ISSN : (Online)
DOI : https://doi.org/10.14377/JAPR.2014.3.30.5
Effects of Cosmetic Surgery Advertising : Advertising Strategies of an Emerging Market in Korea
Cosmetic surgery procedures have exploded globally during the past decade and have become socially acceptable to the general public (Skillman & Chester 2011). There are several reasons for the recent rise in popularity of cosmetic surgery. First, advances in cosmetic surgery medical procedures have resulted in better surgical results with shorter re-covery times, higher safety records, and better consumer satisfaction (Sarwer, Magee & Crerand 2004; Swami et al. 2008). In addition, in-dividuals’ higher incomes and price competition among cosmetic surgery clinics have enabled more people to afford surgery (Edmonds 2007). Moreover, the increasing portrayal of cosmetic surgery by the media in-creases the influence of vicarious experiences, leading to an increase in cosmetic surgery (Lee, Lim & Chang 2006) by lowering anxiety levels and heightening people’s willingness to undergo procedures (Swami et al. 2008). Personal issues, such as low self-esteem and familial pressures, have also driven many to seek surgery (Latteier 1998).
Most researchers believe that the influence of the mass media is the most important factor driving growth in the cosmetic surgery industry (Sarwer, Magee & Crerand 2004; Swami et al. 2008). For instance, Delinsky (2005) found that exposure to media messages significantly in-fluences individuals’ knowledge of and likelihood of having cosmetic surgery. Therefore, individuals’ attitudes toward cosmetic surgery become more positive as they learn more about cosmetic surgery through media exposure. As with vicarious and personal experiences, exposure to media messages may increase perceived familiarity with and knowledge of both cosmetic surgery procedures and people who have undergone or will un-dergo cosmetic surgery. Hence, cosmetic surgery is perceived as an ap-propriate personal response to body dissatisfaction.
As cosmetic surgery demands have increased due to the aforementioned reasons, marketing promotions such as advertisements started appearing in major media (e.g., magazines), portraying cosmetic surgery as a “beauty- related product.” Yet, not too long ago, there was a dearth of cosmetic surgery advertising from the 1970s through the mid-1990s (Lee, Lim & Chang 2006), mainly because the rate of cosmetic surgery procedures were not in vogue. However, since the late 1990s, cosmetic surgery advertising has significantly increased along with increases in the procedure rate.
The history of cosmetic surgery promotional tools is quite short in many countries due to its distinct product nature. Consequently, marketers do not always have clear ideas on how to effectively approach customers. The strategies used to promote cosmetic surgery differ from those used for regular product lines because, compared with other surgeries and products, reasons for having cosmetic surgery stem from different motiva-tions and different decision-making processes (Pruzinsky & Edgerton 1990). As opposed to diet or makeup, which have been the subjects of most empirical studies relating to “beauty,” cosmetic surgery carries more weight in terms of decision-making because it permanently transforms one’s body. Therefore, people have a strong desire to obtain more accu-rate information about cosmetic surgery rather than simply word-of-mouth information, which has traditionally served as the most powerful promotional tool to spread information on cosmetic surgery.
This study, therefore, focuses on how to create effective promotional messages for cosmetic surgery procedures in order to improve the “brand image” of cosmetic surgery and increase customers’ “purchasing in-tention,” which in this study is represented by intention to get a consultation. To this end, an experiment was conducted in Seoul, Korea, a country that exports the cosmetic surgery medical practice to neighbor-ing countries, has the most cosmetic surgeons as a percentage of its pop-ulation, and is the nation with the highest cosmetic surgery procedure rate in Asia (Choi 2005; International Society of Aesthetic Plastic Surgery 2009; Shin 2011). The remainder of this article begins by providing a general background on the current Korean cosmetic surgery industry as an emerging cosmetic surgery market. This discussion is followed by a de-scription of the theoretical framework used to generate the hypotheses for this study.
