1
Forecasting Addictive Consumer Behaviour in Plastic Surgery:
A Case Study in Vietnam
Abstract
Studies in Vietnam and other countries reveal that the number consumers willing to consider
cosmetic surgery has increased. The purpose of this paper is to stimulate a research agenda by
illuminating a key empirical issue on forecasting deviant consumer behaviour in Vietnam in
relation to aspects of cosmetic surgery.
Questions considered, include; what are the factors that affect consumers’ experiences and
consumer’s addictive behaviour after undergoing plastic surgery? What is the probability of
becoming addicted to or retaking cosmetic or plastic surgery? Do demographics have any bearing?
Primary data was collected from surveys and questionnaires distributed to both female and male
consumers. The respondents either have had plastic surgery or are expected to have plastic surgery.
The findings indicate that self-image and self-esteem are the most important factors influencing
addictive consumer behaviour. Other factors such as demography and psychological aspects are
also increasingly important but not are not as powerful an influence.
While the Logit model reveals that a married consumer is 8.92 times more likely to repeat cosmetic
surgery than a single consumer. Similarly, a younger consumer is 5.11 times more likely to repeat
cosmetic surgery than an older consumer.
This finding carries strategic implications for plastic surgery marketing.
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1. Introduction
Literature (Kvalem et al., 2006; Fox, 1997) indicates that more people are dissatisfied with their
physical appearance (Appendix 2). Approximately 65,000 surgical cosmetic procedures were
performed in the UK in 2008 (MNT, 2013), with breast enlargement being the most popular,
followed by facial surgery, rhinoplasty (nose alteration), liposuction, and face-lifts. The prevalence
of plastic surgery is not surprising as it is the oldest of the healing arts in history. Alas, this search
for perfection has created addictive behaviour in relation to cosmetic surgery (Schouten, 1991). In
this study, plastic surgery was characterised as deviant behaviour because the sample comprise the
respondents who had plastic surgery on multiple occasions (repeat patients) as well as who are
expected to have repeat plastic surgery in the future. Hence, this research will forecast this
addictive consumer behaviour. Although the literature (Dowling, 2013; ABCS, 2013; Costhetics,
2011) indicates a difference between plastic and cosmetic surgery, this study employs the terms
interchangeably.
Following relevant literature (Fisk et al, 2010; Krych, 1989; Powers, 1993), we define deviant
consumer behaviour as addictive behaviour, which differs from the “normal” standard. Although
the discourse on deviant or addictive behaviour by consumers is acknowledged in relevant
literature (Workman & Paper, 2010; Fisk et al, 2010; Lohr, 2009; Fullerton and Punj, 1997) the
subject has not been prioritised in consumer research (Harris and Reynolds, 2003; Fullerton &
Punj, 1997). The behaviour is similar to substance abusers because of inability to control their
addictive purchasing habit (Black, 2007). Unfortunately, most research on consumer deviant
behaviour relates to substance addiction (Faber et.al, 1995; Hirschman, 1993), which has focused
attention on the damage that consumers can inflict on themselves, but does not evaluate the
probability of the addictive behaviour. Hence, although the subject has become a stimulating area
of research due to its psychological and financial impacts on markets and consumers (Fullerton and
Punj, 1993; Harris and Reynolds, 2003), there are very limited empirical studies on the subject.
Accordingly, our overall understanding of deviant consumer behaviour in cosmetic surgery
remains limited. Therefore, it is intended, that this study will fill a gap in the relevant literature, and
address topics such as the cultural values embodied in a developing country such as Vietnam. The
limitations of this study are that, since the research was carried out in Vietnam, the findings of this
research may not be germane to other countries and the limitations of a small sample (as a case
study). Accordingly, this paper aims to answer several research questions such as:
1) What are the internal and external factors that affect consumers’ experiences, and what
aspects affect the consumer’s addictive behaviour after undergoing plastic surgery?
2) What is the probability of or how likely is a consumer to become addicted to or retake
cosmetic or plastic surgery?
