|Year : 2016 | Volume
| Issue : 1 | Page : 12-16
University students and cosmetic surgery in Nigeria: A survey of perception, attitudes, and experiences
Amina I Abubakar1, Mustapha A Jamda2, Abdulrasheed Ibrahim3, Abdulwahab Ajani4, Kayode Iyun5, Kingsley O Opara6
1 Department of Plastic Surgery, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
2 Department of Community Medicine, University of Abuja, Abuja, Nigeria
3 Department of Surgery, Division of Plastic Surgery, Ahmadu Bello University, Zaria, Nigeria
4 Department of Surgery, Division of Plastic Surgery, Lagos State University Teaching Hospital, Lagos, Nigeria
5 Department of Plastic Surgery, University College Hospital, Ibadan, Nigeria
6 Department of Surgery, Imo State University Teaching Hospital, Orlu, Imo, Nigeria
|Date of Web Publication||10-Nov-2016|
Department of Surgery, Division of Plastic Surgery, PMB 06, Abuth, Shika Zaria, Kaduna State
Source of Support: None, Conflict of Interest: None
Introduction: A global trend to improve appearance has been observed with the advent of technological civilization and contemporary culture. This is related to social customs that places high premium on appearance, and the increased accessibility of cosmetic surgery. This article explores the perception of cosmetic surgery among university students in Nigeria.
Materials and Methods: Self-administered questionnaires were used to collect data. It was divided into four sections; demographic, knowledge, attitude, and experience with cosmetic surgery. The association between knowledge, attitude, practice, and sociodemographic characteristics was sought using Chi-square statistical test. Statistical significance was set at P ≤ 0.05.
Results: The respondents perceptions of what cosmetic surgery means include surgery for beauty 673 (52%), surgery on the face 84 (7%), use of chemicals for beautification 35 (3%), correction of deformity 37 (2.8%), and 116 (9%) were not sure. A significant association was found in attitude in the 15-25 age group, when asked about willingness to undergo cosmetic surgery. (P = 0.014) and recommending cosmetic surgery (P = 0.024). There was no statistically significant difference in gender when comparing the knowledge, attitude, and practice of cosmetic surgery. There was a significant difference in knowledge of cosmetic surgery among 3 rd and 4 th year students related to having heard about cosmetic surgery (P = 0.048) and knowledge of difference between cosmetic surgery and plastic surgery (P = 0.001). Participants that were single were more aware of cosmetic surgery (P = 0.013) and knew someone who had cosmetic surgery (P = 0.000).
Conclusion: Attitudes toward cosmetic surgery are positively related to age, level of study, and marital status. However, there was no statistically significant difference based on gender. Our study also suggests that respondents are aware of the existence of cosmetic procedures, but they do not know what it actually means.
Keywords: Attitude, cosmetic surgery, experience, perception, university students
|How to cite this article:|
Abubakar AI, Jamda MA, Ibrahim A, Ajani A, Iyun K, Opara KO. University students and cosmetic surgery in Nigeria: A survey of perception, attitudes, and experiences. Nigerian J Plast Surg 2016;12:12-6
|How to cite this URL:|
Abubakar AI, Jamda MA, Ibrahim A, Ajani A, Iyun K, Opara KO. University students and cosmetic surgery in Nigeria: A survey of perception, attitudes, and experiences. Nigerian J Plast Surg [serial online] 2016 [cited 2019 Aug 19];12:12-6. Available from: http://www.njps.org/text.asp?2016/12/1/12/193733
| Introduction|| |
Practices designed to enhance appearance by making a physical change has a long and distinguished history. These practices date back to the time of the Pharaohs and are described in most primordial groups and essentially all of the higher civilizations.  Tribesmen in Brazil wear disks and plugs as jewelry in perforated and progressively stretched lips and earlobes. Scarification of the skin as a method of beautification or as a symbol of distinction is popular among several African tribes. In ancient Athens, women bound their chests tightly to produce atrophy of the breasts because the small, firm breast was associated with poise and grace.  With the advent of technological civilization and culture, a widespread wish to improve appearance may relate to contemporary social customs. This strongly emphasizes the importance of common esthetic norms that are strongly marketed and an increased accessibility of cosmetic surgery. ,,,,
The popularity of cosmetic surgery as an acceptable form of body modification has created a flourishing industry.  The exceptional increase in the number of elective cosmetic surgical procedures is well documented.  The British Association of Aesthetic Plastic Surgeons estimates that the demand for cosmetic surgery rose by nearly 40% between 2004 and 2005. , The American Society for Aesthetic Plastic Surgery reported more than a 100% increase in the number of cosmetic surgery procedures performed in the United States between 1997 and 2010. , In Asia, cosmetic surgery has become an accepted practice and countries such as India and China have become Asia's most popular cosmetic surgery destination. 
