Journal of Aesthetic & Reconstructive Surgery

Keywords

Mobile commerce; Aesthetic medicine; Physical attractiveness; Risk; Gender

Introduction

With the advancement of science and technology and an increasingly aging society, interest in age-defying treatments and improving external appearances has surged [1]. The market for aesthetic medicine in Chinese market began to rapidly grow in 2017, with the total number of aesthetic medical treatments exceeding 10 million, making it the second largest market for aesthetic medicine after the United States. With the popularity of social media and live broadcasts, mobile celebrity endorsements have become a popular way for mobile sellers [2]. According to the “2020 China Medical Beauty Industry White Paper,” the market for aesthetic medicine in mainland China reached US$32 billion in 2020, and occupied 17% of the total global market size leading the world [3].

Aesthetic doctors can be the core brand resource for aesthetic medical platforms. Many aesthetic medical apps attempt to package doctors as app celebrities to provide more direct and diversified services [4]. Internet celebrities (App celebrities) are touted as internet sensations, either intentionally or unintentionally, due to their appearance, talent or special events [5]. Internet celebrities (App celebrities) have similar marketing techniques as traditional advertising spokespersons for recommending products. Therefore, consumers’ purchase intentions are deeply affected by the spokesperson’s physical attractiveness [6] professionalism, credibility, persuasiveness, and familiarity, etc. [7]. Especially when aesthetic medical apps advertise that doctors are both app celebrities and service doctors, their services are viewed as more direct and diverse [4].

The aesthetic medicine industry is a service industry that attaches great importance to technology. The physical attractiveness, beautification skills, and medical knowledge of the aesthetic medicine personnel play an important role in consumer impressions of service quality [8]. Consumers could develop the initial attitude in response to the physical appearance of personnel or may derive expectations from the service personnel’s appearance [9]. The physical attractiveness of service personnel is one of the most conspicuous and observed personal characteristics [10].

The field of aesthetic medicine includes medical cosmetics, nonsurgical plastic surgery, and plastic surgery [1]. Aesthetic medicine combines professional medical procedures and cosmetology techniques and focuses on using noninvasive techniques to improve or change physical appearances and shapes for cosmetic purposes [11]. Aesthetic medical services tend to advertise that the service cost is reasonable, the service risk is low, and the recovery time is fast after an aesthetic medical procedure [12]; however, many risks are involved in aesthetic medicine (especially in microsurgery and cosmetic surgery). The removal of wrinkles or scars using hyaluronic acid may cause infection. The skin Radio-wave treatments may cause lipoatrophy and skin burns. Using Botox to remove wrinkles may cause muscle stiffness, drooping eyebrows or crooked corners of the mouth. Using pulsed light spots to remove scars and shrink pores may cause mild blood stasis or black scabs on the skin [12].

Numerous studies discussed with the topic of physical attractiveness and consumer outcomes [13]. More physical attractiveness is associated with having more friends [14] and engaging in more customer citizenship behavior [15]. Moreover, a positive social reaction is elicited [16], improves consumer trust [17], and decreases the perceived risk [18]. Although literatures have stated that celebrities can help to stabilize brand loyalty [19] and in turn stimulate consumer purchase intentions [20], no studies have explored whether aesthetic medicine app celebrities' physical attractiveness affects consumer perceived risk.

The United States has a stable and large middle class, with middleand high-income groups focused on improving their quality of life. According to the data from ISAPS 2016, women account for 92% of all consumers of aesthetic treatments in the United States; approximately 60% of women aged 19 to 50 are aesthetic medicine consumers and the population penetration rate is 3.8%. In Asia, most aesthetic medicine consumers are also women [21]. According to data from IiMedia Research, the proportion of Chinese men and women who are beauty consumers is 11.1% and 88.9%, respectively [22].

Previous studies have used physical attractiveness to predict customer outcomes and compared outcomes between genders. Some studies have found that when women are more attention to their physical appearance, they will compare themselves with attractive models and be willing to pay less due to negative social comparisons [23,24]. Another study found that the physical attractiveness of one’s partner is associated negatively with subjective risk perception. In that study, the participants had lower intention to take precautionary action. Moreover, this effect was stronger for men [25].

However, whether aesthetic medicine app celebrities’ physical attractiveness affects the perception of consumer perceived risk is uncertain. Is there a moderating effect between aesthetic medicine app celebrities’ physical attractiveness and consumer perceived risk? This study thus aimed to answer the following gaps: 1) clarification of the relation between aesthetic medicine app celebrities’ physical attractiveness and consumer perceived risk; and 2) clarification of the effect of gender salience on aesthetic medicine consumers who are less sensitive to perceived risk when encountering an attractive app celebrity.

