cosmetics
Article
Awareness of Cosmetic Procedures among Adults Seeking to
Enhance Their Physical Appearance: A Cross-Sectional Pilot
Study in Central Jordan
Safwan M. Aladwan 1 , Ashok K. Shakya 2, * , Rajashri R. Naik 3 and Kelvin I. Afrashtehfar 4,5, *
Citation: Aladwan, S.M.; Shakya,
A.K.; Naik, R.R.; Afrashtehfar, K.I.
Awareness of Cosmetic Procedures
among Adults Seeking to Enhance
Their Physical Appearance: A
Cross-Sectional Pilot Study in Central
Jordan. Cosmetics 2023, 10, 19.
https://doi.org/10.3390/
cosmetics10010019
Academic Editors: Mohamad
Goldust and George Kroumpouzos
Received: 4 December 2022
Revised: 5 January 2023
Accepted: 9 January 2023
Published: 16 January 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Cosmetics 2023, 10, 19. https://doi.org/10.3390/cosmetics10010019
1 Department of Cosmetics, Faculty of Allied Medical Sciences, Pharmacological and Diagnostic Research
Center, Al-Ahliyya Amman University, Amman 19328, Jordan
2 Department of Pharmaceutical Sciences, Faculty of Pharmacy, Pharmacological and Diagnostic Research
Center, Al-Ahliyya Amman University, Amman 19328, Jordan
3 Department of Medical Laboratory Sciences, Faculty of Allied Medical Sciences, Pharmacological and
Diagnostic Research Center, Al-Ahliyya Amman University, Amman 19328, Jordan
4 Evidence-Based Practice Unit, Clinical Sciences Department, College of Dentistry, Ajman University,
Ajman City P.O. Box 346, United Arab Emirates
5 Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern,
3010 Bern, Switzerland
* Correspondence: ashokkumar2811@gmail.com or ak_shakya@ammanu.edu.jo (A.K.S.);
kelvin.afrashtehfar@unibe.ch (K.I.A.)
Abstract: The increase in urban society in the use of cosmetic practices to rejuvenate oneself or
obtain a more appealing appearance has influenced the practices of cosmetic dermatologists, general
medical practitioners, plastic surgeons, and dental practitioners, among others. The pharmaceutical
industry has evolved to meet customers’ desire to be more physically attractive irrespectively of
age and gender. This study aimed to preliminarily explore Jordanian adults’ awareness of dental,
facial, and other cosmetic procedures. The reasons for undergoing such cosmetic procedures and
self-reported knowledge of the side effects or risks associated with these interventions were also
explored. The results show that the participants had undergone various procedures to enhance
their looks, attractiveness, and confidence. None of the female participants wanted to emulate a
celebrity. Most participants were aware of the side effects associated with cosmetic procedures, which
may be attributed to their educational backgrounds, as the participants’ minimum qualification was
12th grade and their easy access to information services such as electronic media. A multicenter, large-
scale, regional study is required to determine the associations, correlations, and recommendations for
individuals seeking cosmetic treatment, cosmetic health providers, and policymakers.
Keywords: botulinum neurotoxin; high-intensity focused ultrasound; radiofrequency micro-needling;
bleaching; whitening; laser hair removal; cosmetic procedure
1. Introduction
The goal of cosmetic procedures is to enhance an individual’s appearance. Altering
physical appearance is an age-old process. Irrespective of age and gender, everyone aspires
to look young, attractive, and beautiful. In the present world, people are becoming more
and more fascinated by physical appearance or beauty. In a country such as the USA,
beauty is defined by the media through magazines, television, and social media. The
desirable situation is depicted as a person with a perfect career, family, and social status
and a perfect physique or impeccable looks [1]. There has been a global rise in the number
of individuals undergoing cosmetic procedures to achieve that perfect look.
According to the ISAPS (International Society of Aesthetic Plastic Surgery), in 2018,
there was an increase in nonsurgical procedures of 11.6% and an increase in all cosmetic
procedures of 5.1% [2]. In 2006, around 11.7 million cosmetic surgeries and nonsurgical
https://www.mdpi.com/journal/cosmetics
Cosmetics 2023, 10, 19 2 of 11

procedures were performed in the United States [3]. In 2014, 15.6 million cosmetic proce-
dures (both minimally invasive and surgical) were performed. This represented an increase
in these procedures of 3% since 2013, accounting for around 12.9 billion dollars [4]. In
2019, 18.1 million cosmetic surgeries and 16.1 million minimally invasive procedures were
performed in the USA [5]. Since 1997, a whopping 475% increase in such procedures has
been observed. A similar rise in the trend to enhance a person’s look has also been observed
in developing countries. Among Asian countries, India and China have the highest shares
in this field [6]. This rise may be attributed to the media and social pressure to excel in
the workforce, look attractive, change physical features that individuals are not happy
with, and gain confidence. Young, physically attractive people tend to excel or have more
confidence than others [7,8]. The emphasis on individual physical appearance in media
coverage, the internet, and television has led to an increase in cosmetic procedures. Due to
beauty ideals, people increasingly seek aesthetic surgery and anti-aging cosmetics in their
quest for eternal youth [9–11]. More and more people are becoming aware of cosmetic pro-
cedures through these platforms because of easy access to information technology. Women,
in general, are more aware and pay more attention to cosmetics (appearance) and fashion.
A literature search revealed that there are reports available on the knowledge of
individuals who have undergone cosmetic procedures. However, there are no reports on
this matter for people living in central Jordan. Therefore, this pilot study compared the
knowledge between adult men and women regarding cosmetic procedures or surgery,
including the types of procedures they opt for, awareness of the adverse effects associated
with them, the reasons for undergoing procedures, and satisfaction with the results of
different procedures.