In line with global trends, there is a surge in the demand for cosmetic surgery in most developing countries including Nigeria. Despite this, there is a paucity of research on cosmetic surgery in most low resource settings. Such research is essential because there may be cross-cultural differences in attitudes or reasons for considering cosmetic surgery.  In addition, understanding these issues is also important for the plastic surgeons, as there may be relevant psychosocial outcomes in terms of the delivery of quality cosmetic surgery care and patient satisfaction. ,, This article explores the perception of cosmetic surgery among university students in Nigeria.
| Materials and methods|| |
This is a cross-sectional descriptive study of students selected from five Nigerian Universities from different regions; Ahmadu Bello University Zaria, Imo state University, University of Ibadan, Lagos state University, and University of Abuja. These universities were selected to provide a geographically diverse sample. Data were collected between September 2011 and March 2012. A multistage sampling technique was used to recruit participants: In the first stage, five universities were selected from a list of tertiary institutions with plastic surgery specialists; in the second stage, sample size was proportionately distributed based on the population of students in the universities; in the third stage, the sample allocated to each university was proportionately divided according to the level of study of the students; in the fourth stage, the number of subjects allocated to each level was randomly selected from the list of number of students at the level.
Pretested, self-administered, and semi-structured questionnaires were used to collect data on knowledge and perception of the respondents. The questionnaire was divided into four sections; demographic, knowledge, attitude, and experience with cosmetic surgery. The questionnaire included a range of open-ended questions as well as multiple-choice questions and closed questions with the answer options as Yes or No. Before completing the questionnaires, participants were provided with instructions regarding the nature of the study, the informed consent process, and confidentiality of personal data. To maintain confidentiality, questionnaires were made anonymous. The questionnaire took approximately 15 min to complete. Data were collated manually and analyzed using STATA version 10 stata statistical software, StataCorp LP. Descriptive data were presented as summaries. The association between knowledge, attitude, practice, and sociodemographic characteristics was then sought using Chi-square statistical test. Statistical significance was set at P ≤ 0.05.
| Results|| |
A total of 1300 questionnaires were distributed and returned, giving a response rate of 100%. The distribution of the respondents according to school was as follows: 121 (9%) from Ahmadu Bello University, 55 (4%) from Imo state University, 372 (29%) from Lagos State University, 334 (26%) from University of Ibadan, and 418 (32%) from University of Abuja. Six hundred and ninety-six respondents (53%) were males, and six hundred and four (47%) were females. The age range of the respondents was 15-46 years with a mean of 22.59 (standard deviation 3.37) years. Forty-three (3%) respondents were married, 1235 (95%) single, and 10 (0.8%) separated, whereas 4 (0.9%) did not indicate marital status. Seven hundred and twenty-four (57%) were 3 rd and 4 th year students, whereas 440 (34%) were 1 st and 2 nd year students. Fifth and 6 th year students that participated in the study were 115 (9%).
Nine hundred and forty-five respondents (73%) had heard of cosmetic surgery, 307 (23%) had not, whereas 48 (4%) did not respond [Figure 1]. The sources of information were media 775 (60%), friends 61 (5%), school 70 (5.4%), seminar 5 (0.4%), and other sources 34 (3%) [Figure 2]. One hundred and eighty-one respondents (14%) thought cosmetic surgery was same as plastic surgery, 764 (59%) said it was different and the differences were listed as general body versus facial by 35 (5%), correction of defects versus fashion by 237 (31%), 10 (1.3%) thought it was surgery versus application of chemicals, 21 (3%) thought it was necessary versus pleasure, 11 (1%) thought was internal versus external, whereas 60% were not sure how they differ.