Literature Review and Hypothesis

Internet celebrities (App celebrities) can form a unique social image through their contributions and become famous through the Internet [26]. Internet celebrities (App celebrities) provide consumers with convincing product information to help e-commerce sellers gain the attention and trust of consumers. Increasingly, app celebrities act as endorsers bridging marketers and consumers by generating informative and persuasive content on social media or other online communities to actively engage consumers [2].

At present, many aesthetic doctors are packaged as app celebrities to gain direct trust from consumers and provide more direct and diversified services [4].

Aesthetic medicine is practiced in clinical departments relating to beauty care and place emphasis on convenience, safety, and affordable prices [11]. Aesthetic medicine is used to resolve skin problems or diseases. Due to negative thoughts, feelings or experiences and aesthetic medicine, consumers are motivated to change their appearance.

Physical Attractiveness can help them improve their relationships and change how they are socially perceived [27]. People believe that they can feel better about themselves, and become more confident after aesthetic treatments [28].

Physical attractiveness refers to the degree to which a person is viewed as aesthetically pleasing by others [10]. Most people pay more attention to the appearance of others in interpersonal relationships, and such perceptions influence whether individuals have positive feelings toward others [29]. Both static and dynamic attraction [30] elicits a positive emotional response from others, induce positive reinforcement, and trigger behaviors that promote closeness [31]. Physical attractiveness is related to the ideal human form and thus evokes pleasure [32].

For consumers, the perceived and tolerable degree of risk is the determinant of purchasing strategy, intention [33], and behavior [34]. Perceived risk is the uncertainty of making a purchase, as a consumer may not necessarily achieve the desired results from a particular purchase [35-37]. Studies on service products have found that perceived risk is influenced by the situation and personal characteristics, thereby affecting purchases and even the selection of which store to shop at. Perceived risk is influenced by studying and comparing the offerings of various brands [38,39].

Associative learning theory is a useful framework to understand the effects of match-up. Associative learning links relationships between established concepts [40,41]. Belongingness, relatedness, fit and similarity determine the associative links between concepts. The more similar two concepts are more likely to be integrated into an associative network [42,43]. This theoretical view is consistent with the assumption of other researchers interested in match-up effects, who have proposed the importance of fittingness [44], congruence [45], appropriateness [46], and consistency [47].

When the service provided is associated with attractiveness, if the physical attractiveness of the service staff is high physical attractive, the consumers are often more willing to pay for the service [9]. Aesthetic medicine is a service industry related to attractiveness; service personnel with highly physically attractive can promote professional services image, and promote consumer perceived trust and recognition [48]. Consumers are more interested in the information and leads provided by highly professional sales staff and tend to give positive comments on the expertise of such service providers [49]. Therefore, when consumers can recognize that service staff have a high degree of professional expertise, the inconsistent interference effect caused by the risk of purchase decision behavior [50] is reduced [51]. On this basis, we put forward the following hypothesis:

H1: When aesthetic medicine app celebrity personnel are highly physically attractive, aesthetic medicine consumers’ perceived risk is low.

Social Comparative Orientation (SCO) represents the personality tendency of individuals with strong social comparative inclinations. They are particularly interested in their status relative to others, and interested in information about other people's thoughts and behaviors in similar situations. People with high SCO seek more comparisons, spend more time making comparisons, respond more to their own comparisons with others, and evaluate their own situation based on comparisons with others [24]. A study found that women with higher SCO tend to pay attention to the similarities between themselves and attractive same-sex models, and show more positive emotions and self-evaluation after contact with models [52].

The aesthetic medicine industry is involved with beauty. When purchasing products or receiving services, the most important clue is the service personnel appearance [53]. Attractive appearance can elicit positive emotional reactions, produce positive enhancement effects, and trigger similar behaviors by others [31].

The halo effect of “what is beautiful is good” often affected people and the people always assume that attractive people have more other good traits [54].

For this study, we assumed that women with high SCO will automatically participate in a process of connecting themselves to their targets, so they will show a more positive attitude towards the product after exposure to it. An increase in the service personnel’s physical attractiveness improves the positive impression of the image and service among women consumers; this creates a halo effect, which lessens the perceived risk [34]. Therefore, this study proposed the following hypothesis:

H2: The negative association between the physical attractiveness of aesthetic medicine app celebrity personnel and perceived risk is stronger for women than for men.

