Scan the Internet, magazines, and newspapers and you’ll find stories daily about plastic surgery or some other form of cosmetic enhancement such as BOTOX® injections. Harder to locate, however, are articles about why these procedures remain as popular as ever and what leads individuals to make these changes to their bodies.

The number of cosmetic procedures performed in the U.S. climbed in 2014 to 15.6 million, according to statistics calculated by The American Society of Plastic Surgeons®. Breast augmentation remained the most popular cosmetic surgery, while BOTOX injections were the top minimally invasive procedure. Although women get about 90% of the procedures, the number of men visiting plastic surgeons’ offices continues to increase, the statistics show.

What the statistics don’t show is what motivates people to get cosmetic procedures. Is it as simple as vanity, or bowing to cultural pressure?  Social media is fueling some of the interest, at least when it comes to aesthetic procedures for the face, according to some plastic surgeons. Patients concerned about the way they appear in selfies, or during teleconferences at work, spark interest in cosmetic enhancements.
But the most likely motivation, according to studies and the personal stories written on sites such as RealSelf, a major online plastic surgery forum, enhancing one’s appearance results in greater self-confidence.

“Self-confidence is the most attractive thing a person can wear,” Dr. Dax Guenther, a plastic surgeon in Boston says, “Any time I’m able to improve someone’s self-confidence it goes far beyond being only ‘skin deep.'”

In general, the limited research exploring why people get plastic surgery finds that people who have undergone elective cosmetic procedures often report higher levels of self-esteem following the procedure. Improving self-confidence, rather than vanity, appears to be the primary motivation. As researchers wrote in a study published last November in the journal Clinical Psychological Science, the most frequent goal of individuals who get plastic surgery is to “feel better about/in one’s own body.”

An earlier study published in the same journal found that most people who undergo plastic surgery have realistic goals. Only 12% of the subjects in the 2013 study, which at the time was the largest of its type ever conducted, believed cosmetic surgery would solve all of their problems or that they would be a “completely new person.”

Those findings echo the opinion of David K. Wellisch, a professor of psychiatry at the David Geffen School of Medicine at the University of California, Los Angeles, who has authored a textbook chapter on the subject of why women consider breast enhancement surgery.

Most women who get breast implants are realistic about the surgery, he Hsays. It’s a body image issue, he says: “They simply are not happy with their bodies and wish to improve them. They have realistic expectations that if this is done, they will look more satisfying to their own eye and to others.”

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