The respondents' perceptions of what cosmetic surgery means include surgery for beauty 673 (52%), surgery on the face 84 (7%), use of chemicals for beautification 35 (3%), correction of deformities 37 (2.8%), and 116 (9%) were not sure [Figure 3].
Four hundred and sixty-seven (40%) reported cosmetic surgery was available in Nigeria, 478 (37%) said it was not, whereas 27% were not sure. Two hundred and seventy-six respondents (21%) knew persons that had cosmetic surgery. The relationship of the persons to the respondents was as follows: Friends 61 (22%), neighbor 9 (3%), close relatives 20 (7%), and acquaintance 65 (24%).
No significant difference was observed in all the age groups with regards to knowledge of plastic surgery. A significant association was found in attitude in the 15-25 age group, when asked about willingness to undergo cosmetic surgery (P = 0.014) and recommending cosmetic surgery (P = 0.024).
No statistically significant difference was observed between male and female respondents when comparing the knowledge, attitude, and practice of cosmetic surgery. These were however significantly positively related to marital status. Participants that were single were more aware of cosmetic surgery (P = 0.013) and knew someone who had cosmetic surgery (P = 0.000).
There was a significant difference in knowledge of cosmetic surgery among 3 rd and 4 th year students related to having heard about cosmetic surgery (P = 0.048), knowledge of the difference between cosmetic surgery and plastic surgery (P = 0.001), and availability of cosmetic surgery in Nigeria (P = 0.019).
| Discussion|| |
This study indicates that 73% of the undergraduate students demonstrate an awareness of cosmetic surgery. This is similar to the findings in the study among banking and civil service professionals in Lagos, Nigeria, where 78% of respondents were aware of facial plastic surgery.  In a recent study by Adedeji et al.,  among healthcare workers in Osogbo, Nigeria, the level of awareness was noted to be 94.4%. Indeed, awareness of cosmetic surgery has increased in recent times, and the high level of awareness in this cohort is hardly surprising.  Adeyemo et al.  suggests that Nigerians, especially female models and those in the upper social class, are increasingly seeking cosmetic surgery for the correction of real or perceived facial abnormalities. Furthermore, stories on cosmetic surgery frequently appear on television channels news programs, and in the pages of fashion and beauty magazines.
The most common source of information about cosmetic surgery in this study was the television. The public is bombarded by mass media images of beauty and cosmetic surgery on a scale unprecedented in history. Several studies have shown that the recent rise in cosmetic surgery television programs has raised public awareness of cosmetic surgery benefits and how to achieve them. ,,, Reality television shows depicting cosmetic surgery have emerged and appeared to impact the craving to seek this type of surgery. Some authors have produced data to support a relationship between viewing reality television depicting cosmetic surgery and interest in surgically altering one's appearance.  Delinsky  is of the opinion that media exposure significantly predicts approval and likelihood of undergoing cosmetic surgery. However, the role of the media is not always positive. The biggest pitfall is that the media tends to raise the expectation levels. The information provided maybe unrealistic with minimal scientific basis.  This raises many important questions for cosmetic surgeons in Nigeria, including their role in determining standards of appearance, the allocation of scarce health care funds, and the potential for social stratification as more affluent patients use cosmetic surgery to enhance their appearance. 
Surgery for beauty was the most frequent response when the respondents were asked what cosmetic surgery means to them. Surgery on the face was the second most frequent response, whereas use of chemicals for beautification was the least common response. This suggests that respondents know about cosmetic surgery, but they do not know what it actually means. , Previously reported studies in the Western literature show that prospective clients are sufficiently aware of cosmetic procedures. , This enables them to make an informed choice of the procedure desired. It is obvious that if a patient approaches a cosmetic surgeon with the desire of getting a face transplantation, any other procedure offered would most likely leave the patient disappointed. 