2. Literature Review
The term ‘plastic surgery’ was coined by Vongraffe in 1818. The word plastic is derived from the
Greek word ‘plastickos’ which means to create, to shape, and to mould. Dhanraj (2006) defined
plastic surgery as a multifaceted speciality that combines form, function, technique, and principle
where deformities and defects of the skin and underlying structures are dealt with. It is also known
as a problem solving speciality, as every patient presents a challenging problem requiring a unique
solution to permanently change a person’s physical appearance but not for medical reasons.
Contrary to plastic surgery, cosmetic surgery is carried out to please the eye of the beholder
(Harper, Phillips and Gallagher, 2005). Around the middle of the century, concern about ageing,
combined with a desire to highlight ethnic indicators, (e.g. adding a crease to the upper eyelid of
Asians), created a wider demand for surgical help to improve appearance, and physicians
eventually accepted cosmetic surgery as a legitimate treatment. In the 21st century, these
“normalization” alterations include liposuction (to remove fat from a body to make it slim),
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rhinoplasty (to change a nose that stigmatizes an individual), Botox (to remove wrinkles and signs
of age), collagen injections, and breast augmentation (to restore youth or enhance beauty).
Boyle (2012) indicates that the driving force behind the increase in demand for cosmetic surgery is
the ageing profile and a reflection of the desire of people to stay young and continue to have a good
social image. With beauty no longer restricted to being a woman’s forte, men have also started to
explore the advantages offered by cosmetic therapy (Kennard, 2007). Overall it can be predicted
that the market for cosmetic surgery is set to grow with an increasing demand among both men and
women (Appendix 1) as it incorporates both health benefits as well as the modern desire to look
young and attractive for as long as possible (Beech and Sheehan,1996).
Since the early 1990s, the demand for cosmetic surgery has also soared in Vietnam (ICL. 2013).
Since Vietnam has turned a kind-eye to Western fashion and its way-of-life, the cosmetic surgery
options have increased dramatically, fuelled by demand from the burgeoning middle class (ICL.
2013). Nowadays wealthy Vietnamese, rather than going abroad, stay at home to have rhinoplasty
(nose job) and take advantage of Vietnamese surgeons’ competence and low prices (Phụ Nữ
Online, 2010; Malo, 2007). Plastic surgery costs in Vietnam are estimated to be approximately
70% lower than those in developed markets such as the US or Israel. Recent figures show that
demand for cosmetic surgery as well as addictive behaviour in Vietnam continues to soar, with 53
private clinics now licensed in the city (Cuong, 2013; Malo, 2007). According to Vnexpress
(2010), of these 53 licensed facilities, 45 are specialized clinics, while eight are general hospitals
that offer plastic surgery services.
3. Research Methodology
Quantitative analysis was employed in this study using correlation analysis and the Logit model.
The Logit model is a form of regression, which is used when the dependent is a dichotomy and the
independents are continuous variables, categorical variables or both. Justification for using a Logit
model is to estimate the probability of a certain occurrence of consumer addictive behaviour based
on several predictor variables such as respondents demographic characteristics and other attitudinal
scores (Appendix 3, Survey Questionnaires). The Logit model has been used increasingly and
successfully in the field of marketing and management (Lange, 2010; McCarty and Hastak, 2007).
In this research, a research question is directed to predict a dichotomous outcome of consumer
addictive behaviour such as whether a consumer is likely to undertake additional cosmetic surgery
in the future. Although this research question could be answered conventionally using an ordinary
regression with an ordinary least squares (OLSQ) technique, it was found to be less robust for
handling dichotomous outcomes due to inherent statistical assumptions such as linearity, normality
and continuity (Tabachnick and Fidell, 2001).
Algebraically, a Logit (log odds) function of π can be given by the following algebraic equations:
3.1
π
odds =
π −1
 π 
log it( π) = log 

1− π 
3.2
log it( π ) = log( π ) − log(1 − π )
3.3
The dependent variable in a Logit model is dichotomous. It takes the value one with a probability
of success π, or value zero with a probability of failure of 1-π. In the above equations, the base of
the logarithm function used is ten; however, the natural logarithm (3.4) is the most frequently used
in empirical literature (Agresti, 1996).
