The Influence of Social Media on the Decision of Rhinoplasty Among Adults in the Western and Southern Regions of Saudi Arabia: A Comparative Cross-Sectional Study

Introduction Rhinoplasty, a cosmetic surgical procedure aimed at altering the appearance of the nose, has gained immense popularity worldwide. Patients undergo this procedure for various reasons, ranging from aesthetic concerns to functional impairments. Social media, being a ubiquitous platform for sharing and consuming visual content, has emerged as a potential influencer for individuals contemplating rhinoplasty. This study aims to investigate the impact of social media on the prevalence of rhinoplasty among individuals residing in the southern and western regions of Saudi Arabia. Methods A cross-sectional study was conducted through an online self-administered questionnaire, targeting male and female adults aged 18 years or older, residing in the western and southern regions of Saudi Arabia. The questionnaire comprised 17 questions, categorized into two sections. The first section sought demographic information, including age, gender, education, and other relevant characteristics. The second section focused on the influence of social media on the decision-making process related to rhinoplasty. Results A total of 1645 participants responded to the survey, with 96.80% being Saudi citizens. The majority of respondents were females (69.11%); 58.52% of the respondents were from the western region of Saudi Arabia, while 41.48% lived in the southern region. Most participants (64.27%) were aged between 18 and 30 years. The study revealed that Snapchat (Snap Inc., Santa Monica, California, United States) was the most influential social media platform, with 43.41% of respondents reporting it as the key influencer for their decision to undergo rhinoplasty. Twitter (Twitter, Inc., San Francisco, California, United States) and Instagram (Meta Platforms, Inc., Menlo Park, California, United States) followed at 22.97% and 12.09%, respectively. Interestingly, 28.42% of respondents acknowledged that social media played a significant role in their decision to undergo rhinoplasty, particularly when promoted by celebrities or trusted figures. Comparing responses from the western and southern regions, the study showed that individuals from the southern region were relatively more influenced by social media, with 27.8% and 29.3% of respondents reporting the influence from the two regions, respectively. Out of the total respondents, only 38.75% reported dissatisfaction with their nose's appearance and condition, while 23.60% expressed a tendency towards undergoing rhinoplasty. Conclusion The study's findings underscore the critical role of social media in influencing patients' decisions to undergo rhinoplasty, particularly in the southern region of Saudi Arabia. Snapchat emerged as the most influential social media platform, with celebrities' pictures before and after the procedure being the leading factor in motivating patients to undergo rhinoplasty. The study highlights the need for further research to explore the potential risks and benefits associated with the influence of social media on patients' decision-making regarding rhinoplasty.

Rhinoplasty, a surgical procedure designed not only for cosmetic purposes but also to address nasal obstruction, is a meticulous surgery that demands precision and clinical skills to achieve optimal results [1].The preoperative phase is crucial as it entails defining anatomical goals, exposing the deformity adequately, preserving normal anatomy, and restoring the nasal airway [2].According to statistics, rhinoplasty accounted for the majority of the 2,314,720 cosmetic surgical procedures performed in 2020 with 352,555 procedures (15%) [3].
In Saudi Arabia, rhinoplasty constituted 60% of all plastic surgeries performed in 2019 [4].A study conducted to determine the influence of social media on the eagerness to undergo facial cosmetic surgeries in Saudi Arabia revealed that 60.4% of participants believed that self-advertising surgeons played a critical role in the upsurge of cosmetic surgery trends, particularly among adolescents whose desire for cosmetic surgery, specifically rhinoplasty, is amplified by social media [5,6].Two studies conducted in Riyadh [7] and Abha [8] reported that the use of celebrity pictures post-rhinoplasty on social media was the primary reason for the willingness to undergo the procedure.
Despite the growing popularity of cosmetic procedures and the increasing number of people desiring to undergo rhinoplasty, most studies conducted on the topic have focused primarily on central regions in Saudi Arabia.As such, the current study aims to examine the influence of social media platforms on rhinoplasty decisions in the western and southern regions of Saudi Arabia.