In this study, 36% reported cosmetic surgery was available in Nigeria, whereas only 21% of the respondents knew someone who had undergone cosmetic surgery. This may reflect the limited information on availability of cosmetic surgery procedures in Nigeria, a low level of awareness of the success achievable and perhaps a low level of social acceptance of cosmetic surgery.  Therefore, the availability of facilities for cosmetic surgery in Nigeria is of the essence. This should include creating a fellowship program in cosmetic surgery as well as the provision of appropriate and adequate surgical facilities.
In this study, no statistically significant difference was observed between male and female respondents when comparing the knowledge, attitude, and practice of cosmetic surgery. This is not consistent with previous studies in which participants were asked to rate their likelihood of having various cosmetic procedures.  In terms of demographic variables, the available research consistently points to women being more likely than men to consider having cosmetic surgery, a finding that mirrors actual procedural data.  This gender difference may echo the greater sociocultural pressure that women experience to live up to idealized images of physical perfection.  Those men were equally likely to consider cosmetic surgery in this study can be explained by the more recent stronger emphasis placed on men's attractiveness, which has led more men to alter their physical appearance by seeking cosmetic surgery. ,
There is a significant association in attitude in the 14-25 age group when asked about willingness to undergo cosmetic surgery (P = 0.014) and recommending cosmetic surgery (P = 0.024). Sarwer et al.  observed that the stereotypical cosmetic surgery patient is thought to be an older woman interested in surgery as a way to push back the hands of time. The classical patient, however, is much younger; approximately, 50% of all patients are between the ages of 35 and 50 years and 27% are 34-year-old or younger.  In recent years, most developed countries have witnessed a remarkable increase in the number of cosmetic procedures being performed annually particularly among young people. Of the 12.5 million procedures performed in 2009, the younger age groups accounted for the vast majority of patients.  There are several reasons for this. First, the surgery is safe with very few significant complications. Second, the society continues to invest on physical appearance and attractiveness. Third, we live in a culture that emphasizes competition and encourages self-improvement as a way to gain a competitive advantage. And finally, cosmetic surgery lives up to expectations. The vast majority of patients who have had cosmetic surgery are satisfied and say the surgery is awesome. 
In this study, marital status showed a significant association with level of study when predicting the likelihood of undergoing cosmetic surgery. Respondents that were single and either in 300 or 400 level were more aware of cosmetic surgery, more likely to know someone who had cosmetic surgery and the availability of cosmetic surgery in Nigeria. This finding is consistent with that of an earlier study that the typical patient seeking cosmetic surgery is female, 25-year-old or less, has a university degree, is seeking cosmetic surgery primarily for esthetic reasons and has no history of cosmetic surgical procedures.  It is possible that these women are seeking cosmetic surgery to achieve the life that they have always dreamed of. For example, beginning a great career, getting married, and having children. 
The large sample size and geographical diversity of participants are strengths of the study. However, it also has some limitations. First, this is a self-report survey research. While surveys are commonly used for needs assessments, the results are heavily dependent on the content and context of the questionnaire; thus, the results must be considered from this standpoint. Second, reliance on university students limits our ability to generalize our findings. Research with more diverse samples is clearly warranted, including nonuniversity population samples, as well as adolescents and older adults.  Third, It is acknowledged that participants may hold beliefs and attitudes that suggest cosmetic surgery is acceptable, and yet show little or no interest in actually having cosmetic procedures.  Subsequent studies are needed to elucidate the likelihood of actually undergoing specific procedures and the perceived benefits, limitations, and factors associated with making surgery a realistic option. ,,
| Conclusion|| |
We believe our study is an accurate portrayal of the perception of cosmetic surgery among university students in Nigeria. Attitudes toward cosmetic surgery are positively related to age, level of study, and marital status. However, there was no statistically significant difference based on gender. Our study also suggests that respondents are aware of the existence of cosmetic procedures, but they do not know what it actually means. These may have important implications for plastic surgeons and patients in Nigeria wishing to understand the growing interest in cosmetic surgery and in making an informed choice of the procedure desired.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]