2. Materials and Methods

The study was conducted in July–October 2022 and used a questionnaire that was
completed by individuals willing to undergo cosmetic procedures to enhance their physical
appearance. The participants were individuals from Safwan Dermatology and Aesthetic
Clinics (Amman, Jordan) and were sourced in collaboration with the Safe World Aesthetic
Network for Medical Management and Continuing Medical Education (Amman). The
study’s objective was to investigate the awareness, knowledge, and risks associated with
cosmetic procedures. The results were statistically analyzed with Sigma Plot version 12 and
Prism version 5.0. The study included individuals aged 18 to 60, both males and females,
irrespective of educational background and marital and financial status (Table 1). The
minimum qualification was graduation from 12th grade. The study was carried out with
the consent of the participants after receiving ethics committee approval. The participants
(18 years or older) were Jordanian or residents of Jordan who did not suffer from a chronic
or psychological disease. The participants were not on chronic medications. Nonlactating
and nonpregnant female participants were included in the survey.

Table 1. Demographic parameters of the included participants.

Variable Males (n = 20) Females (n = 40)

Age (years) a 27.0 [25.0–30.8] (19.0–60.0) 30.5 [27.8–37.3] (21.0–58.0)
Marital status (%)
65/35/0 40/45/15
(Single/Married/Divorced)
Physical activity (%) (Active/Sedentary) 60/40 80/20
Fitzpatrick skin type (%) (1/2/3/4/5/6) 5/35/40/15/5/0% 5/37.5/47.5/10/0/0%
Notes: a Median [interquartile] (range).

3. Results
The participants’ demographic parameters are presented in Table 1. All participants had
received the COVID-19 vaccine, and the survey was conducted immediately post-COVID-19.
The questionnaire included the following questions:
 The participants’ demographic parameters are presented in Table 1. All participants
had received the COVID-19 vaccine, and the survey was conducted immediately post-
COVID-19.
The questionnaire included the following questions:
Cosmetics 2023, 10, 19 3 of 11

3.1. Reasons for Undergoing Cosmetic Procedures

The participants’ main for
3.1. Reasons reason for undergoing
Undergoing cosmetic procedures was ‘to look at-
Cosmetic Procedures
tractive’ (females: 62%; Themales: 50%),main
participants’ as presented in Figure cosmetic
reason for undergoing 1, followed by ‘towas
procedures gain confi-
‘to look attrac-
dence with an enhanced physical
tive’ (females: 62%;appearance’ (females:
males: 50%), as presented42.2%; males:
in Figure 25%)by
1, followed and‘to ‘to
gainchange
confidence
features which theywith
didan not
enhanced physical appearance’
like’ (females: (females:
24.4%; males: 42.2%;
50%). males:
None 25%)female
of the and ‘to partic-
change fea-
tures which they did not like’ (females: 24.4%; males: 50%). None of the female participants
ipants wanted ‘to wanted
copy a ‘tocelebrity or look like them’, whereas 10% of men wanted to look
copy a celebrity or look like them’, whereas 10% of men wanted to look like
like a celebrity. a celebrity.

Male Female
Change Feature you don’t Like

Attractive

Gain Confidence

Copy Celebrity

0 20 40 60 80
Percentage (%)

Figure 1. Reasons for undergoing

Figure 1. Reasonsafor
cosmetic procedure
undergoing a cosmeticamong Jordanian
procedure participants.
among Jordanian participants.

3.2. Depth
3.2. Depth of Knowledge of Knowledge
Regarding Regarding
Cosmetic Cosmetic Prior
Procedures Procedures Prior
to the to the Survey
Survey
The results presented in Figure 2 as percentages show responses related to participants’
The results presented
knowledge in Figure
prior 2 as percentages
to participation show
in the survey. responses
In this section, werelated
assessedto
thepartici-
knowledge
pants’ knowledgeofprior to participation in the survey. In this section, we
individuals who had undergone different procedures prior to the survey. assessed the
knowledge of individuals who had undergone different procedures prior to the survey.
3.2.1. Radiofrequency Microneedling (RFMN)

3.2.1. Radiofrequency Around 20% of the male participants had some knowledge; however, many were
Microneedling (RFMN)
unaware about RFMN (50%), whereas 15% had general knowledge, and only 11.0% had
Around 20%tried
of thethe male participants
procedure. had participants
75% of female some knowledge; however,
had general many
knowledge, and were
7.5% had
some knowledge.
unaware about RFMN Around15%
(50%), whereas 12.5%had
of female participants
general had undergone
knowledge, and onlyRFMN.
11.0% had
tried the procedure.
3.2.2.75%
HighofIntensity
femaleFocused
participants had(HIFU)
Ultrasound general knowledge, and 7.5% had
some knowledge. Around More 12.5% of female
than 67.5% participants
of female participantshad
had undergone RFMN.
general knowledge about HIFU, and
22.5% of females had already tried it. Regarding males, 55% were not aware of this cosmetic
3.2.2. High Intensity Focused
procedure, Ultrasound
while only 5% had(HIFU)
tried this procedure. About 15% of participants had general
knowledge.
More than 67.5% of female participants had general knowledge about HIFU, and
22.5% of females had
3.2.3. already tried it. Regarding males, 55% were not aware of this cos-
Dermal Procedures
metic procedure, while only 5%
Similarly, had65%
about tried this procedure.
of female participants About 15% ofdermal
had undergone participants hadand
procedures,
27.5%
general knowledge. had general knowledge. In contrast, 25% of males had some knowledge in this area,
20% of individuals had general knowledge, and around 10% had undergone this type of
procedure, while 35% of participants had no knowledge about such procedures. Dermal
3.2.3. Dermal Procedures
procedures include BoNT, hyaluronic acid, and platelet rich plasma (PRP) injection.
Similarly, about 65% of female participants had undergone dermal procedures, and
27.5% had general3.2.4. Whitening
knowledge. In contrast, 25% of males had some knowledge in this area,
The majority of the female participants had good knowledge of skin whitening pro-
20% of individuals had general knowledge, and around 10% had undergone this type of
cedures. A quarter of the females had tried this type of procedure. Regarding male
procedure, while participants,
35% of participants hadknowledge,
15% had some no knowledge
30% had about such
general procedures.
knowledge, Dermal
only 5% had under-
procedures include BoNT, hyaluronic acid, and platelet rich plasma (PRP) injection.
gone skin whitening, and around 45% had no knowledge of whitening. Whitening includes
Cosmetics 2023, 10, 19 4 of 11