Methodology

Settings and samples

This study used the quota-sampling method. Samples were constituted from the consumers of 3 shopping malls in Taiwan. All 900 participants were given an assurance of confidentiality and were told that there were no rights or wrong answers to the questionnaire items after they saw the celebrity of so young aesthetic medicine app advertisement. The questionnaires were self-administered by the respondents. At the cut-off date for data collection, 360 questionnaires were valid, and indicated the 40.0% response rate. The questionnaire was originally written in English and then translated into Chinese through back translation method [55]. The instrument is shaped based on feedback from a pilot sample of 30 consumers. Pilot participants have no difficulty in understanding the items in the survey tool; therefore, there is no compelling reason to make any amendments to the questionnaire.

In designing the questionnaire used three approaches to minimize the common method variance effect (CMV). First, this study interspersed open-ended questions throughout the questionnaire to prevent respondents from falling into patterns related to Likert or the semantic differential scales. Second, the anchor of the scale is different for different structures. Finally, some reverse coding items were in the questionnaire. After collecting the data, CMV was tested by Harman’s one-factor test. If CMV was a serious problem in this study, we would expect to merge a single factor from factor analysis or account one general factor for most of the covariance in the criterion variables [56]. This study performed factor analysis on all items and extracted two factors with eigenvalues greater than one. In addition, there is no general factor in the unrotated factor structure, with Factor 1 accounting for less than 20% of the variance. Thus, the questionnaire design and the post hoc test found that CMV was not a problem.

Measures

This study measured an independent variable (physical attractiveness) and dependent variable (risk).

Physical attractiveness

The scale used to measure physical attractiveness referred to and was amended from five items of Ohanian et al. [57]. The scoring uses a Likert 5-point scale, and the answers range from strongly disagree (1) to strongly agree (5). A higher score indicated a higher degree of agreement with the statement. One sample item was the following: “I think app celebrity personnel should be attractive in appearance” (α= 0.928).

Risk

The scale used to measure risk referred to and was amended from 10 items [58]. A 5-point Likert scale was used and the answers ranging from strongly disagree (1) to strongly agree (5). Sample items include the following: “The aesthetic service I received can be purchased at lower prices”; “the aesthetic service I received was not as good as the service personnel claimed”; “the aesthetic service I received may have caused damage to my body”; “The aesthetic service I received is not in line with my personal style”; and “I am afraid that my family and friends will not be pleased with the style of the aesthetic service I received” (α= 0.786). For analyzing gender in the model, men received a score of 1, and women received a score of 2.

Analysis

Using AMOS 7.0 performs confirmatory factor analysis (CFA) and structural equation modeling (SEM) on the scale to evaluate dimensionality and convergence and discriminant validity [59]. These measures also used SPSS 17.0 to perform alpha and Pearson product-moment correlation analysis to evaluate internal consistency and discriminant validity.

Results

Table 1 presents the characteristics of the respondents, of whom 69.0% were women, 50.3% were between the ages of 41 and 60, 54.4% had a university degree, and 41.6% reported incomes of US$16,667–33,334.

Table 1: Characteristics of the respondents (n=360).

These measures are influenced by a series of CFAs to assess dimensionality and convergence and discriminant validity. According to the results of the CFA, several items were deleted due to low standardized loadings (<0.50) or insignificant t values.

Deleting items are widely used in the scale purification process, and the other empirical studies could observe the similar patterns [60]. Table 2 indicates that the magnitude of the standardized loadings (ranging from 0.717 to 0.890) and all t values (ranging from 2.183 to 4.586) were significant (CFI=0.896, RMR=0.041). All 15 items had standardized loadings greater than 0.70. The magnitudes of the loadings, along with their significant t values, provided support for convergent validity [59].

Table 2: Scale items, reliabilities, and confirmatory factor analysis results.

A series of paired CFAs are used to solve the problem of discriminative validity. We fit a two-dimensional model for each pair of the study constructs at first, and forced the items representing each factor into a single factor solution. The results strongly indicate that each group of items represents a potential construct, providing evidence of discriminative validity [59]. The internal consistency analysis is performed by calculating the alpha of each construct. Table 2 shows that almost all alphas are greater than the benchmark recommended by Nunnally of 0.70 [61].

The results of the analysis of variance show that the perceived risk of aesthetic medicine consumers differed significantly between genders (p = 0.045, p<0.05). The perceived risk of aesthetic medicine for men was higher than for women (mean value of 31.63 vs. 29.65, respectively). There was no significant difference in the perceived risk of aesthetic medicine consumers when assessed according to age, education, or monthly salary.

The composite score of each construct is calculated by averaging the scores of the items representing the construct. Table 3 shows that the correlations between the study constructs ranged from 0.048 (age and education) to 0.569 (age and salary). None of the correlation coefficients are equal to or higher than 0.90 [62], which provide further evidence for the discriminant validity. Table 3 shows the means and standard deviations of the composite scores.

Table 3: Correlation of all variables (N=366).

