Exploring the Links Between Body Dysmorphic Concerns and Acceptance of Cosmetic Surgery: The Role of Internal and External Shame as Mediators

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ABSTRACT Introduction Cosmetic surgery has become increasingly normalized in many societies, including Lebanon, where appearance enhancement is often associated with identity, social acceptance, and social mobility. Body dysmorphic concerns (BDC) and shame have both been associated with attitudes toward cosmetic surgery; however, the emotional processes underlying these associations remain insufficiently explored. The purpose of this study is to assess the mediating role of shame in the relationship between BDC and acceptance of cosmetic surgery in Lebanese adults. Methods In this cross‐sectional study, 399 Lebanese participants aged 18 years and older were enrolled. Measures used were the Acceptance of Cosmetic Surgery Scale (ACSS), the Dysmorphic Concern Questionnaire (DCQ), a screening measure of subclinical dysmorphic concerns, and the External and Internal Shame Scale (EISS). Results Indirect associations statistically consistent with partial mediation models involving total, internal, and external shame were observed between BDC and acceptance of cosmetic surgery. Higher BDC was significantly associated with higher shame and directly associated with higher acceptance of cosmetic surgery. Higher shame was significantly associated with lower acceptance of cosmetic surgery. Conclusion These results indicate that the role of shame in crafting attitudes toward cosmetic surgery is rather complicated as an emotional variable. BDC and shame can be screened for during preoperative consultations by clinicians to determine which patients are at risk of having psychological concerns. Applying mental health care to the perspective of aesthetic medicine can increase patient satisfaction and result in an ethical, patient‐centered approach.

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