Cosmetics 2023, 10, x FOR PEER REVIEW 4 of 11

the use of retinol, retinyl propionate, lactic acid, Kojic acid, Tranexamic acid, nicotinamide,
and other similar chemicals alone or in combination.

High-intensity Radiofrequency
50

focused ultra- micro-needling

Not aware 0.0

(RFMN)
Some Knowledge 20
7.5
General Knowledge 15
75.0
Tried 10
12.5
Not aware 55
sound (HIFU)
0.0
Some Knowledge 20
5.0
General Knowledge 15
67.5
Tried 5
22.5
Not aware 35
0.0
Procedures
Dermal

Some Knowledge 25
2.5
General Knowledge 20
27.5
Tried 10
65.0
Not aware 45
0.0
Whitening

Some Knowledge 15
5.0
General Knowledge 30
65.0
Tried 5
25.0
Not aware 35
0.0
PEELING

Some Knowledge 0
7.5
General Knowledge 30
57.5
Tried 10
30.0
5
Removal (LHR)

Not aware 0.0

Laser Hair

Some Knowledge 15
2.5
General Knowledge 55
25.0
Tried 20
70.0
20
neurotoxin (Bo

Not aware 0.0

Botulinum

Some Knowledge 15
2.5
NT)

General Knowledge 45
30.0
Tried 20
67.5

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0

Male Female

Figure2.2.Depth
Figure Depthof
ofknowledge
knowledgeabout
aboutcosmetic
cosmeticprocedures
proceduresprior
priortotothe
thesurvey.
survey.

3.2.4.Peeling
3.2.5. Whitening
The majority
Male of the
participants female
need participants
better knowledge had good
about knowledge
peeling of skin
since only whitening
30% pro-
had general
cedures. A quarter of the females had tried this type of procedure. Regarding
knowledge in this area, and 10% had tried this procedure. Regarding female participants, male partic-
ipants,
the 15% were
statistics had some knowledge,
the opposite. More30%thanhad general
57.5% knowledge,
of females only 5%
had general had undergone
knowledge in this
area,
skin and 30% had
whitening, andtried this cosmetic
around 45% hadprocedure.
no knowledgeThe peeling procedure
of whitening. involves
Whitening the use the
includes of
30%
use salicylic acid
of retinol, for 30propionate,
retinyl min. lactic acid, Kojic acid, Tranexamic acid, nicotinamide,
and other similar chemicals alone or in combination.
3.2.6. Laser Hair Removal
3.2.5.Laser hair removal (LHR) is a popular procedure, and most female participants had
Peeling
sufficient
Maleknowledge inneed
participants this area.
betterMost female participants
knowledge about peeling(70%)
sincehad tried
only 30%LHR, unlike
had general
knowledge in this area, and 10% had tried this procedure. Regarding female participants,
the statistics were the opposite. More than 57.5% of females had general knowledge in this
area, and 30% had tried this cosmetic procedure. The peeling procedure involves the use
of 30% salicylic acid for 30 min.
 Cosmetics 2023, 10, x FOR PEER REVIEW 5 of 11

Cosmetics 2023, 10, 19 3.2.6. Laser Hair Removal 5 of 11

Laser hair removal (LHR) is a popular procedure, and most female participants had
sufficient knowledge in this area. Most female participants (70%) had tried LHR, unlike
maleparticipants
male participants (20%).
(20%). Slightly
Slightly over
over half
half of
ofthe
themale
maleparticipants
participantshad
hadgeneral
generalknowledge
knowledge
about this procedure.
about this procedure.

3.2.7. Botulinum
3.2.7. Botulinum Neurotoxin (BoNT)
More than
More than 62.5% of females had had undergone
undergonebotulinum
botulinumneurotoxin
neurotoxin(BoNT)
(BoNT)injection,
injection,
andall
and all female
female participants knew about BoNT. BoNT. Only
Only 15%
15%ofofthe
themale
maleindividuals
individualshad
hadsome
some
knowledge regarding BoNT, 45% had general knowledge about BoNT,
knowledge regarding BoNT, 45% had general knowledge about BoNT, and around 20% of and around 20%
of individuals
individuals hadhad tried
tried BoNT.
BoNT. It is It is interesting
interesting to note
to note that most
that most participants
participants were were well
well aware
aware
of of theprocedure
the BoNT BoNT procedure they would
they would undergo.
undergo. However,
However, someparticipants
some male male participants still
still needed
needed
to to learn
learn about about
other other procedures.
procedures.