The Republic of Korea as an Emerging Cosmetic Surgery Market
Market reports have shown that during the 1990s, Asians were more likely to undergo cosmetic surgery procedures than any other ethnic group (Lee & Rudd 1999). Especially in Korea, one out of four adults has un-dergone either surgical or non-surgical cosmetic surgery (Jeon 2011), and more than 63% of female high school students expressed desire to get some type of cosmetic surgery (Han 2011). Moreover, a new concept of cosmetic surgery has emerged – the so-called ‘filial cosmetic surgery’ (Baek 2006; Kim 2002), which children or grandchildren give to their pa-rents or grandparents to help them look younger (Baek 2006; Woo 2006). This type of surgery usually treats aging problems by using Botox or la-ser peeling (Baek 2006; Son 2007). Reports show that the cosmetic sur-gery market is no longer dominated by certain age groups; rather, it is popular among all generations in Korea (Lee, Lim & Chang 2006).
Both industrial reports and academic reports recognize Korea as an emerging cosmetic surgery market. Over a period of ten years (2001-2010), Korean plastic surgeons contributed 607 papers to SCI and SCI(E) jour-nals, which amount to about 22% of all published cosmetic surgical papers. In addition, the International Society of Aesthetic Plastic Surgery (2009) revealed that the ratio of plastic surgeons and cosmetic surgery procedures in Korea to the general population is the highest in the world. The dynamic development of Korean cosmetic surgery advocates the cos-metic surgery medical tourism among nearby Asian countries such as China and Japan (Shin 2011).
Reasons for pursuing cosmetic surgery often relate to body dissat-isfaction and low self-esteem (Lee, Lim & Chang 2006). Korean women have the highest level of self-dissatisfaction of their physical appearance among Asian women, and those women prefer to “transform” their ap-pearances via cosmetic surgery rather than to “improve” themselves by dieting or applying makeup (Marie France Bodyline 2004). According to a study by Lee, Lim, and Chang (2006), people who have had or would like to have cosmetic surgery showed more interest in physical attractive-ness than those who were not interested in getting cosmetic surgery. The former were also not satisfied with their current appearance and thought that they had experienced discrimination due to their appearance. Moreover, those who felt dissatisfaction with their appearance had more favorable attitudes toward having cosmetic surgery.
Interestingly, undergoing cosmetic surgery is not considered to be a confidential or private issue in the Korean society, but rather an act of self-maintenance for improving body satisfaction (Choi 2005). Celebrities who have undergone cosmetic surgery and revealed it are considered to be honest people and receive positive attention from the public (Kim 2012). Koreans believe that criticizing cosmetic surgery is trite and that encouraging these procedures to improve body satisfaction is an enlight-ened opinion (Kim 2012).
Due to its rapid growth and strong focus on physical beauty as com-pared to other countries, Korea is considered to be a globally emerging cosmetic surgery market. With careful execution, the findings of this study are expected to expand its implementations and advertising strat-egies to other countries.
The Positive Effects of Celebrity Endorsement in Advertising Messages
Celebrity endorsement is one of the most popular advertising strategies (Agrawal & Kamakura 1995) because advertisers believe that messages conveyed by a well-known spokesperson increase advertising recall and attention for some consumers (Ohanian 1991). Most research related to celebrity endorsement has focused on source credibility and the attractive-ness of models, which suggests that celebrities influence consumers through attributes such as trustworthiness, attractiveness, likeability, famil-iarity, and expertise (Ohanian 1990, 1991). Ohanian’s research (1990) has further reproduced three dimensions of celebrity endorser credibility: expertise, trustworthiness, and attractiveness. That is, celebrity endorsers are considered credible when they are perceived to be conversant, truth-ful, and physically attractive.
Yet consumers do not see all celebrities as equally credible. Research has found that consumers determine the credibility of an endorser through their own subjective judgments (La Ferle & Choi 2005). Therefore, en-dorsers perceived as credible – regardless of their actual credibility – are expected to show more positive effects on a consumer’s attitude toward advertising (La Ferle & Choi 2005).