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3.4
ln( π) = ln( π) − ln(1 − π)
Accordingly, the Logit model of any number π can be provided algebraically by the following
equations:
3.5
 π 
log it(π) = ln 

 π −1 
3.6
 π 
ln 
 = δ0 + δ1X1 + δ2 X 2
 π −1 
Following the equations, 3.5 and 3.6, relevant empirical literature (Hosmer and Lemeshow, 2000)
reveal that a simple Logit model (with a single predictor variable) can take on the following forms:
3.7
eδ +δ X
π=
0
1+ e
1
δ0 +δ1X
Where π stands for the probability that the dependent variable equals one, δ0 for constant, δ1 for a
parameter coefficient of X and e for the base of the natural logarithm.
One hundred and fifty survey questionnaires were sent to Vietnam and distributed to clustered local
participants. The participants were selected by using a cluster random sampling technique. A
cluster technique was used because a list of the members of a population could not be obtained but
a list of clusters of the population were obtainable from the clinics or centres of plastic surgery in
Vietnam. Accordingly, it is more economical rather than stratified random sampling (Lohr, 2009).
The participants were guaranteed anonymity and confidentiality, which had increased significantly
their participation and response rates. After filtering the questionnaires and removing unusable and
blank answers, 122 usable questionnaires remained. The questions (Appendix 3) asked in the
survey are based on relevant literature on consumer behaviour (Solomon, 2012) and based on selfconcept, on theories regarding the factors influencing consumers’ decisions to undergo cosmetic
surgery, and on consumer satisfaction with plastic surgery.
4. Empirical Findings
The findings indicate that the majority of respondents were between 26 and 54 years old (80.9%).
Previous studies (Kalfus, 2012) indicated the majority of female respondents who had undergone
cosmetic surgery were between 18 and 44 years old. Other female respondents said they would
have plastic surgery if cost were not an issue. Similarly, a study conducted by Asaps (2011) found
that in a sample of 1,000 women between the ages 18 and 30, 72% indicated they wanted to have
cosmetic surgery; 49% said they planned to have work done at some point in the near future. In
another study, Agovino (2007) found that women tend to begin visiting plastic surgeons when they
are in their late 30s and early 40s to restore their youthful appearance with procedures such as
Botox shots. Hence, the explanation of the above result is that the findings from Vietnam are in line
with earlier findings that typical consumers of cosmetic surgery are people in the middle age range,
typically between 26 and 34 years old, who want to avoid the effects of ageing.
The findings reveal that the majority of respondents (64.1%) did not feel satisfied with their facial
features, including the nose, eyes, lips, and the whole face. The breasts were the second feature
they were most dis-satisfied with, accounting for 15.8%, followed by 7.5% who did not feel
satisfied with their skin. Dissatisfaction with the stomach accounted for 5.8%, while 1.7% were
unhappy with their legs. Only 0.8% or one respondent was dissatisfied with his or her neck.
Looking at past studies (Châu, 2011), the reason many respondents thought that their faces were
unattractive is because of the environmental atmosphere in Vietnam.
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The findings show that 60.8% of the respondents had surgery on their faces, including lips, cheek,
chin, nose, and hair (60.8% or 73 respondents). A further 20 respondents (16.7%) had breast
augmentations, while eight respondents (6.7%) had liposuction and seven (5.8%) underwent
dermabrasion. Scar revisions were performed on five respondents (4.2%), three respondents (2.5%)
had a tummy tuck, two respondents (1.7%) underwent penis enhancement surgery, and two others
(1.7%) had other types of surgery. The results of this study support Roald and Skolleborg’s (2009)
findings that the numbers of facial surgery are increasing rapidly. In their 2011 study, they found
that plastic surgeons reported an increase in the numbers of Hispanic, Asian-American and
African-American patients. Of the four most popular cosmetic procedures, African-Americans and
Hispanics were most likely to have received rhinoplasty (88%), which is a 10% increase from
2010). Asian-Americans were most likely to have undergone either blepharoplasty (56%) or
rhinoplasty (35%). One explanation for this result is that most Asian people do not have a “proper”
face, especially with regard to their nose and cheeks, and the majority of plastic surgical procedures
concentrate on the face (Joethy and Tan, 2011).