3.3.
3.3. Awareness
Awareness among
among the Participants concerning
concerning Cosmetic
Cosmetic Procedures
ProceduresPrior
Priorto
toTreatment
Treatment
As
As expected,
expected, more female participants
participants were
wereaware
awareof ofBoNT
BoNT(92.5%)
(92.5%)than
thanmales
males(30%).
(30%).
For
For dermal
dermal fillers, 85% of female
female and
and 30%
30%of ofmale
maleparticipants
participantsknewknewabout
aboutthetheprocedure.
procedure.
75%
75% ofof females
females and 35% of males had had some
some awareness
awarenessof ofhair
hairtransplants
transplantsor orhair
hairremoval
removal
procedures.
procedures.Females
Femaleswereweremore aware
more of HIFU
aware (60%)(60%)
of HIFU than male
than participants (40%). Around
male participants (40%).
55% of female
Around participants
55% of were aware
female participants wereof aware
liposuction versus 60%
of liposuction of male
versus 60%participants,
of male partic-and
concerning
ipants, and laser skin resurfacing
concerning and mammoplasty,
laser skin resurfacing 57.5% and 57.5%
and mammoplasty, 37.5%andof females
37.5% of knew
fe-
about
malesthese
knewprocedures
about thesecompared
procedures to 30% of male
compared toparticipants.
30% of male These procedures
participants. Thesehad been
proce-
performed on 33.3% of individuals, a minuscule percentage compared
dures had been performed on 33.3% of individuals, a minuscule percentage compared to to other cosmetic
procedures.
other cosmeticMen had moreMen
procedures. knowledge
had more (60%) than women
knowledge (60%) (50%) about abdominoplasty,
than women (50%) about ab-
also known as aalso
dominoplasty, tummy
known tuck.
as aAdditionally,
tummy tuck. males (50%) had
Additionally, more
males awareness
(50%) had more regarding
aware-
rhytidectomy
ness regardingthan females (40%).
rhytidectomy Figure (40%).
than females 3 depicts
Figurethe 3awareness
depicts thelevels of participants
awareness levels of
prior to treatment.
participants prior to treatment.

100
90
80
70
PERCENT

60
50
40
30
20
10
0
High Radio
intensity Hair Botulinum frequency
Abdomino Chemical Rhytidec Blepharo Mammo- Laser skin Dermal
focused removal/ neurotoxin micro Liposuction
plasty peeling tomy plasty plasty resurfacing fillers
ultrasound Implant (BoNT) needling
(HIFU) (RFMN)
Female 50 85 30 60 40 77.5 92.5 50 37.5 55 57.5 85
Male 60 45 45 40 50 35 30 25 30 60 30 30

Figure 3.
Figure 3. Awareness
Awareness levels
levels of
of participants
participants prior
prior to
to treatment.
treatment.

3.4. Preference
3.4. Preference of
of Participants
Participants Willing
Willing to
to Undergo
Undergo Different
Different Cosmetic
Cosmetic Procedures
Procedures
Participants who had not undergone a CP were
Participants who had not undergone a CP were asked about asked about theirtheir
willingness to un-to
willingness
dergo a CP.
undergo a CP.More
Morefemales
femaleswere
weremore
moreinterested
interestedininenhancing
enhancingtheir
theirphysical
physicalappearance
appearance
through different CPs than males. When the participants were asked about their
through different CPs than males. When the participants were asked about their willingness willing-
ness to undergo a procedure, 35% of male participants were willing to have
to undergo a procedure, 35% of male participants were willing to have a procedure done, a procedure
done, whereas
whereas 87.5% 87.5% of females
of females said they
said they required
required it now,
it now, andand 92.5%
92.5% said
said they
they werewilling
were will-
ing to have it done in the future (Figure 4). Most female individuals who visited
to have it done in the future (Figure 4). Most female individuals who visited the clinic the clinic
were interested in under-eye procedures, accounting for around 82.5% of people who
underwent this procedure, whereas none of the males had undergone this procedure. A
similar result was observed in lip procedures, where 75% of the individuals in the survey
had undergone lip enhancement with lip fillers; however, none of the male individuals
had. Female participants (70%) primarily opted for cheek fillers, a procedure also known as
 were interested in under-eye procedures, accounting for around 82.5% of people who un-
derwent this procedure, whereas none of the males had undergone this procedure. A sim-
Cosmetics 2023, 10, 19 ilar result was observed in lip procedures, where 75% of the individuals in the survey6 of had11
undergone lip enhancement with lip fillers; however, none of the male individuals had.
Female participants (70%) primarily opted for cheek fillers, a procedure also known as
cheek augmentation,
cheek augmentation,whereas
whereasonly only15%15% ofof male
male participants
participants hadhad undergone
undergone this this proce-
procedure.
dure.percentages
The The percentages of female
of female and maleand individuals
male individuals
who hadwhoenhanced
had enhanced their jawlines
their jawlines were
were 57.5%
57.5% and respectively.
and 30%, 30%, respectively.
Around Around
57.5% 57.5% of females
of females and 15%andof15%
malesof had
males had en-
enhanced
their
hancedchins using
their chin
chins fillerchin
using to give shape
filler and shape
to give enhance andtheenhance
jawline. the
More male participants
jawline. More male
(45%) had undergone
participants (45%) had skin texture procedures
undergone skin texture than females (40%).
procedures Around (40%).
than females 30% of Around
women
and 20% of men had undergone various processes for their sagging
30% of women and 20% of men had undergone various processes for their sagging skin.skin. Skin whitening
procedures
Skin whiteningwere procedures
less popularwere than less
otherpopular
procedures
than(15%),
other as fair/light skin
procedures (15%),predominated
as fair/light
in this
skin population sample.
predominated Many people
in this population were interested
sample. Many people in improving their appearance
were interested in improving by
enhancing their under-eye
their appearance by enhancing area their
and sculpting
under-eyetheir
areajaw,
and cheeks, and
sculpting chin,
their giving
jaw, them
cheeks, and a
defined and well-structured
chin, giving them a defined and profile or physical appearance.
well-structured profile or physical appearance.

