1. Introduction

To be seen beautiful is one important need of the modern man. Meanwhile, women do more care than men about their physical attraction and society puts more pressure on them to become beautiful. Consequently, women are forced to change their body so that, they encompass the cultural standards of beauty is propagandized by media and cosmetic industry advertisements. Slim women and shaved and fit men are the most common of such standards. These patterns, so, alter persons’ body image which, in turn, affects body satisfaction, mental and physical health and the way the body is perceived [5].

Beck and Giddens [3] state that the modern life is defined through conscious or unconscious knowledge about unpredictable risks caused by human agency. These risks could be either biological (e.g. AIDS, air pollution) or social (e.g. crime, discrimination and poverty) or technological (e.g. plane crash, nuclear weapons). To respond these risks, the scholars believe that man picks a variety of life styles and health patterns to control the body and lessen such risks.

Furthermore, human identity as a social construction in high-risk societies is widely threatened by extinction of common traditions and values. Consequently, individuals constantly require deciding whether to accept or reject these risks. Integrated with consumption capitalism, the social risks cause some concerns for peoples which, in turn, compel them focus on the self and the body in order to confront the risks. Appearance and changing it play a considerable role in the process of identity construction through the market continuously presents a bulk of personal needs besides providing the consumers an image of the favorite body especially when the identity having been tied to physical appearance [2].

Here, one example of adoption of such risks is cosmetic surgery that functions as a mechanism through which the identity finds meaning and is frequently constructed and reconstructed. Individuals take on high-risk cosmetic surgery since it is one way to transform the self. As a result, cosmetic surgery brings many potential risks for the consumer. Generally speaking, concerning more about the physical appearance and consequently increase of cosmetic surgery could be regarded as a response to living in risk societies as well as growing significance of the body for the individual’s identity [1].

In Iran, likewise, during recent decades having a beautiful face and an attractive body (e.g. slimness) has been substantial standards of beauty. Thus, Iranian men and women following such patterns have been engaged in different body management techniques and cosmetic surgeries despite the fact that past generations did not emphasize on slimness as today’s do. The folktales also illustrate the Iranian beauty taste using the “fleshy body” metaphor to highlight how much different is the Iranian beauty standard compared with the current slimness in the West [6].

The history of the first appearance of cosmetic surgery in Iran backs to 1955, but it has developed within the recent years to the extent that cosmetic surgery is known more as a profitable business rather a medical specialty. In this regard, some believe that countries producing the cosmetic surgery technologies less use them and a majority of consumers are in countries where women possess an inferior social position versus men. If in the past there was a whole definition of beauty, currently, detailed description of face and body beauty according to the patterns the media are broadcasting matters [1]. So, being beautiful on the basis of the defined standards could be causing frustration for those who are not beautiful in such way. Accordingly, since the number of Iranians tends towards cosmetic surgery either men or women are persistently growing, the present study aims to undertake a gender analysis on the Iranians’ opinions about cosmetics surgery.

2. Literature Review and Background

Prior to the World War II, plastic surgery had been performed to camouflage scars, treat congenital diseases such as harelip and hide the complications of such disease as AIDS and syphilis. In post WW II, however, because the soldiers needed a good face to be hired, physicians used plastic surgery for those whose skin was burned. But after this time, a major challenge arose and that, if plastic surgery can help people improve their appearance and have a better life or a better job, why not to do it? [13]

Accordingly, along with expansion of beauty tastes especially among women in the U.S., the challenge made plastic surgery an inevitable phenomenon. Now, cosmetic surgery implies using medical techniques or operations to improve appearance [11]. The cosmetic surgery unlike traditional surgeries has no medical justification and is done merely to modify the physical appearance. These surgeries embrace a wide range of complex operations from rhinoplasty to simple and outpatient surgeries like laser hair removal in beauty salons. As it was mentioned earlier, women are more interested in adoption of the risk of cosmetic surgery, though, currently, most of men benefit from cosmetic surgery in order to ameliorate the body. The Iranian men are not an exception, either [8].