The findings reveal that friends and family had the greatest influence on consumers who underwent
plastic surgery (36.7% or 44 respondents were influenced by friends and 25% or 30 respondents by
family). Twenty-five respondents (20.8%) indicated that they had personal reasons for having
surgery. Past experience, was a reason given by 13.3% or 16 respondents. The last influencing
factor was media/magazines/celebrities, which accounted for 4.2% or five respondents, who had
undergone surgery because of media and celebrity influences. Interestingly, the results of this study
are not in line with those of a previous study (Shaffer, 2010) about the factors that influence people
to undergo plastic surgery. For example, the influence of celebrities in Vietnam is low compared
with other industrialized or European countries. Shaffer (2010) pointed out that celebrities these
days are far more open about their plastic surgeries, and the ones who do not need any work are
still inspiring to people who are unhappy about their looks. The explanation for this result is that
the celebrities in Vietnam are not used to plastic surgery and that not many of them have had it, or
have only undergone small and simple nonsurgical operations, which are hard to notice, so,
celebrities in Vietnam did not have a great influence on consumers’ decisions regarding plastic
surgery. The majority of Vietnamese respondents (64.1% or 77 respondents) did not think that a
particular celebrity inspired them to undergo surgical procedures. Twenty-five respondents (20.8%
or 25) think that they are influenced by celebrities, while 15% or 18 respondents gave no opinion.
Compared with findings from similar studies in the US and in some European countries, Toscano’s
study (2010) indicates that Hollywood celebrities are a big influence to most people when
considering cosmetic surgery.
The results reveal that the variables X1, X4, X11, X18 are significant predictors of Q16, or of how
likely a consumer is to carry out addictive behaviour. Based on SPSS results, the multiplicative
form of the model can be rewritten as follows:
4.1
π
1.631−0.831X
1− π
=e
1
π
= e 2.188 −0.773X 4
1− π
4.2
Ln (π/1-π) is known in the literature (Agresti, 1996) as the log-odds and (π/1-π) as the odds. By
using this simple Logit model of 4.1 (one explanatory variable of the respondents’ age, whether the
respondent is younger or older than 34 years), the odds that a subject of given classification can be
predicted accordingly. The finding indicates that a younger consumer (X1=0) is 5.11 times more
likely to repeat cosmetic surgery than an older consumer. Whilst, an older consumer (X1=1) is only
2.23 times more likely to repeat the surgery. While the Logit model of 4.2 reveals that a married
consumer (X4=0) is 8.92 times more likely to repeat cosmetic surgery than a single consumer.
Whilst, a single consumer (X4=1) is only 4.12 times more likely to repeat the surgery.
Using additional explanatory variables, the Logit model can be re-produced accordingly:
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ln
π
= 0.223 − 0.176X1 + 0.311X 4 + 0.06X11 + 0.877X18
1− π
4.3
This equation 4.3 tells us that increasing age decreases (-0.176) the log odds of repeating cosmetic
surgery (ceteris paribus, holding other variables constant). This finding seems to contradict
findings in earlier studies (Agovino, 2007) which reveal that the older the people are, the more
likely they are to retake cosmetic surgery to maintain their beauty and counteract the effects of
ageing. The result reveals that a greater number of young people are not satisfied with their
physical appearance compared to the older generation.
Interestingly, the findings show that being married increases the log odds (+0.311) of having more
cosmetic surgery in the future (ceteris paribus). According to Ethridge’s study (2012), there has
been a rise in the number of married women getting plastic surgery. The majority are 32 to 40 years
old, were married at a young age (in their early 20s), and have one or two children. In addition,
Beckman (2012) revealed that more married women than ever before are having plastic surgery,
compared to married men. One reason for this is that they feel pressure to keep their husbands
happy. Some respondents indicate that they are tweaking their looks to feel better about
themselves. Hence, women may have all the right motives, including doing it for herself and for
her husband, since, in a healthy relationship, both individuals have a stake in the plastic surgery
process. In addition, a study by Edgerton et al. (1985) indicated that the typical facelift patient has
been classified as a married, upper-middle class, socially active woman who is grateful for and
enthusiastic about her enhanced appearance.