100
92.5
87.5
90
82.5
80 75
70
70

60 57.5 57.5
Percent

50 45
40
40 35 35.0
30 30
30
20
20 15 15 15 15

10
0.0 0
0

Different type of cosmetic procedures and willingness of participants

FEMALE MALE

Figure4.4.The
Figure Thewillingness
willingness ofof participants
participants to to undergo
undergo different
different cosmetic
cosmetic procedures
procedures at the
at the timetime of
of the
the survey and to consider it in the future.
survey and to consider it in the future.

3.5. Awareness
3.5. Awareness among
amongIndividuals
Individualsofof
thethe
Adverse Effects/Risks
Adverse Associated
Effects/Risks with with
Associated Cosmetic
Cosmetic
ProceduresProcedures
The awareness level among the participants regarding adverse effects or risks asso-
ciated with procedures is shown in Figure
Figure 5.5. Few men knew about the adverse effects of
sagging
sagging skin procedures,
procedures, whereas 30% of women knew
whereas 30% of women knew about them. Most females (73.3%)
and 30% of males were aware of of the
the risk
risk of
of bruises
bruises and
and edema,
edema, whereas 50%
50% were
were aware
aware
of the risk of redness after the procedure. Almost half of the women and one quarter
of the men were aware that some procedures might lead to scarring or bleeding. A few
participants (20% of females and 10% of males) were aware of both hyperpigmentation and
hypopigmentation. Some females (30%) knew about the side effects of sagging skin and
headaches, while only 10% of males knew about headaches.
 of the risk of redness after the procedure. Almost half of the women and one quarter of
the men were aware that some procedures might lead to scarring or bleeding. A few par-
ticipants (20% of females and 10% of males) were aware of both hyperpigmentation and
of the risk of redness after the procedure. Almost half of the women and one quarter of
hypopigmentation.
the men were awareSome females
that some (30%) knew
procedures mightabout the
lead to side effects
scarring of sagging
or bleeding. A fewskin
par- and
headaches, while only 10% of males knew about headaches.
ticipants (20% of females and 10% of males) were aware of both hyperpigmentation and
Cosmetics 2023, 10, 19 7 of 11
hypopigmentation. Some females (30%) knew about the side effects of sagging skin and
90 headaches, while only 10% of males knew about headaches.
80
80 75
90
70 80
80 75
60 52.5
70
45 42.5 47.5 45
50 60
52.5 40
40 50 45 42.5 47.5 45
30 30 30 32.5 30 30 30 40
30 40 25
30 30 30 32.5
20 30 20 20 17.5 20 17.5 30 30 20
20 30 25
20 2010 20 10 17.5 10 20 1017.5 10 10 20
10 20 5 5
10 10 10 10 10 10 0
0 10 5 5
0
0

Female Male
Female Male

Figure 5. Participants’ awareness regarding the risk factors associated with cosmetic procedures.
Figure 5. Participants’ awareness regarding the risk factors associated with cosmetic procedures.
Figure 5. Participants’ awareness regarding the risk factors associated with cosmetic procedures.
3.6. Opportunity
3.6. OpportunitytotoTry
TryDifferent CosmeticProcedures
Different Cosmetic ProceduresbybyJordanian
Jordanian Participants
Participants
3.6. Opportunity to Try Different Cosmetic Procedures by Jordanian Participants
Some
Someparticipants stated
participants stated that they
stated that
that theywould
wouldbebewilling
willing to undergo
toundergo
undergo specific
specific procedures
procedures
Some participants they would be willing to specific procedures if
ifgiven
given
if giventhe
thetheopportunity
opportunity
opportunity and
and
and with
with
with the
the
the necessary
necessary
necessary resources
resources
resources (money)
(money)
(money) covered.
covered.Around
covered. Around
Around97.5% 97.5%
97.5% of
offemale
female
of female participants
participants
participants voted
voted
voted for
for thedermal
forthe
the dermal
dermal filling
filling
filling and
and
and BoNT
BoNT
BoNT procedures,
procedures,
procedures, whereas
whereas
whereas 45%
45%45%
ofof of
male
maleparticipants
male participants opted
participantsopted for
optedfor BoNT
forBoNT
BoNTand and
and 30%
30%
30% opted
opted
opted fordermal
forfor dermal
dermal fillers.
fillers.
fillers. More More
More
male male
male partici-
partici-
participants
pants
pantsvoted
voted voted
for for
forpeeling
peelingpeeling and skin tightening
tightening
andtightening
and skin thanfemales
than
than females females
(Figure (Figure
6). 6). 6).
(Figure

Skin Tighteneing 22.5

22.5
Skin Tighteneing
Type of Cosmetic Procedure

35
Type of Cosmetic Procedure

35
Peeling 35
35
Peeling 65
65
Whitening 25
Whitening 5 25
5
Dermal 97.5
Dermal 30 97.5
30
Botox 97.5
Botox
45 97.5
45
0 20 40 60 80 100
0 20 40
Percentage 60 80 100
Percentage
Female Male
Female Male

Figure 6. Participants’ desired cosmetic procedures when offered free of charge.

3.7. Effectiveness of Cosmetic Procedures

In this section, participants were asked their opinion on the effectiveness of the pro-
cedures on a scale from 0 to 10. The results indicate no significant differences in opinion
 Figure 6. Participants’ desired cosmetic procedures when offered free of charge.

3.7. Effectiveness of Cosmetic Procedures

Cosmetics 2023, 10, 19 8 of 11
In this section, participants were asked their opinion on the effectiveness of the pro-
cedures on a scale from 0 to 10. The results indicate no significant differences in opinion
regarding the effectiveness of laser hair removal, while for dermal procedures, BoNT,
regarding the effectiveness of laser hair removal, while for dermal procedures, BoNT,
RFMN, and HIFU, female participants graded their effectiveness significantly higher than
RFMN, and HIFU, female participants graded their effectiveness significantly higher than
male participants (Figure 7).
male participants (Figure 7).