Gimlin [9] argues that for social theorists and sociologists, cosmetic surgery symbolizes a fierce attack on the human body to achieve beauty. Cosmetic surgery is a technique of extreme and risky change of the body and to subjugate it.

In the modern world, the body is a flexible entity rather a fixed and pre-determined one. Peoples reconstruct themselves through body modification. The concept of masculinity is changing in the world of men [13]. Body image as a priority enforces women to get engaged with social comparisons through media pictures. These women most likely will experience the negative consequences of such comparisons [4]. Further, Groetz et al [10] conclude that after getting exposed to pictures of slim body women, the young women experience an undesired sense towards looking at other pictures. Women with negative body image are intended to be affected more by the negative impacts of watching these images.

Alamdar and Ghale Bandi [1] state that cosmetic surgery is the result of a specific psychological pattern. Individuals who tend towards cosmetic surgery are classified in narcissistic and obsessive personality patterns. Extreme engagement with the body image may become a psychological disorder.

Any request for cosmetic surgery must be investigated in interaction with psychological-personal factors and the cultural impacts. So, the narcissistic and obsessive personality patterns more probably request frequent rhinoplasty surgery compared with other personality patterns. The reason could be because excessive perfectionism among such personality patterns absolutely concentrates on the self aiming to increase beauty and intelligence. Also, the kind of body image women holds plays an imperative role in their confidence in comparison to men. This, therefore, repeatedly coerces women to demand for cosmetic surgery [7].

Tavasoli and Modiri [14] report that the chief motive for women to do plastic surgery is to become more beautiful and consequently boost their confidence. This preference in one hand is affected by some personal characteristics and on the other hand is influenced by external obligations. In a way that single and highly educated women hold more negative body image and low confidence. Furthermore, family, friends, relatives, husbands, physicians, satellite and TV channels are considerably effective on such tendency, respectively. However, the women’s desire to plastic surgery was irrelevant to age, employment, class, life satisfaction, beliefs and religious attitudes.

Other study indicates that a majority of individuals take on the risk of plastic surgery are married females belonging to the lower-middle class and lower- class families. Though, doing numerous plastic surgeries as an indication of a consumption behavior does not function to discriminate among social classes since lower social classes similarly manage their bodies through cosmetic surgery. Prevalence of cosmetic surgery among lower- social classes designates social significance of beauty and in following, achieving higher social status and social respect. Body attraction and face beauty as some part of life style can discriminate different social groups of the same social class [12].

Approaching cosmetic surgery from a different view, Enayat and Mokhtari [6] realize that woman’s body image shapes through sexual attitudes they hold towards themselves, men towards women and women towards men. Actually, how women perceive their body is influenced by men’s attitudes towards women’s physical body. On the other hand, advances in cosmetic surgery technologies have amplified concerns to the body and face beauty and as a result, men’s growing attention to women’s physical body.

Taking the above points together, cosmetic surgery is a multi faceted phenomenon is interwoven to various psychological and social parameters. Lots of quantitative studies have revealed global pervasiveness of cosmetic surgery, while, the qualitative investigations have highlighted personal attitudes and experiences on cosmetic surgery.

3. Materials and Method

In spite of a large body of quantitative and qualitative research on cosmetic surgery, yet, the focus group discussion (FGD) has been less applied. Focus groups, unlike individual interviews, provide the added dimension of the interactions among members [17]. Focus groups have been described as particularly useful at an early stage of research as a means for eliciting issues which participants think are relevant, which can then be used to inform design of larger studies [16]. The method therefore seemes appropriate for an exploratory investigation. Hence, since in Iran within the recent years cosmetic surgery has changed to an excessive trend, the focus group discussion makes the contribution to confront participants of either sex to discuss about and exchange their opinions on cosmetic surgery. In fact, the purpose of conducting FGD is to uncover the socio-cultural and personality drivers of unnecessary preference to cosmetic surgery and the role of gender in this regard. The stage of reasoning of the testimony was used discourse analysis. A semi-structured focus group guide used as a basis for discussion. Furthermore, to minimize moderator bias and putting the participants at ease, the moderator was from a similar background to the participants.

