The marketing, advertising and mediation of cosmetic surgery in the United States has become a controversial issue. The debate began with the normalization of unrealistic beauty images due to excessive exposure to cosmetic surgery in the media and consumer self-diagnosis. Surgeons use aggressive marketing tactics for preventative procedures and prey on insecurities. Moreover, the proliferation of cosmetic surgery in the media in conjunction with misleading advertising has created an environment where consumers have false and unrealistic expectations and perceptions of cosmetic surgery. This article discusses the history of cosmetic surgery, marketing and advertising tactics as well as mediated theory to understand the ethical issues involved in elective surgery. The goal of this paper is to suggest regulation and protection for vulnerable audiences. / text

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This thesis uses a combination of vignettes and interviews to explore social approval of cosmetic and sexual reassignment surgeries as a means of studying sex and gender in contemporary society. It draws from poststructuralist, queer, symbolic interactionist and intersectionality theories. This study found that social approval was higher for normative surgeries than for non-normative surgeries. The main themes that emerged in regard to social approval were respondents‘ religious beliefs, their social distance from a person undergoing surgery, their concerns with possible risks or complications, and their views on an individual‘s right to control their own body. Underlying the vast majority of the responses was an essentialist view of sex that influenced how participants‘ viewed the various surgeries.

Two experimental phases examined the characteristics impacting the physical attractiveness stereotype and a potential stereotype shift. From reading a description of a hypothetical target, Phase 1 of this study revealed that participants considered an overweight attractive woman significantly more likely to help a friend in need and significantly more likely to become a friend than an underweight attractive woman. These findings provide understanding of how particular stereotypes may provide social benefits. In Phase 2, knowledge of the woman's plans for liposuction, which was disclosed in a second description of the target, dramatically lowered the participants' evaluations of her physical attractiveness, willingness to help a friend in need, and likelihood as a potential friend. The women's ratings of the target's willingness to help a friend dropped significantly more than the men's ratings. These results indicate that evaluations of physically attractive women may decline if they choose to unnaturally alter their appearance.

In the current climate in which it seems like popular media determines normality, it is not surprising to find that reality television, especially programs geared towards elective cosmetic surgery, are correlated with the decision making processes associated with actually pursuing cosmetic surgery. Research suggests that attitudes towards cosmetic surgery have changed dramatically due to the public's exposure to reality makeover shows; these shows have increased the popularity of such procedures and have highlighted and implied that cosmetic surgery is associated with little pain and risk. In this study, I sought to determine if attitudes toward cosmetic surgery vary as a function of ethnicity and gender, as well as examine the influence of the media on openness to pursuing cosmetic surgery. Examining how others view those who pursue elective cosmetic surgery and the variables associated with those who obtain cosmetic surgery will shed light on the processes associated with the decision to pursue the procedures.

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O avanço de estudos na área do comportamento do consumidor nas últimas duas décadas, com proposições e testes de modelos sobre confiança, satisfação, lealdade, risco, valor percebido, entre outros, bem como estudos conceituais destes e outros construtos, vem desafiando a comunidade acadêmica a realizar pesquisas inovadoras, que tragam um diferencial para a teoria de marketing. Neste sentido, este trabalho baseia-se no entendimento e desenvolvimento do construto Esperança, importante na compreensão do comportamento do consumidor e, objeto de poucos e recentes trabalhos na área de marketing. Foi escolhido para o estudo, o consumidor de cirurgia plástica estética, por causa da presença do sentimento de esperança neste processo de compra, bem como pelo risco envolvido neste