Table 3 also shows that salary correlated significantly with risk (r= 0.146, p<0.05). This positive correlation indicated that aesthetic medicine consumers with higher education had higher risk perception. Table 3 also shows that gender and physical attractiveness correlated negatively with perceived risk. These results showed that men had a higher risk perception (r= −0.120, p<0.05) and physical attractiveness correlated negatively with risk (r= −0.235, p<0.05).

MHMR was used to determine whether the relationship between physical attractiveness and risk was moderated by gender. In Step 1, after standardization and calculation of the relevant variables, the risk measure was regressed on the measures of age, education, and salary. As shown in Table 4, there was a significant increase in R² (ΔR² = 0.051, p<0.05), suggesting that physical attractiveness significantly negatively affected risk (β=−0.244, p<0.05) and thereby supporting H1. In Step 2, risk was regressed on the two-way interaction terms of physical attractiveness × gender. The entry of the main effects and the two-way interaction terms into the model resulted in a significant increase in R² (ΔR² = 0.093, p<0.05). Thus, gender plays a moderating role between physical attractiveness and perceived risk.

Table 4: Moderated hierarchical multiple regression for predicting risk.

Finally, we divided the sample into two groups based on gender (men and women). As evident in the results presented in Table 5, we determined that the significant negative effect of physical attractiveness on perceived risk among men was much higher than that among women (β = −0.262 >−0.109, p<0.05). Thus, H2 was not supported.

Table 5: Moderated hierarchical multiple regression for predicting risk (by gender).

Discussion

Our findings supported H1 in that physical attractiveness negatively affects risk (H1), but did not support H2 in that the physical attractiveness of the provider of aesthetic services has a stronger negative effect on perceived risk for women than for men.

Aesthetic medicine is a service industry related to beauty, and consumers expect to become more beautiful. Despite the associated risks (financial, performance-related, physical, psychological, and social) of cosmetic procedures, the higher the personnel’s physical attractiveness is, the higher the evaluation of the professionalism of the aesthetic service by the consumer will be this fosters consumer trust [63].

Consumers will be more interested in professional information and clues if they already trust the professional knowledge and professionalism of the staff and believe that their services are safe and reliable [49]. The perceived risk of aesthetic medicine is thus reduced. This viewpoint conforms to the argument [49] that service personnel with high professionalism and expertise can show a positive image, consumers will trust the information and clues they provide.

Moreover, we found that there is a stronger negative correlation between the physical attractiveness of app celebrities and the perceived risk for men compared with women. This finding was different from the findings of Buunk et al. [24] and Bosch et al. [52] but was consistent with the findings of Agocha et al. [2] and Townsend et al. [64]. They found that, compared with women, men are more willing to exchange personal information with individuals with high physical attractiveness than with those with low physical attractiveness. Moreover, they tend to express lower risk perception and a weak intention to take precautionary action. We suggested that, as consumers of aesthetic medicine, men are likely more confident in collecting information and exercising correct judgment. Once they have selected a physically attractive app celebrity personnel provider, they tend to be more convinced that their choice is correct.

Managerial Implications and Further Study

During consumption, perceived risk affects consumer intention [33]. If the perceived risk is low, purchasing will be facilitated [65]. This study found that the use of aesthetic medicine app celebrity personnel with a high degree of physical attractiveness could significantly reduce the perceived risk of aesthetic medicine for the consumer. Therefore, this study recommended that appearance and composure should be important factors in selecting service personnel, especially in the aesthetic medicine industry. In terms of personnel training, the improvement of attractiveness should be the main training item, and appearance should be included in the performance appraisal project, so as to enhance the positive impact of service personnel on consumers. In addition, as aesthetic medicine is a highly professional service industry, the operator should encourage proactively personnel to acquire higher education and more experience to ensure that consumers are provided with a highly professional interface.

We further suggested that aesthetic medicine app celebrities should be chosen carefully, especially by men, as the selfconfidence of men can affect their judgment and decisionmaking [66]. This study found that the physical attractiveness of app celebrities has a major influence on the judgment of male consumers. After being successfully persuaded, male consumers will be more willing to share their experience with their friends, and they can thus help promote the business.

Conclusion and Limitations

This study had two methodological limitations. First, our findings were limited by the cross-sectional design. Second, there were introduced biases in the self-report scale that measures physical attractiveness and risk. This study found the moderating effect of gender on the relation between physical attractiveness and risk. Other demographic variables (age, education, and salary) also seemed to have a moderating effect. Future studies on these moderators are warranted.

Acknowledgment

This manuscript was edited by Wallace Academic Editing. Conflicts of Interest: The author declares no conflict of interest.

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