3.1. Participants

The selection of participants took place via the chain sampling method where a subject has a dual role of an interviewee and an introducer simultaneously. So, other participants are selected from the initial participant’s friends and relatives who are familiar enough with the research criteria. Thus, the new participants are introduced to the moderator. Accordingly, 12 subjects aged 21 through 35 years old were specified and three focus groups (4 subjects each) were formed. Of the total participants, 5 were male and 7 were female and 5 subjects (2 men and 3 women) had done cosmetic surgery before. All interviewees were living in the capital city of Iran and except three individuals, the rest were college students. In order to settle the problem of a dominant voice overriding other voices was dealt with by the technique of making the focus groups homogenous for example in terms of age, experience, education and sex. In this study the groups were homogenous in terms of education and current occupational position.

3.2. Procedure

Regarding the scenario where the discussion happened, a covered room into a small park located near to an Iranian university. The meeting was led by the researcher that acted as chairperson and an observer and it lasted one hour and five minutes (01:05:00). The statements were written down and then transcribed. In this study, the gender analysis examines the disparity among men and women in desire to cosmetic surgery, different levels of cultural pressure they tolerate to follow beauty standards and attitudes they hold towards body modification.

4. Content Analysis and Results

After analyzing each of the contributions given by the participants, the transcripts were coded conceptually. That is, the data are analyzed and classified in different conceptual categories. In the present study, focus groups discussion, implementation of the data and selection of proper codes were performed concurrently.

Then, the summarized data were arranged in specific core concepts. That is to say, a few major themes were created and the concepts were categorized according to the themes. Next, the themes were reviewed and possible complex themes became simpler.

In the last stage, the themes were analyzed. At the end of each interview, the interviewee’s opinions were repeated. The facilitator restated mentioned ideas and asked the participant to make the interviewer correct in case a concept is misunderstood. This was in order to validate the data.

A. The Individuals’ Perception of Beauty

This category points to the idea of most of participants about the role of media and beauty patterns.

a. The Impact of Media Specially Satellite Channels

“Foreign media impose on the Iranian families the Western standards of beauty. Satellite channels are everywhere to tell you, you must be beautiful…” (Woman)

b. Lack of a Strong Personality

“Some women and few men are easily fooled and waste their money to purchase fake cosmetic products, anti aging creams, vibrators etc, are advertised every day on satellite. They have weak characters…” (Man)

c. Beauty is Relative

“There are some culturally fixed standards of beauty in each country. An Iranian beautiful man or woman must be tall, has a white skin, has big eyes and white teeth and long black hair. If you do not have them you are ugly...” (Woman)

It was observed that beauty is a product of the media especially satellite channels, nevertheless , the impact of satellite channels on changing somebody’s body image varies as it is more significant for weak characters who always imitate the media-defined beauty standards. Moreover, beauty is a relative concept. There is not only one aesthetical form; rather, there are various forms of beauty. In fact, relativity of beauty is culture-sensitive. Each society has specific beauty patterns, which the individual’s beauty is gauged accordingly. Overall, two core concepts of beauty are identified: beauty as an inner feeling or a personal entity, and beauty as an external or social phenomenon. A personal understanding of beauty correlates to different concepts of self-acceptance, and having a positive attitude towards the self and balance. Yet, beauty as an external and social entity has to do with significance of “the Important Others”, and “the Important Generalized Others”. Here, beauty is something beyond the individual control and a role is assigned to culture. That is to say, during the socialization process, culture dictates individuals who are beautiful and who are not. There are hidden forces struggling to present a holistic aesthetic definition, all the same and constrained in specific beauty patterns.