Figure
Figure 7.7. Effectiveness
Effectiveness ofof cosmetic
cosmetic proceduresasasrated
procedures ratedbybyparticipants.
participants.

4. Discussion
4. Discussion
The number of people seeking cosmetic surgeries has increased, and one of the reasons
The number of people seeking cosmetic surgeries has increased, and one of the rea-
for this may be the increased popularity of minimally invasive procedures, such as BoNT
sons for this may be the increased popularity of minimally invasive procedures, such as
and filler injections [12]. This may be justifiable as we observed this trend in our study,
BoNT and filler injections [12]. This may be justifiable as we observed this trend in our
with 80.6% of individuals opting for BoNT and dermal filling. In BoNT procedures,
study, with 80.6% of individuals opting for BoNT and dermal filling. In BoNT procedures,
botulinum toxin is injected to relax or paralyze the facial muscles associated with wrinkles
botulinum toxin is injected to relax or paralyze the facial muscles associated with wrinkles
on the forehead and around the eye region. Cheek filler procedures, also known as cheek
on the forehead and around the eye region. Cheek filler procedures, also known as cheek
augmentation, are conducted to increase the volume of the cheeks and the area around
augmentation, are conducted to increase the volume of the cheeks and the area around
the cheekbones. They create a plumping effect on the skin, making it look youthful.
the cheekbones. They
Abdominoplasty, alsocreate
known a plumping
as a tummy effect
tuck,onisthe skin, making
undergone to giveit look youthful.
a toned shape to Ab-the
dominoplasty, also known as a tummy tuck, is
abdomen. HIFU is a relatively new technique that tightens the skin. undergone to give a toned shape to the
abdomen. HIFU is
According toaprior
relatively
research,newone technique
of the key that tightens the
motivators skin.
for cosmetic surgery is changing
According to prior research, one of the key motivators
one’s body image [13]. In the present study, 24.4% of the individuals for cosmetic surgery is chang-
had undergone
ing one’s body image [13]. In the present study, 24.4% of the individuals
cosmetic surgeries or procedures to change body parts that they were not satisfied with. had undergone
cosmetic
After sixsurgeries
months, or procedures
women who had to change
receivedbody partssurgeries
cosmetic that theygraded
were not satisfied
their with.
attractiveness
After six months, women who had received cosmetic surgeries graded
significantly better [13]. According to Brown et al. [14], self-rated physical attractiveness their attractiveness
significantly
significantlybetter
affects[13]. Accordingtotoundergo
willingness Brown etcosmetic
al. [14], self-rated
procedures. physical
In ourattractiveness
study, 60% of
significantly
participants stated that they had undergone a procedure to increase study,
affects willingness to undergo cosmetic procedures. In our 60% of par-
their attractiveness.
ticipants
This justifies the statement that physical attractiveness is one of the critical factors forThis
stated that they had undergone a procedure to increase their attractiveness. more
justifies
and morethe statement
people opting that physical
to undergo attractiveness
a procedure. is one of the critical
Kamburoglu andfactors
Ozgurfor more
[15] and
reported
more people
similar opting
results, whereto undergo
most of athe procedure.
adolescent Kamburoglu
participantsand were Ozgur
happy [15] reported
with similarof
the outcome
results,
the CPwhere
in termsmostof of the adolescent
increasing participants
self-esteem, improvingwere body
happyimage,
with theandoutcome
makingof the CPA
friends.
instudy
termson ofChinese
increasing self-esteem, improving body image, and making
women who had experienced teasing due to their physical appearance friends. A studyin
ontheir
Chinese
adolescence opted for surgery and experienced a confidence level boost due totheir
women who had experienced teasing due to their physical appearance in their
adolescence opted for
enhanced physical surgery and
appearance experienced
post-surgery a confidence level boost due to their en-
[16].
hancedThere
physical appearance post-surgery
is well-grounded evidence showing[16]. that self-esteem increases after surgery.
There77%
Around is well-grounded
of participants evidence
stated that showing
they were thatsatisfied
self-esteem
with increases
the resultsafter surgery.
of procedures
Around
such as77%LHR, of dermal
participants
methods,statedandthatBoNT.
they were
Thesesatisfied with said
participants the results of procedures
their confidence level
wasas
such higher
LHR,after
dermal themethods,
procedure, and which
BoNT. aligns
These with a previous
participants report
said their[17] where women
confidence level
stated
was thatafter
higher they the
felt more attractive
procedure, whichafter breast
aligns augmentation.
with In a recent
a previous report [17] qualitative
where women study,
Chinese
stated thatwomen
they feltstated
more that they hadafter
attractive become breasta new person by shedding
augmentation. In a recent their old image
qualitative
after surgery [18]. According to a study conducted by the Dove Global Beauty Research
Commission (2016), around 89% of women in Australia admitted to having canceled an
appointment to meet friends, special occasions, and job interviews on days they felt they
were not looking good [19]. These findings demonstrate physical appearance’s value
Cosmetics 2023, 10, 19 9 of 11

in individuals’ lives, including factors such as self-esteem and performance in a given