Although numerous studies have examined the effectiveness of celeb-rity endorsement in American advertising, relatively little is known about the topic in international advertising contexts (Baek 2005). According to several studies, Korean advertisements also depend greatly on celebrity endorsements, with even heavier usage of celebrities than in the United States (Baek 2005; Cutler, Javalgi & Lee 1995). Like American adver-tisers, Korean advertisers believe that using celebrity endorsements in ad-vertising is the most effective strategy for distinguishing their products from their competitors’ products; as a result, the use of celebrity endorse-ments in advertising is thriving (Lee, Paek & Kim 2004).
An empirical study demonstrated that Koreans show more favorable at-titudes toward ads with celebrity endorsements regardless of the type of product (Yoon & Chae 2004). This phenomenon can be explained by the results of La Ferle and Choi’s (2005) study, which found that in Korea, celebrities are perceived as more credible than non-celebrities because of their broad recognition and popularity in society. Moreover, they have a high profile and status in society, as well as the extra power given to them via repeated media exposure (La Ferle & Choi 2005). With its basis in Confucianism, the Korean society has emphasized the values of respect and social class (Chang 1979); this longing to increase one’s status and respect explains the strong dependence on celebrity endorsements and sta-tus appeals in Korean advertising (Cutler, Javalgi & Lee 1995). For that reason, celebrities are expected to show a socially desirable and credible image to consumers, and thus, Koreans are more likely to be positively influenced by advertising with celebrity endorsements than by advertising with non-celebrity endorsements (La Ferle & Choi 2005).
H1a: Those who are exposed to cosmetic surgery advertising with a ce-lebrity will have a more favorable attitude toward the ad than will those who are exposed to cosmetic surgery advertising with a non-celebrity.
The Dual Mediation Hypothesis (hereafter DMH) explains the relation-ship between a consumer’s attitude toward an ad and his or her attitude toward the brand and purchase intention (MacKenzie, Lutz & Belch 1986). According to several researchers, positive attitude toward a brand leads to a significant intention to buy that brand, thus indicating a pos-itive relationship between attitude toward the brand and purchase intention. As attitude toward the brand is influenced by attitude toward the advertising, and purchase intention is influenced by attitude toward the brand, the dual mediation hypothesis indicates strong linear relation-ships between attitude toward the advertising and attitude toward the brand and between attitude toward the brand and purchase intention (Brown & Stayman 1992; MacKenzie et al. 1986). Based on DMH, if a stimulus advertisement (cosmetic surgery advertisement) affects consum-ers’ attitudes toward the advertisement, it can be expected that these atti-tudes affect the consumers’ attitudes toward the brand, which in turn af-fects purchase intention (i.e., intent to visit for a consultation).
H1b,c: Those who are exposed to cosmetic surgery advertising with a celebrity will have a more favorable attitude toward the advertised clinic (H1b) and intent to visit the advertised clinic for a consultation (H1c) than will those who are exposed to cosmetic surgery advertising with a non-celebrity.
Responses on Ad Acceptance via Message Appeals
Studies on the type and impact of message appeals have a long history (LaTour & Henthorne 1994; Pelsmacker, Geuens & Anckaer 2002; Scott & Stout 1987). Early studies dealt primarily with message appeals (emotional vs. rational), and studies evaluating these appeals in terms of effectiveness of communication found either that there is no difference between those two appeals or that emotional appeals are more effective (McGuire 1969).
As emotional and rational appeals have been the foundation of various studies, they can also be investigated in order to classify advertising aimed at persuading either consumers’ affective or cognitive behaviors. According to Acker and Stayman (1992), an emotional message can be classified as an advertising message that brings about affective responses in consumers, while a rational message evokes cognitive responses (Puto & Wells 1984). Affective responses typically occur quickly upon ex-posure to stimulus objects, and are emotional, attract attention, and tend to be lower-order processes (Zajonc 1980). Compared with affective re-sponses, cognitive responses are generally rational, conscious, and ana-lytical and are believed to pass through higher-order processing (Hoch & Loewenstein 1991).