B. Patterns of Beauty

In this category patterns of beauty and relevant factors are shown.

a. The Role of Family

“When a person grows up in a noble family, s/he thinks about beauty as little as possible. This person does not sit in front of TV to become beautiful…” (Woman)

b. The Role of External Factors

“The government allows different fashion magazines to publish. They advertise artificial beauty patterns. TV shows use slim actresses to convince the female audience she is overweight…” (Woman)

“Show something you are rich. It is simple, cosmetic surgery and changing the body. Now, peoples know that you have much money and you are different…” (Man)

The speeches reveal that media are ineffective on some because of the momentous role of family and family norms. Moreover, other different sources take action to create patterns of beauty as: the environment, society, fashion, the government, political structures, papers, and magazines. The society deliberately promotes favorite aesthetical standards and as such, beautiful and attractive individuals have been employed in prestigious jobs in one hand, and on the other hand, it directs financially powerful social classes get engaged with cosmetic surgery which the society has produced the ideal beauty patterns before. In this sense, beauty and body attraction discriminate different social classes and the aesthetical patterns are institutionalized by the government and media. Further, gender inequalities emerge when male agents persuade women undertake larger body modification.

C. Beauty a Capital

a. Significance of Beauty and Physical Attraction

In this matter, a mention is made of the significance of beauty and physical attraction, according to one participant that states:

“Yes, I agree that beauty is not all, however, accept that society judges you based on how much attractive you are. Good jobs and higher salaries are given to beauties. Beauty is money and ugliness is poverty…” (Woman)

Being beautiful is a value for the current Iranian society. Undertaking a cosmetic surgery regardless of the result is a determinant priority in life. Social and professional opportunities are unequally distributed since those who may not be culturally beautiful fail to attain necessary facilities and consequently, they are frustrated.

D. Drivers of Cosmetic Surgery and Body Modification among Women

In the current unit of analysis are described motives according to them women tend towards cosmetic surgery. Following the accounts:

a. Desire to Equity

“I did rhinoplasty because I feel more equality with my friend belongs to a rich family. She spends much money on cosmetic surgeries, so do I. it gives me a good sense we are the same…” (Woman)

“When I changed my nose form, I saw that other boys and men give attention to me. I could talk with more girls and boy peers…” (Woman)

From the testimonies is shown information about women’s desire to become socially equal and womanly competitions stimulate them to change their body. Moreover, the impact of men has not to be overlooked. Any attempt to be seen beautiful and attractive are influential on prevalence of cosmetic surgery among women.

b. Change of Identity

“Some people need to express themselves with a new thing. These do not like what they are. It is that thing which represents the person…” (Woman)

In the account is observed, finding a new identity or changing the identity and resolving personality shortcomings are other motives of cosmetic surgery. If an individual, for instance, is rich she never ever wishes cosmetic surgery, rather, the one who feels ugly undertakes cosmetic surgery in order to stimulate others to identify her by the physical change she has made.

c. Social Pressure

Opposing views were presented where one of the participants shared her experience from an apparent change of behavior of some male:

“I remember when I referred to an office the employee did not respond me properly since I had not worn heavy makeup and I had not operated my nose or other plastic surgeries. I had worn ordinary clothing and a natural face. But, when a woman with heavy makeup and operated face came to the office, I saw that the employee’s behavior changed. It was unexpected…” (Woman)

“…but I disagree. I do not think that only heavy makeup and plastic surgery may change one’s behavior especially a male employee. I see in my workplace that women with light or no makeup or plastic surgery come and they are satisfied. I think the women wearing heavy makeup or do rhinoplasty surgeries, botax, tattoo etc., because they are totally under the influence of society ordering them to get beautiful as much as possible…” (Man)

Due to the low cost of cosmetic surgery in Iran, most of Iranian women have experienced at least one of such surgeries. In spite of economic conditions in Iran, but women mostly arrange for doing cosmetic surgery which, highlights the social indulge in beauty. on the other hand, strong sense of perfectionism and physical appearance idealism besides women’s excesses and too much influence from social forces have lead to extreme rate of cosmetic surgery in Iran. It seems that Iranian women have tolerated higher pressure of perfectionism is imposing by the Iranian society.

d. Lack of Confidence

This category refers to the way somebody obtains confidence. In this group of people it becomes evident that the problem of confidence is one outstanding cause of cosmetic surgery among women and so, they constantly seek ways to increase it.