task [20].
According to Sarwer et al. [21], the idea of a perfect woman has changed. In today’s
world, the ideal woman has a perfect physical appearance and excellent features, which
are only present in a minority of people. Magazines and television are all focused on this
perfect woman, and average women who lead ordinary lives dream of this perfect picture
and seek cosmetic procedures to look like celebrities and to look more attractive. However,
in our study, none of the participants wanted to look like a celebrity. Instead, most wanted
to look more attractive, change their body image, and gain confidence, while less than
10% of the male participants had undergone a CP to look like a celebrity. In a cross-cultural
study conducted on Chinese and Dutch women, Wu Y et al. [22] showed that the reason for
cosmetic surgery might be related to the positive association between physical appearance
and materialistic success.
In the present study, all participants were aware of some risks associated with CP.
Most female participants (80%) were aware of risks, compared to 45% of male participants.
Most participants were aware of bruises, swelling, scars, and redness. Thapa observed
a similar trend [23]. Adejeji et al. [6] reported that 83.1% of the participants were aware
of side effects (deformation of body parts, cancer, keloid, death, infection, and bleeding).
Awareness of the risk factors associated with CP may be attributed to the awareness among
the population of procedures and their education, since all the participants in the present
study were educated. Some patients had experienced side effects that lasted for a few days
and then disappeared. The findings were convincing; more women were aware of the risk
factors than men.
It may be noted that the enormous social pressure on women to conform to the ideas of
society in terms of attractiveness, as evidenced by the increase in the number of women with
eating disorders and concern for their body image, has led them to opt for cosmetic surgery.
Studies have shown that, in different domains of society, there is a bias towards attractive
women and discrimination towards unattractive women [24,25], especially among young
women [26]. Hence, it is not surprising that more and more women are opting for facial
and dental cosmetic procedures [27–29]. However, our study showed an increase in the
number of males who had undergone cosmetic procedures, and a rise in this number has
been seen in recent years when compared to previous years. A similar observation was
made by Furnham and Levitas [30]. They attributed this to the media propagating the
current view of cosmetic surgery.
As mentioned above, women are expected to have more knowledge about beauty
enhancement treatments than men. Indeed, studies have shown that female participants
have more knowledge in this area and have undergone more procedures [6,31,32]. A
similar trend was observed in our study concerning knowledge and the various procedures
participants underwent. According to Brown et al., this may be attributed to the social
pressure on women to always be attractive and conform to specific beauty standards [14].
The limitations of this study are the need for more data from others and the lack of earlier
studies concerning Jordan.

5. Conclusions
Within the limitations of the present cross-sectional study, the factors behind the
decision by participants to undergo cosmetic procedures were shown to be: to enhance
body image, increase physical attractiveness, and gain self-confidence. As there is not
much literature or scientific evidence to show the correlation between altered body image
and gain in self-confidence, there is a need for further research in this area to identify the
specific reasons behind the desire for these procedures. Identifying specific reasons may
help us address them more effectively. Further research is needed to explore the increase in
male participants undergoing enhancement procedures in recent years.
Cosmetics 2023, 10, 19 10 of 11

Author Contributions: S.M.A., A.K.S. and R.R.N. conceived and designed the experiments; S.M.A.
and A.K.S. performed the experiments; S.M.A., A.K.S., R.R.N. and K.I.A. analyzed the data; S.M.A.,
A.K.S. and R.R.N. wrote the paper; S.M.A., A.K.S., R.R.N. and K.I.A. edited the final manuscript. All
authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was carried out in accordance with the Declaration
of Helsinki and approved by the ethics committee of clinic (ERB/SDAC/2022/4/1, 6 April 2022).
Informed Consent Statement: Written informed consent was obtained from the patient(s) to publish
this article.
Data Availability Statement: The data presented in this study are available (at clinic) and on request
from the corresponding authors. The data are not publicly available to maintain confidentiality.
Acknowledgments: We thank the Deanship, Faculty of Pharmacy, Medical Sciences, and the Dean of
Research and Higher Education of Al-Ahliyya Amman University, Amman, Jordan for providing the
necessary facilities. Article processing fees (APC) supported by the Deanship of Scientific Research,
Al-Ahliyya Amman University, Amman, Jordan and Universität Bern, Switzerland (IOAP discount).
Conflicts of Interest: The authors declare that they have no conflict of interest.