In looking at cognition and affect, researchers have found that when exposed to an ad with an informational/rational message, individuals in high need for cognition are more attracted to the ad than those in low need for cognition (Ruiz & Sicilia 2004). These individuals respond more favorably in terms of attitude toward the ad, attitude toward the brand, and purchase intention when they are in the thinking process (Hoyer & Maclnnis 2007). In contrast, when the ad presents an emotional message, individuals with high preference for affect show favorable attitudes to-ward the ad (Sojka & Giese 1997). Thus, these individuals tend to have more positive attitude toward ad, attitude toward brand, and higher pur-chase intention (Hoyer & Maclnnis 2007).
As seen in prior research on message appeals and their effectiveness, there are still many contradictory studies on which message type – emo-tional or rational – is more effective in advertising. It is an ongoing and, at this point, a difficult-to-predict research topic. Cosmetic surgery is clas-sified in this study as a ‘beauty-related product,’ and researchers point out that beauty-related products fit better with an emotional message (Holbrook 1978). Consequently, the emotional message can be expected to elicit more positive attitudes toward the ad. In addition, based on the DMH, the following hypotheses can be projected:
H2: Those who are exposed to cosmetic surgery advertising with an emotional message will have a more favorable attitude toward the ad (H2a), attitude toward the advertised clinic (H2b), and intent to visit the advertised clinic for a consultation (H2c) than will those who are ex-posed to cosmetic surgery advertising with a rational message.
Elaboration Likelihood Model Analysis of Source Factor
According to Petty and Cacioppo (1986), the Elaboration Likelihood Model (hereafter ELM) distinguishes two different routes to evaluate in-formation based on an individual’s motivation and ability to process in-formation: a central route and a peripheral route. To determine the route taken, the first deliberation is whether the individual is motivated to eval-uate the presented information based on his or her personal relevance, re-sponsibility, or need for cognition. If the individual is motivated to proc-ess information, the central route is followed. If the individual is not mo-tivated to process information, the peripheral route is employed. If periph-eral cues such as attractive sources or positive/negative affect are pre-sented, relatively temporary attitudes may be changed. If neither central nor peripheral information was available at this consideration, the prelimi-nary attitudes would stay.
Individuals who are highly motivated to process information but do not have the ability to process it will follow the peripheral route as long as peripheral cues are present. However, individuals with both the motivation and the ability to process information will follow the central route for cognitive processing, which determines initial attitudes such as negative/positive/neutral. When individuals are not motivated or do not have the ability to process information fully, the peripheral route is used, which means that attitudes are formed or changed by characteristics not directly related to the processed information.
More to the point, many variables can affect the elaboration likelihood model (Petty et al. 1987). One of them, source attractiveness – how at-tractive an endorser is, based on physical beauty in advertising – was studied by Petty and Cacioppo (1986). They found that source attractive-ness can play three different roles according to the ELM: serving as pe-ripheral cues, playing as persuasive arguments, and affecting the level of argument elaboration.
Under conditions of relatively low elaboration likelihood – which means subjects were in low need for cognition – source attractiveness acted as a peripheral cue, improving attitudes depending on whether a message included strong or weak arguments. Under conditions of rela-tively high elaboration likelihood – which means subjects were in high need for cognition – increased source attractiveness was more important as a central cue and was served up as a persuasive argument. Lastly, un-der the conditions of relatively moderate elaboration likelihood, source at-tractiveness influenced the argument elaboration, which increased persua-sion if the argument was strong, but decreased persuasion if it was weak.
Beauty-related products are promoted better with emotional messages (Holbrook 1978) and attractive endorsers (Petty et al. 1987). As a result, the celebrity/emotional message combination is expected to attract more customers for cosmetic surgery – a beauty-related product. In addition, Korea is categorized as a collectivistic country with a high-context com-munication style that depends on symbols and implicit expression rather than explicit words (Hall 1976). It is also categorized as a country with high uncertainty avoidance, which refers to having a preference for a well-known source rather than an unknown source (Hofstede 1984). Based on these two cultural dimensions, the celebrity/emotional message combi-nation is expected to be more effective than the non-celebrity/rational mes-sage combination in measuring advertising effectiveness among Koreans.