A Pearson product-moment correlation (r) was also computed to assess the relationship between
the number of times consumers have had plastic surgery and the consumers’ satisfaction levels
after surgery (r= 36.20%, Sig. <0.05). The findings indicate that the more times people have plastic
surgery, the more satisfied they feel about themselves. This seems to support the hypothesis of
addictive consumer behaviour. The theoretical explanation relates to how the consumers define the
concept of self-esteem (Soest, 2006). For example, when a consumer has relatively low self-esteem
before surgery, after having the plastic surgery, they are happy with the results; they believe that
there is now nothing wrong with them. On the other hand, the findings support the hypothesis that
people with lower self-esteem think that cosmetic surgery will give them more confidence and selfesteem (Edmonds, 2007) and so they believe more plastic surgery will make them happier, since
they will be perfect. The model of 4.3 reveals that the respondents’ perception towards feeling
more beautiful and confident have significantly affected the likelihood of them retaking cosmetic
surgery. That is, being more confident after cosmetic surgery increases the log odds (+0.877) of
having more cosmetic surgery in the future (ceteris paribus). All parameter coefficients of the Logit
model of 4.3 are significant at a 1% level as indicated by Wald statistics.
In addition, knowing more people (who have had cosmetic surgery) increases (+0.006) the log odds
of someone repeating plastic surgery. This finding is supported by the Pearson product-moment
correlation, which indicated a significant relationship between the consumers’ self-confidence after
cosmetic surgery and their intention to undergo more surgery (r= 0.695, Sig. <0.05). The findings
indicate a positive correlation between the level of consumer satisfaction after having plastic
surgery and the intention to have more surgery in the future. According to Emievil (2010), when
consumers are not satisfied with their appearance after having plastic surgery, they might try
alternative surgeries in the future. However, previous research, such as that by Teitelbaum (2004),
contradicts Emievil’s study. People want to be perfect and are not satisfied with themselves, so
tend to have increasingly higher demands and undergo more plastic surgery in an attempt to reach
their target of perfection. Juxtaposing the two studies reveals the differences in relation to the
findings. This finding carries strategic implications for plastic surgery marketing, for example, the
surgical institutions should focus on a specific segment of consumers such as repeat buyers,
married female and younger consumers.
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Appendix 1
Global Cosmetic Surgery Market Analysis by Segment
2006-2013 (in £ Billion)
Source: Adapted from BCC Research (2009)
Appendix 2
Before and After Cosmetic Surgery
Source: Adapted from Pandey et al. (2012)
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Appendix 3
1) What is your age?
2) What is your gender?
3) Where do you live?
4) What is your marital status?
5) What is the highest level of education you have completed?
6) What is your monthly income?
7) To what extent do you agree with the statement “Beauty is more important than brains”?
8) To what extent do you agree with this statement “You feel self-confident about your
appearance”.
9) What do you feel is the most unattractive feature on your body?
10) To what extent do you agree with this statement “Ageing will influence your beauty”.
11) How many people who have had a cosmetic surgical procedure do you know?
12) Which has the largest influence in your choice to do the cosmetic surgery?
13) To what extent do you agree with this statement “A particular celebrity inspires you to do
the procedure”.
14) To what extent do you agree with this statement “You are really worried before doing the
cosmetic surgical procedure”.
15) Where did you have the cosmetic surgical procedure?
16) How many times have you had a plastic surgical procedure?
17) What types of plastic surgery have you undergone?
18) To what extent do you agree with this statement “I feel more beautiful and self-confident
after having a cosmetic surgical procedure”.
19) To what extent do you agree with this statement “You would feel embarrassed if someone
knew that you had undergone a cosmetic surgical procedure before”.
20) To what extent do you agree with this statement ”If you could go back time, you would not
have had a cosmetic surgical procedure”.
21) To what extent do you agree with this statement “Cosmetic surgery is harmful to your
health”.
22) To what extent do you agree with this statement “You will have a cosmetic surgical
procedure in the future”.
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