References
1. Haas, C.F.; Champion, A.; Secor, D. Motivating factors for seeking cosmetic surgery: A synthesis of the literature. Plast. Surg.
Nurs. 2008, 28, 177–182. [CrossRef] [PubMed]
2. ISAPS. Global Survey Results. 2018. Available online: https://www.isaps.org/wp-content/uploads/2020/10/ISAPS-Global-
Survey-Results-2018-1.pdf (accessed on 15 July 2020).
3. ASPS. American Society of Plastic Surgeons. Available online: http://www.plasticsurgery.org (accessed on 20 January 2022).
4. ASPS. Complete Plastic Surgery Statistics Report. Available online: https://www.plasticsurgery.org/news/plastic-surgery-
statistics?sub=2014+Plastic+Surgery+Statistics#section-title (accessed on 20 January 2022).
5. PSS. Plastic Surgery Statistics. Available online: https://www.plasticsurgery.org/documents/News/Statistics/2019/plastic-
surgery-statistics-full-report-2019.pdf (accessed on 20 January 2022).
6. Adedeji, O.A.; Oseni, G.O.; Olaitan, P.B. Awareness and attitude of healthcare workers to cosmetic surgery in osogbo, Nigeria.
Surg. Res. Pract. 2014, 2014, 869567. [CrossRef] [PubMed]
7. Kaats, G.R.; Davis, K.E. The Dynamics of Sexual Behavior of College Students. J. Marriage Fam. 1970, 32, 390–399. [CrossRef]
8. Mathes, E.W.; Kahn, A. Physical attractiveness, happiness, neuroticism, and self-esteem. J. Psychol. 1975, 90, 27–30. [CrossRef]
[PubMed]
9. Ehlinger-Martin, A.; Cohen-Letessier, A.; Taieb, M.; Azoulay, E.; du Crest, D. Women’s attitudes to beauty, aging, and the place of
cosmetic procedures: Insights from the QUEST Observatory. J. Cosmet. Dermatol. 2016, 15, 89–94. [CrossRef]
10. Muise, A.; Desmarais, S. Women’s Perceptions and Use of “Anti-Aging” Products. Sex Roles 2010, 63, 126–137. [CrossRef]
11. Weihermann, A.C.; Lorencini, M.; Brohem, C.A.; de Carvalho, C.M. Elastin structure and its involvement in skin photoageing. Int.
J. Cosmet. Sci. 2017, 39, 241–247. [CrossRef]
12. Walker, M.E.; Patel, A.; Alcon, A.; Pavri, S.; Shah, A.; Ng, R.; Tookes, H.E.; Price, G.J. A 12-Year Analysis of the Relationship
between Market Trends and Cosmetic Case Volume. Plast. Reconstr. Surg. 2014, 134, 43–44. [CrossRef]
13. Sarwer, D.B.; LaRossa, D.; Bartlett, S.P.; Low, D.W.; Bucky, L.P.; Whitaker, L.A. Body image concerns of breast augmentation
patients. Plast. Reconstr. Surg. 2003, 112, 83–90. [CrossRef]
14. Brown, A.; Furnham, A.; Glanville, L.; Swami, V. Factors that affect the likelihood of undergoing cosmetic surgery. Aesthet. Surg. J.
2007, 27, 501–508. [CrossRef]
15. Kamburoğlu, H.O.; Ozgür, F. Postoperative satisfaction and the patient’s body image, life satisfaction, and self-esteem: A
retrospective study comparing adolescent girls and boys after cosmetic surgery. Aesthetic. Plast. Surg. 2007, 31, 739–745.
[CrossRef] [PubMed]
16. Ip, K.T.V.; Ho, W.Y. Healing Childhood Psychological Trauma and Improving Body Image Through Cosmetic Surgery. Front.
Psychiatry 2019, 10, 540. [CrossRef] [PubMed]
17. Sarwer, D.B. Body image, cosmetic surgery, and minimally invasive treatments. Body Image 2019, 31, 302–308. [CrossRef]
[PubMed]
18. Wu, Y.; Mulkens, S.; Alleva, J.M. Body image and acceptance of cosmetic surgery in China and the Netherlands: A qualitative
study on cultural differences and similarities. Body Image 2022, 40, 30–49. [CrossRef] [PubMed]
19. Cash, T.F.; Melnyk, S.E.; Hrabosky, J.I. The assessment of body image investment: An extensive revision of the appearance
schemas inventory. Int. J. Eat. Disord. 2004, 35, 305–316. [CrossRef] [PubMed]
20. Fares, K.; Hallit, S.; Haddad, C.; Akel, M.; Khachan, T.; Obeid, S. Relationship Between Cosmetics Use, Self-Esteem, and
Self-Perceived Attractiveness Among Lebanese Women. J. Cosmet. Sci. 2019, 70, 47–56.
Cosmetics 2023, 10, 19 11 of 11

21. Sarwer, D.B.; Magee, L.; Clark, V. Physical appearance and cosmetic medical treatments: Physiological and socio-cultural
influences. J. Cosmet. Dermatol. 2003, 2, 29–39. [CrossRef]
22. Wu, Y.; Alleva, J.M.; Broers, N.J.; Mulkens, S. Attitudes towards cosmetic surgery among women in China and the Netherlands.
PLoS ONE 2022, 17, e0267451. [CrossRef]
23. Thapa, D.P. Awareness of Cosmetic Dermatology Procedures among Health Workers in a Tertiary Care Hospital. Indian Dermatol.
Online J. 2019, 10, 139–143. [CrossRef]
24. Watkins, L.M.; Johnston, L. Screening Job Applicants: The Impact of Physical Attractiveness and Application Quality. Int. J. Sel.
Assess. 2000, 8, 76–84. [CrossRef]
25. Dipboye, R.; Fromkin, H.; Wiback, K. Relative importance of applicant sex, attractiveness and scholastic standing in evaluation of
job applicant resumes. J. Appl. Psychol. 1975, 60, 39–43. [CrossRef]
26. Del Monte, S.; Afrashtehfar, K.I.; Emami, E.; Abi Nader, S.; Tamimi, F. Lay preferences for dentogingival esthetic parameters: A
systematic review. J. Prosthet. Dent. 2017, 118, 717–724. [CrossRef] [PubMed]
27. Alikhasi, M.; Yousefi, P.; Afrashtehfar, K.I. Smile design: Mechanical considerations. Dent. Clin. North. Am. 2022, 66, 477–487.
[CrossRef] [PubMed]
28. Afrashtehfar, K.I.; Bryant, S.R. Understanding the lived experience of north american dental patients with a single-tooth implant
in the upper front region of the mouth: Protocol for a qualitative study. JMIR Res. Protoc. 2021, 10, e25767. [CrossRef]
29. Afrashtehfar, K.I.; Assery, M.K. Five considerations in cosmetic and esthetic dentistry. J N J. Dent. Assoc. 2014, 85, 14–15.
30. Furnham, A.; Levitas, J. Factors that motivate people to undergo cosmetic surgery. Can. J. Plast. Surg. 2012, 20, e47–e50. [CrossRef]
31. Hammadi, H.A.; El-shereef, E.A.A. Study of Knowledge, Attitude and Practices of Plastic Surgery among Females Students at
Faculty of Education, Taif University, Saudi Arabia. Am. J. Public Health Res. 2017, 5, 63–69. [CrossRef]
32. Crockett, R.J.; Pruzinsky, T.; Persing, J.A. The influence of plastic surgery "reality TV" on cosmetic surgery patient expectations
and decision making. Plast. Reconstr. Surg. 2007, 120, 316–324. [CrossRef]

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