H3a: There will be an interaction effect between spokesperson and message type in cosmetic surgery advertisements.
H3b,c,d: For cosmetic surgery advertisements, the celebrity/emotional message combination will yield more favorable attitudes toward the ad (H3b), more favorable attitudes toward the advertised clinic (H3c), and higher intent to visit the advertised clinic for a consultation (H3d) than will the non-celebrity/rational message combination.
A 2 x 2, between-group, posttest-only experiment examining consum-ers’ responses toward the advertisement, the advertised clinic, and visiting intent to the clinic was undertaken. This study specifically looked at how spokesperson type (celebrity vs. non-celebrity), message type (emotional vs. rational), and the interaction effects between these two elements affect consumer responses to advertising because these characteristics determine both the attributes and the effectiveness of the advertisement. Moreover, since women tend to evaluate their physical attractiveness more negatively than men evaluate theirs, women have reported a greater likelihood of getting cosmetic surgery than men have (Brown et al. 2007; Lee & Rudd 1999). Based on this phenomenon, this study examined women only. In addition, given that the study examined participant measures of advertis-ing effectiveness, other variables that could influence the results of the study needed to be controlled as covariates. Four covariates were con-trolled for this study.
Prior to the experiment, several pretests were conducted to select ap-propriate spokespersons and messages. Twenty-two female Koreans, sim-ilar in demographics to those from the planned main experiment sample, participated in pretest one, which gave them five minutes to list the names of five female Korean celebrities they considered to be beautiful and credible. The celebrity names were then ranked based on the fre-quency of mention, and the most frequently mentioned celebrity, Taehee Kim, was used in the stimulus advertisement.
For the non-celebrity endorsed ad, the researcher chose five photographs of females from Cyworld.com, an online social networking site in Korea that is similar to MySpace in the United States. These five photo-graphs were chosen so that the women’s ages, hairstyles, makeup, poses, and other characteristics were comparable to the celebrity selected in the earlier stage. Using an approach similar to the one outlined above, a pan-el of 23 female Koreans were asked to indicate the most attractive wom-an from the five non-celebrity photos.
For the two message types – emotional and rational – the researcher selected messages from real cosmetic surgery advertisements in Korea. The messages were slightly modified by combining several advertisements from the Web. Both types of messages were about eyelid surgery, since it is the most common type of cosmetic surgery among Korean women (Lee, Lim & Chang 2006; Shin 2011).
Using these spokespersons and messages, four stimulus advertisements were created. A fake clinic appeared as the advertised brand to avoid any possible familiarity effects generated from ‘brand awareness.’
A panel of 151 female Koreans, living in Seoul, Korea, participated in this study. Inappropriate answers for the manipulation conditions and missing answers were eliminated, resulting in a final sample size of 143. The participants included 79% undergraduate students (N = 113), 17.5% graduate students (N = 25), and 3.5% (N = 5) who indicated that they were career women. All participants were 20- to 35-year-old women.
The experiment was administered online. When logging onto the study site, participants were given study information and instructions. Once they agreed to take part, participants were randomly assigned to one of the four experimental conditions. Each of the participants was led to a stim-ulus advertisement, then they were asked to fill out the questionnaire con-taining dependent measures, manipulation checks, covariates, and demo-graphic questions. Upon completing the study, they were debriefed by a summary statement and dismissed.
Dependent Measures. Participants were asked to indicate their attitude toward advertising using a seven-point, semantic differential scale that asked them how they felt about the stimulus advertisement; the scale in-cluded four items anchored by “unlikable/likeable,” “bad/good,” “negative/ positive,” and “unfavorable/favorable” (α = .96). Attitude toward the ad-vertised clinic was measured by another seven-point, semantic differential scale including four items anchored by “bad/good,” “dislike quite a lot/like quite a lot,” “unpleasant/pleasant,” and “poor quality/good quality” (α = .96). Intent to visit for a consultation was measured on a seven-point, Likert-type scale (strongly disagree/strongly agree) asking how likely par-ticipants were to consider the advertised clinic the next time they visit a cosmetics surgery clinic. They were also asked to rate their agreement across statements such as “The next time I need cosmetic surgery, I will choose Dr. Beauty,” “If I had needed cosmetic surgery during the past year, I would have selected Dr. Beauty,” and “In the next year, if I need cosmetic surgery, I will select Dr. Beauty” (α = .91).