tipo de consumo, enriquecendo a análise do modelo. Assim, o foco desta tese foi elaborar e testar as influências do construto Esperança num modelo teórico aplicado ao comportamento do consumidor de cirurgia plástica estética no Brasil, principalmente na relação com os construtos Satisfação do Cliente, Confiança no Médico, Expectativas, Ansiedade e Risco Percebido. São apresentadas 12 hipóteses de pesquisa, integradas a um modelo teórico, relacionando a Esperança e outros construtos que impactariam na satisfação. Foi realizada uma revisão bibliográfica nas áreas pertinentes, que auxiliassem o entendimento dos construtos, de modo a se obter a descrição necessária ao processo de desenvolvimento do modelo teórico proposto, que foi testado pela Modelagem de Equações Estruturais (SEM). O estudo foi realizado em duas fases de pesquisa, sendo uma qualitativa e a segunda quantitativa. Na primeira, foram realizados dois grupos focais com consumidoras de cirurgia plástica estética, e entrevistas em profundidade com especialistas; e, na segunda, um websurvey, obtendo-se uma amostra total de 384 pessoas, das quais 207 que já haviam realizado uma cirurgia plástica estética, e, 170 das que têm a intenção de fazer. Um modelo alternativo ainda foi testado para estas amostras, a partir das proposições levantadas nos grupos focais. Os resultados obtidos demonstram que a Esperança desponta como importante construto nos modelos testados, com a confirmação de diversas hipóteses e proposições, denotando a necessidade de incluí-la em modelos futuros, pela proporção elevada de explicação que exerceria nos demais construtos, principalmente a Satisfação. Destaca-se que os modelos desta tese, apesar de complexos, apresentaram medidas adequadas, que nos deixam margem para afirmar que houve uma contribuição para a área de marketing. Limitações e futuras pesquisas são ainda consideradas ao final da tese. / In the last two decades the Consumer Behavior area has progressed through propositions and testing Models such as Trust, Satisfaction, Loyalty, Risk, Perceived Value, among others, as conceptual studies of these and other constructs have been challenging the Academic community to carry out innovative research and bring a differential to the theory of Marketing. Therefore, the present research focus on the understanding and development of the construct Hope, an important aspect for better understating the consumer behaviors and a subject fairly explored by the literature. Cosmetic Surgery consumers were chosen for this study as the presence of the feeling Hope in the decision making process, as well as perceived risk, can enrich the Models. The focus of this Thesis was to extend and test the influence of the construct Hope in a theoretical Model applied on consumers of aesthetic plastic surgery in Brazil, mainly in relation to the constructs of Customer Satisfaction, Trust (in doctor), Expectations, Anxiety and Perceived Risk. Hence 12 hypotheses were proposed and united in a theoretical Model which the construct Hope was related to constructs that tends to impact on consumers satisfaction. A literature review in the relevant fields was conducted aiming to provide a better understanding of the constructs adopted in the Model proposed as way to obtain the necessary description of the development process, which was tested by Structural Equation Modeling (SEM). Two phase data collection were conducted for this research adopting qualitative methods at the first stage and quantitative at the second. At first two focus groups with female cosmetic surgery consumers followed by in-depth interviews with experts accomplished the qualitative phase. For the quantitative stage a web survey was applied and obtained a total sample of 384 females, including 207 consumers who had made aesthetics plastic surgery and 170 consumes with the intentions to do it. Based on the propositions that appeared in the focus groups an extended Model was tested using the sample described above. The result shows that Hope emerges as an important construct in the Model tested, with a confirmation of different hypotheses and propositions emphasizing the need to include the construct Hope in future Models due to the high proportion of explanation this construct would play with the others, especially with the construct Satisfaction. Its important to observe that the Models applied in this Thesis, despite their complexity, were able to present appropriate measurements allowing saying that this research has made a contribution to the field of Marketing. Limitations and future research were also considered at the end of this Thesis.