“There are women who do not love who they are. They look for a remedy. Bingo! The solution is cosmetic surgery. When you change something you do not like, you are a new person, and you have a good feeling...” (Woman)

“My friend had a big nose. However, she always was depressed. Although she was good in her lessons, she could not make good communications with others. So, she did cosmetic surgery and now she feels this new nose has given a strong sense of confidence can successfully interact with friends…” (Woman)

Lack of a sense of self-love, especially dearth of confidence and struggling to boost it to be accepted socially, are of two new reasons on cosmetic surgery decisions. Cosmetic surgery associates to confidence so that, through cosmetic surgery the society approves the individual and allows her to move upward economically or socially. Though, if the individual suffers from physical problems preventing her from feeling well, she must operate so that she will be satisfied personally. Hence, the issue of confidence is a social and personal variable depending on how the individual sees the self.

E. Cosmetic Surgery among Men

a. Lack of Confidence

This category shows some points of rejection of men’s cosmetic surgery. On the other hand, two participants believe that when men undertake cosmetic surgery it signals women that lack of confidence is not a female problem only.

“It’s a big nightmare when a man decides to do cosmetic surgery. It is totally nonsense. What does it mean? Can you imagine men with puffy eyes, thin nose or thin lips?” (Woman)

“I think a man is known for a woman with his neatness not beautiful face. I don’t like a man with an operated face. This man certainly is so crazy…” (Woman)

“I agree that beauty is important for everyone, but, oh my God, a man with thin body and a womanly face? I think he must be a weak character imitates wrong patterns of beauty…”(Woman)

Beauty is a womanly concept and women are required to be attractive, though neat and handsome men are regarded beautiful. Men must care only about their health not to worry about face beauty. Moreover, men who do cosmetic surgery definitely suffer from lack of confidence and cosmetic surgery comes to add something new to their characters, to bring them a new identity.

b. Women’s Expectations and the Patriarchy System

“… but I think men who do cosmetic surgery are also under the pressure of their wives or other women…” (Man)

“Yes, some women compare their husbands with Hollywood actors and want their husbands to become similar to them. But, there is one thing here. This reality is still hidden that the patriarchy system determines men and women’s beauty together, though it is more evident for women…” (Man)

In the current unit of analysis is described an equal pressure both sexes are tolerating to maintain or make their face beautiful and body attractive. Although, some women reject men’s cosmetic surgery and some force them to do cosmetic surgery, however, women at the same time agree that men’s surgery is an indication of the patriarchy system dominance on men, either. The system now has found new victims to constrain and compel them imitate pre-defined cultural patterns of beauty.

F. Cosmetic Surgery: Good or Bad?

In this matter were shown a series of agreement on doing cosmetic surgery.

a. An Opportunity for Better Life

“I believe that cosmetic surgery is a technology and technology is not essentially evil if it is used well. Lots of people were born with some physical deficiencies so, why not use cosmetic surgery to resolve those problems?” (Man)

“Definitely, I also agree that cosmetic surgery is a gift someone can receive. Do not you like having a small change in your body? So, use the gift…” (Woman)

The speech reveals that most of participants approach the cosmetic surgery with a positive attitude. There is no gender difference whether or not use the cosmetic surgery. In fact, although cosmetic surgery is a matter of concern for one sex more than the other, but either men and women interpret cosmetic surgery an opportunity for making a better life since a person may lose a good chance in his/her life or job because of that physical problem.

b. Beauty is not a Priority

In the current unit of analysis is described how much attention must be given to beauty.

“Beauty is important, but how much? I tell you not so much. Yes, many girls and women do everything to add to their beauty, but I believe it is not the way. There are other important things in life…” (Woman)

“There is not an ideal beauty, you know. Nobody can say that cosmetic surgery guarantees your beauty…” (Woman)

“Men love beauty like women do, though when a man sees a girl or woman first he looks for other criteria besides beauty. I dislike women whom beauty and looking for different plastic surgeries are everything for them…” (Man)

From the testimonies are shown information about significance of beauty for men and women. It is revealed that in spite of some gender differences in doing cosmetic surgery , yet, generally speaking, beauty has not to be a first hand priority in life and extreme engagement in cosmetic surgery and body transformation signify lower levels of socialization and greater materialism. Giving more attention to strong personality, good sense of reasoning and higher education are emphasized. Actually, either male and female participants clearly insisted on cosmetic surgery fails to bring peoples a perfect beauty, so it would be much better that men and women reinforce other personality attributes .

