors, also actively and even unconsciously ‘filtered out’ body images and related messages from the wider media. This attitude to, and relationship with the media, appears from previous research to be closely linked with negative attitudes to personal physical appearance, secondary to negative comparisons with idealised appearances in the media.


The positive body image women, for example, always ‘discounted’ the appearance of women in glossy magazines or on Film, by always adding in riders; such as these images were re-touched and not ‘real’. Also that the women had access to assistance which is it was impossible for ordinary women to avail themselves of, such as personal trainers, make up artists and stylists, so it was unrealistic to mount comparisons between themselves and these idealized images. This active process appeared to protect the women from being negatively effected by the daily bombardment with this imagery.


Again it would seem from this research that cosmetic medical professionals would be taking a grave risk over longer term outcomes, if they didn’t actively get involved in understanding and helping improve the way their patients might leave the clinic physically better, but still prone to unhelpful comparisons with the images coming at them from the wider media.


Finally the psychologists conducting this study holistically summarized the key underlying theme that united all the women who were positive about their bodies – this sample did not merely accept their physical selves; instead they expressed love for their bodies via thoughts, emotions, and protective behaviors.


Cosmetic professionals would be well advised to take away some lessons from this research.


In particular, about how to help their patients change the way they appreciate their bodies or think about their appearance, after a successful procedure. This will help to ensure that cosmetic improvements are also accompanied by psychological changes, which work synergistically together, to assist in greater well being, linked to improved feelings about appearance over the longer term.


It’s easy to forget that helping patients improve their appearance is not in fact the only end goal – it’s assisting people in feeling better about their appearance more generally. And in so doing elevating overall happiness.


Dr Raj Persaud FRCPsych is a Consultant Psychiatrist working in private practice in Harley St, London W1




‘‘But I Like My Body’’: Positive body image characteristics and a holistic

model for young-adult women. Body Image 7 (2010) 106–116. Nichole L. Wood-Barcalow, Tracy L. Tylka, Casey L. Augustus-Horvath. The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, United States.