INTRODUÇÃO: Alterações funcionais e estéticas da parede abdominal, tais como flacidez de pele, lipodistrofia e diástase dos músculos retos abdominais, podem contribuir para a diminuição da autoestima e bem-estar do paciente. A lipoaspiração da parede abdominal durante a abdominoplastia com descolamento amplo tem sido contraindicada devido ao aumento do risco de complicações. A lipoabdominoplastia realiza apenas o descolamento seletivo do retalho ao longo das bordas mediais dos músculos retos abdominais, preservando os vasos perfurantes abdominais, o que permite a realização, com maior segurança, da lipoaspiração concomitantemente com o tempo cirúrgico da abdominoplastia. O objetivo do presente estudo foi avaliar o resultado estético da lipoabdominoplastia em pacientes com sobrepeso - Índice de Massa Corporal (IMC entre 25 e 29.9) quando comparadas com pacientes de peso normal (IMC entre 18,5 e 24,9). M?TODO: Foi realizada uma análise comparativa de resultados estéticos após a lipoabdominoplastia em dois grupos de 30 pacientes, um com IMC entre 25 e 29,9 e outro, de controle, com IMC entre 18,5 e 24,9, operadas entre 2000-2009. Para a avaliação dos resultados estéticos, foi utilizada a escala com parâmetros objetivos, desenvolvida pela Disciplina de Cirurgia Plástica da FMUSP, empregada por sete avaliadores independentes - três médicos, três não-médicos e o próprio cirurgião, no pré e pós-operatório. A escala avalia cinco aspectos em fotografia, volume do abdome, contorno lateral, excesso de pele ou flacidez, aspecto do umbigo e estética da cicatriz na parede abdominal. Os dados comparativos foram submetidos a análise estatística, com valor de significância \"p\" de 0,05. RESULTADOS: Tanto no grupo total (n=60) quanto em cada grupo isoladamente, a média das notas do pós-operatório foi significativamente maior que a média das notas do pré, para todos os avaliadores. Da mesma forma, a média das notas do Grupo II (de controle) sempre foi significativamente maior que a do Grupo I (de sobrepeso), tanto no pré como no pós-operatório, para todos os avaliadores, embora a média do ganho obtido - ou a diferença entre as notas do pós e do pré-operatório, que mede a melhora no resultado estético, tenha sido maior no Grupo I (de sobrepeso). Tanto no pré como no pós- operatório, a média das notas dos avaliadores não-médicos foi significativamente maior que a média das notas dos médicos. No pós-operatório, a média da nota na avaliação do cirurgião foi significativamente maior que a média dos avaliadores médicos e que a dos avaliadores não- médicos. O Índice de Correção Intraclasses (ICC) foi elevado e significativo, indicando alto grau de confiabilidade interna entre os profissionais. CONCLUSÃO: Houve diferença significativa na avaliação estética dos resultados da cirurgia do abdome, quando comparados os dois grupos com diferente IMC: o grupo de controle (IMC entre 18,5 e 24,9) apresentou resultado superior na média das notas, tanto no pré como no pós-operatório, para todos os avaliadores. Embora ambos os grupos tenham apresentado significativa melhora na avaliação estética após a lipoabdominoplastia, o ganho de melhora entre o pós e o pré-operatório foi maior no Grupo com IMC entre 25 e 29,9 / BACKGROUND: Aesthetic and functional deformities of the abdominal wall, as skin flaccidity, lipodystrophy and diastasis of rectus abdominis muscles may contribute to decreased self-esteem and well-being of the patient. Liposuction of the abdominal wall in traditional abdominoplasty (wide undermining) has been criticized for increasing the risk of complications. The lipoabdominoplasty performs a selective undermining of the flap along the medial borders of the rectus abdominis muscles, preserving the abdominal perforating vessels, thus allows liposuction during the same procedure of abdominoplasty with greater safety. The aim of this study was to evaluate the aesthetic results of lipoabdominoplasty in overweight patients (Body Mass Index - BMI 25-29.9) as compared to patients with normal weight (BMI between 18.5 and 24.9), operated by the same technique. METHODS: A comparative and retrospective analysis of late follow up results after lipoabdominoplasty between two groups of 30 patients, one with BMI between 25 and 29.9 and a control group with BMI between 18,5 and 24.9, operated from 2000 to 2009. To evaluate the aesthetic results was used a scale with objective parameters developed by the Plastic Surgery Department of São Paulo University, held by seven independent evaluators - three doctors, three no doctors and the surgeon. Five items in photography were evaluated - the abdominal volume, the lateral contour, excess of skin flaccidity, the appearance of the navel and quality of scar in the abdominal wall, both in pre and postoperative period. The data was submitted to statistical analysis. RESULTS: Both in the whole study population (n = 60) as in