5. Discussion and Conclusions

Currently, beauty has become a new engagement for the Iranians. Meanwhile, media has accelerated the pace of body management techniques and has defined specific beauty standards must in any circumstances be achieved to. On the other hand, the special place of beauty and association with satisfaction and enjoyment are embodied on women, have intensified the significance of beauty in the society. So, in a close cooperation with the market, media inculcate the potential audiences follow the beauty patterns and consequently direct their consumption.

Along with media, prevalence of cosmetic surgery among the Iranians is measure of the patriarchy system affecting perception of beauty. As a matter of fact, under the cultural pressure of the patriarchy system to force women to comply with stereotype gender ideals; a majority of women accept the risk of body management techniques. Thus, as long as the dominance of the patriarchy system continues to constrain women’s power to control their body, women’s body becomes an object of cosmetic surgery. Here, the feminist approach argues that ideal styles of body all are products of ideology and the stratification system of the gender society.

However, cosmetic surgery could further be a source of the individual’s agency as it is an indication of controlling the self and autonomy. In this regard, women’s choice is a substantial factor. That is to say, despite women undertake the risk of cosmetic surgery, they at the same time experience a sense of satisfaction, objectification and constant struggle to take the control of their body. Given that, the risk of cosmetic surgery is a path women come to power. As women feel they have chosen the favorite identity by their own.

Furthermore, inapt expansion of cosmetic surgery in Iran has been affected, as well by the mental and affective motives. Need for public attention is one chief cause of concerns to physical appearance and consequently, doing cosmetic surgery. In circumstances where the most apparent layer of identity becomes so outstanding that suppresses other aspects of personality, the kind of body image the surgery applicants possess is more negative than the actual image. This image in turn is a function of social feedbacks. In fact, any request for aesthetical surgery originates in type of image others hold against the individual. This is the case of generalized others or important generalized others.

The FGD results also highlight looking at the body as a social symbol of the consuming identity and the body-orientation consumption in modern life. In a society where beauty plays a growing significant impact on determination of human identity, through modification of bodily characteristics, individuals respond to the condition and intend to create a social body, a body which is approved physically and socially.

The main reason could be considering the aesthetical surgeries as a collective action as it is no longer a personal priority, rather a social problem in the Iranian society. In this regard, cosmetic surgery especially for women is more a strategy of acquisition of symbolic capital and even transforming it into other forms of capital.

Several previously performed studies have beard out that facial cosmetic surgery is a womanly dialogue for shaping woman’s power. Though, women who define their physical body identity enclosed in cultural standards of beauty, trap in a vicious circle not only takes them away the body satisfaction, but they may also suffer from consequent physical and mental disorders.

Considering men’s preference towards cosmetic surgery, the problem should be clarified through increasing dominance of physical attraction in finding a good job and dating. The results depict that like women; men are under social pressure of physical attraction and face beauty standards. Hence, when cosmetic surgery changes to a social norm, in most occasions, men who refused to adopt the risk of aesthetical surgery would more probably lose ideal professional opportunities.

Taking the above points together, physical appearance affects by far the body satisfaction. Although, the results revealed that beauty must be accounted besides personality and behavior, beauty still has its determinant impact on the individuals’ confidence. This implies then that aesthetical concerns embrace a great portion of the individual’s identity. Therefore, in spite of possessing a strong personality, but imitation of the beauty standards provides peoples a favorite identity.

It was further recognized that according to the participants, cosmetic surgery is an opportunity given to the individual so that, s/he reconstructs the body as the media and society dictate, and gets indulged in the identity s/he has made. Construction of such identity is so dreamy that the risk of cosmetic surgery could be tolerable. As a result, whole participants entirely agreed upon adoption of the body modification and the body satisfaction as Foucault says the body is a subject of interference and medical care.