Sampling and data collection
This research utilized a cross-sectional design to investigate the influence of social media platforms on rhinoplasty decisions among adult residents of the western and southern regions of Saudi Arabia and compare the efficacy of the effect on enhancing or motivating the desire to undergo rhinoplastic surgery between the two different regions.The study included all individuals aged 18 years or older, irrespective of gender, who had not undergone rhinoplasty.It was conducted between September 22, 2022, and October 22, 2022.The sampling technique employed cluster sampling, whereby participants were randomly selected from two distinct regions and contacted through a WhatsApp broadcast message (Meta Platforms, Inc., Menlo Park, California, United States) that contained the questionnaire, study rationale, and research objectives.To ensure the survey's comprehensibility, 20 individuals familiar with the study's inclusion criteria, 10 from each region, pretested the questionnaire.The survey, which comprised 17 questions divided into two parts, was adapted from a previous study on social media's impact on rhinoplasty decisions [7].The first part collected demographic data such as age, gender, marital status, education level, occupation, and region of residence from all participants.The second part included inquiries about social media use and its effect on rhinoplasty decisions.Participants gave written consent to participate, and their anonymity and data confidentiality was ensured.

Statistical analysis
In this study, IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States) was employed for data analysis.The results were presented using frequency and percentage figures for categorical data.The chi-square test was utilized to examine the association between demographic variables and selected variables, and a P-value of less than 0.05 was considered statistically significant.Furthermore, a comparative analysis of the results from the distinct regions was performed to identify the most influential factors in each region and evaluate their impact based on frequency and percentage.

Results
In this study, a sample of 1682 participants responded to an online survey; 28 were excluded for being under the age of 18 years and the responses from 1654 were analyzed, predominantly comprising Saudi nationals (96.80%).The majority of respondents were female (69.11%), and their geographical distribution revealed a higher concentration in the western region of Saudi Arabia (58.52%), with the remaining respondents residing in the southern region (41.48%).Furthermore, most respondents were in the age group of 18-30 years (64.27%) and held a bachelor's degree (68.74%).Regarding their marital status, the sample consisted of a greater proportion of single individuals (48.25%) than married individuals (47.58%).Additionally, 48.31% of respondents were employed, while 32.29% were students.A comprehensive summary of the sample characteristics is presented in Table  The results indicate that Snapchat (Snap Inc., Santa Monica, California, United States) was the most frequently used social media platform (43.41%), followed by Twitter (22.97%) (Twitter, Inc., San Francisco, California, United States), while Instagram (Meta Platforms, Inc.) was the least used (12.09%).The analysis of social media use across demographic characteristics revealed that Snapchat use differed significantly across demographic characteristics except for gender (p=0.92945)(Table 2), whereas Instagram use varied significantly across demographic characteristics except for educational level (p=0.05297)(Table 3).Similarly, Twitter use differed significantly across various demographic characteristics except for nationality (p=0.47007)(Table 4), while WhatsApp use differed significantly across different social demographic characteristics except for nationality (p=0.05538) and region (p=0.05924)(Table 5).According to Figure 1, which presents data on the percentage of users who use various apps to find information about rhinoplasty, Snapchat is the most commonly used app with an overall percentage of 64.69%.The findings of this study indicate that almost half of the respondents reported taking one to five selfies per day (46.92%) with a considerable proportion (28.42%) of the participants acknowledging the impact of social media on their decision to undergo rhinoplasty.It is noteworthy that a majority of participants reported rare encounters (35.55%) with news articles regarding rhinoplasty on social media platforms, while a significant proportion reported weekly exposure (33.19%).The results also revealed that Snapchat was the most frequently used platform for accessing articles about rhinoplasty (64.69%).Furthermore, nearly one-third of the respondents (29.9%) expressed belief in the safety of rhinoplasty based on social media advertisements, while a quarter (25.21%) reported being influenced by celebrity images before and after the procedure.Notably, a substantial proportion of participants (30.89%) reported being influenced by advertisements promoting non-surgical cosmetic procedures, followed by those promoting surgical cosmetic procedures (22.97%).In terms of participant satisfaction with the shape of their noses, a majority (61.25%) reported contentment, while a significant proportion (38.75%) expressed dissatisfaction.Among those dissatisfied, a considerable proportion (23.60%) expressed a desire to undergo rhinoplastic surgery.The reasons for considering surgery were primarily for the purpose of enhancing self-confidence (32.48%) or improving appearance (32.48%).On the other hand, the majority (76.36%) of participants reported no intention to undergo rhinoplastic surgery, citing reasons such as self-acceptance and the belief that cosmetic surgeries do not offer any benefits (67.70%).These findings are presented in Table 6.The analysis of the data revealed a statistically significant association between the frequency of taking selfies and the inclination towards rhinoplastic surgery, with a p-value of 0.000.Specifically, the findings indicated that participants who take a higher number of selfies per day were more likely to express a desire for rhinoplastic surgery.Notably, a substantial proportion (66.2%) of participants who reported taking 6-10 selfies per day expressed a desire for rhinoplasty.Further details on this association can be found in Table 7.