each group separately, the average score of the postoperative period was significantly higher than the pre, for all evaluators. Likewise, the average score of Group II (control) was always significantly higher than that of Group I (overweight), pre and postoperatively for all evaluators, although the mean difference between the post and pre-operative scores, which measures the improvement in the aesthetic result, was higher in Group I (overweight). Postoperatively, the average score, when assessed by the plastic surgeon was significantly higher than when assessed by other doctor and no doctor evaluators. The average score by non-medical evaluators was significantly higher than the average pointed out by doctors, both in the pre and postoperative period. The Intra Class Correction was high and significant, indicating a high degree of internal reliability between professionals. CONCLUSION: A significant difference was noted in the aesthetic evaluation of the abdomen when compared the two groups with different BMI: the control group (BMI between 18,5 and 24,9) presented superior results in grades in both the pre and post results for all evaluators. Both groups showed significant improvement in aesthetic evaluation after lipoabdominoplasty, but the gain between the pre and the postoperative was higher in the group with BMI between 25 and 29.9

A partir de uma abordagem do fenômeno das cirurgias plásticas enquanto algo que se conforma na prática, esta dissertação versa sobre os limites entre o reparador e o estético relativos a esses procedimentos. Tendo como espinha dorsal a formação das(os) médicas(os) e a constituição dessa especialidade da medicina, tais fronteiras serão abordadas a partir do entendimento de que não apenas auxiliam na conformação das cirurgias plásticas, mas são também constituídas em relação a essas últimas. Através da participação em eventos promovidos por Ligas de Cirurgia Plástica e entrevistas realizadas com graduandas, residentes, cirurgiãs e cirurgiões plásticos, este trabalho tem como objetivo construir uma narrativa, entre tantas outras possíveis, acerca dos modos como os limites entre o estético e o reparador têm se instituído discursivo-materialmente. Antes, contudo, parte-se de uma abordagem histórica a fim de uma compreensão mais situada a respeito de como essa especialidade tem se conformado ao longo do tempo. Por meio de diferentes investimentos esta dissertação trata, em síntese, sobre como esses procedimentos assumem diferentes realidades. Assim, contingências históricas, sociais, econômicas, políticas e materiais, entre inúmeras outras, são compreendidas de maneira indissociável como atuantes na conformação das cirurgias plásticas e dos limites concernentes a elas. Por fim, sugere-se que um entendimento dessas realidades enquanto múltiplas nos auxilia na construção de uma apreensão do conhecimento médico como algo que não está dado, mas como práticas histórico-materialmente situadas. Ainda, a partir da discussão central proposta por este trabalho são estabelecidos pontos de confluência entre as cirurgias plásticas e as fronteiras relativas ao corpo e aos binômios natureza/cultura, saúde/doença, forma/função, entre outros. / This dissertation addresses the limits between the cosmetic and the reconstructive surgeries from an approach of the plastic surgery phenomenon as something that conforms in practice. Having as a backbone the formation of the doctors and the constitution of this specialty of medicine, such boundaries will be approached from the understanding that they not only aid in the conformation of plastic surgeries but also are constituted of this last one. Through the participation in events promoted by Plastic Surgery Leagues and interviews with undergraduates, residents and plastic surgeons, this study aims to construct a narrative, among many others possible, about the ways in which the boundaries between the cosmetic and the reconstructive surgeries have been instituted discursive-materially. First, however, it starts with a historical approach in order to understand more about how this specialty has conformed over time. Through different investments, this dissertation deals, in short, with about how these procedures take on different realities. Thus, historical, social, economic, political, and material contingencies, among countless others, are understood as acting in the conformation of plastic surgeries and the limits concerning them. Finally, it suggests that an understanding of these realities as multiple helps us in constructing an apprehension of the medical knowledge as something that is not given but as historical-materially situated practices. Still, from the proposed discussion by this study, points of convergence between plastic surgeries and boundaries related to the body and to the binomials nature/culture, health/illness, form/function, among others, are established.