Do you want to do a plastic surgery for your nose?
How many times are you taking pictures (selfies) daily?8 displays the results of a study that examined the influence of social media and celebrity photos on individuals' decisions to undergo rhinoplasty, as well as their beliefs and attitudes toward the safety of this procedure.The study found that participants from the southern region were more likely to be influenced by social media, with 29.3% of participants from this region reporting that social media played a role in their decision to undergo rhinoplasty.In contrast, participants from the western region were less likely to be influenced by social media, with only 27.8% of participants reporting such influence.Moreover, when it comes to the impact of celebrity photos, the study revealed that participants from the southern region were more affected, with 27% of them reporting that celebrity photos before and after rhinoplasty influenced their decision, compared to 24% of participants from the western region.The study also found that participants from the southern region were more likely to believe that rhinoplasty is a safe procedure, with 32.4% of them holding this belief, while only 23% of participants from the western region believed so.

Southern region (
Tables 8-9 present additional findings that indicate differences between the southern and western regions in terms of the availability of information about rhinoplasty and individuals' desire to undergo this procedure.According to Table 9, a higher percentage of participants from the southern region reported finding articles about rhinoplasty weekly (33.5%) and monthly (21.9%), while a higher percentage of participants (37.2%) from the western region reported rarely finding new articles about rhinoplasty.Additionally, the desire to undergo rhinoplasty was found to be higher among participants from the southern region (25.1%)compared to those from the western region (22.19%The present study aimed to investigate the relationship between individuals' beliefs about the safety of rhinoplasty and their desire to undergo the procedure.The results of the study revealed a significant relationship between these two variables, with a p-value of 0.000, indicating that those who believed rhinoplasty to be a safe procedure were more likely to express a desire to undergo it.
To further explore regional differences in this relationship, the study examined the relationship between believing rhinoplasty to be safe and the desire to undergo it among participants from the southern and western regions.Table 10 presents the findings of this analysis, indicating that participants from the southern region who believed the procedure to be safe were more willing to undergo it, with 78.5% of them expressing a desire to do so.In contrast, among participants from the western region who believed the procedure to be safe, 64.6% expressed a desire to undergo it.

Discussion
This study was conducted to investigate the effect of social media on individuals from western and southern regions of Saudi Arabia.According to a study conducted to measure the social media effect to induce eagerness to perform facial cosmetic surgeries in Saudi Arabia, 60,4% of the partakers agreed that selfadvertising surgeons played a crucial role in the growth of the cosmetic surgery trend (5).Also, according to a study conducted previously in the central region of Saudi Arabia among patients who underwent rhinoplasty, most of the study sample were influenced by celebrity pictures before and after [7].Hence, this study aimed to examine and highlight the influential role of social media on the proliferation of rhinoplasty procedures in the western and southern regions.
A total of 1654 participants in this study completed the online questionnaire.The main finding is that 28.42% of participants declared that they have been influenced by social media, mainly by pictures of celebrities before and after rhinoplasty; 64.69% reported that they find most of the articles and pictures about rhinoplasty on Snapchat and 46.92% stated that they take around one to five selfies per day.Around 23.6% admitted that they desired to undergo rhinoplasty either to have a better appearance or to become more confident.As the results revealed, the participants from the southern region showed more possibility of being influenced by social media to decide to undergo rhinoplasty than their peers in the western region.
A similar study about social media and its effect on undergoing rhinoplasty was conducted in Riyadh, in which 205 participants who underwent rhinoplasty in the private sector completed an online questionnaire [7].The study stated that 52.7% of respondents were influenced by social media.In the current study, only 28.4% of participants were influenced by social media.The reason behind the difference between the results could be due to different study samples as the current study was among individuals who had not undergone rhinoplasty while Obeid et al.'s study included a population who had already done rhinoplasty. 1.

Most Common Social Media Platforms Used to Receive Information About Rhinoplasty
Other: Google (Google LLC, Mountain View, California, United States), News, None, Reddit (Advance Publications, Inc., Staten Island, New York, United States), TikTok (ByteDance Ltd., Beijing, China), and YouTube (Google LLC) Has social media affected you to undergo nose cosmetics?