Covariates. Level of involvement with cosmetic surgery, exposure to positive word of mouth, current appearance satisfaction, and internalized sociocultural attitudes toward physical attractiveness were considered to be covariates in this study.
The first covariate, level of involvement with cosmetic surgery, is de-fined as how important an individual feels cosmetic surgery is to herself. According to a study by Petty et al. (1986), consumers highly involved in certain products are more attracted to advertising that promotes the product than consumers with low involvement. Thus, participants’ level of involve-ment related to cosmetic surgery had to be controlled for. This covariate was measured by a seven-point, semantic differential scale that asked par-ticipants how they describe the importance of cosmetic surgery to them-selves; the scale included three items anchored by “nonessential/essential,” “not beneficial/beneficial,” and “not needed/needed” (α = .89).
The second covariate, exposure to positive word of mouth, is defined as having an experience of hearing good stories about cosmetic surgery from one’s friends, family, relatives, or other individuals. The reason that this was considered a covariate is related to vicarious experience. A study by Delinsky (2005) found that subjects with friends or relatives who received cosmetic surgery showed a greater likelihood of getting cosmetic surgery because of an increase in reliable information from people that they trust; thus, this variable needed to be controlled for. This covariate utilized three Likert-type (strongly disagree/strongly agree) items that asked whether the participants had heard any positive stories about cosmetic surgery from friends, family, or relatives: “I have heard positive things about cosmetic surgery,” “I have close friends or relatives who have undergone cosmetic surgery and are satisfied with its results,” and “I have close friends or rel-atives who recommended cosmetic surgery to me” (α = .82).
Current appearance satisfaction, which is defined as an individual’s lev-el of happiness with her physical attractiveness, was considered the third covariate in this study. Since previous research suggests that lower self-perceived physical attractiveness promoted a higher likelihood of hav-ing cosmetic surgery (Brown et al. 2007), subjects who perceived them-selves as unattractive may be predisposed to having cosmetic surgery. Current appearance satisfaction was gauged on a seven-point, Likert-type scale with 1 being “strongly disagree” and 7 being “strongly agree” (α = .83). The nine items were “In general, I feel anxious, tense, or nervous about my eyes/nose/lips/forehead/neck/chin/cheekbones/cheeks/ears.”
The last covariate in this study was internalized sociocultural attitudes to-ward physical attractiveness, which is defined as societal influences on one’s body image. Several researchers have claimed that the failure to ob-tain societal ideals of physical attractiveness evokes stronger self-body dis-satisfaction and possibly leads people to consider having cosmetic surgery to get a more socially-desired appearance (Brown et al. 2007; Delinsky 2005). For measuring sociocultural attitude toward physical attractiveness, participants were asked to indicate the extent to which they compared themselves to other women based on various social situations using a nine-item, seven-point, Likert-type scale with the endpoints of “strongly dis-agree” and “strongly agree” (α = .84). The statements were “TV shows and movies that show women in good physical appearance make me wish that I were in better physical appearance,” “I do not wish to look like the fe-male models who appear in TV show or movies,” “I tend to compare my face to TV and movie stars,” “Attractiveness is very important if you want to get ahead in our culture,” “It’s important for people to look attractive if they want to succeed in today’s culture,” “In today’s society, it’s not im-portant to always look attractive,” “I often read magazines and compare my appearance to the female models,” “How I look does not affect my mood in social situations,” and “I often compare my appearance to people.”
Manipulation Check Measures. A series of questions asked whether each stimulus advertisement presented a celebrity or non-celebrity spokes-person and an emotional or rational message. The actual questions in-cluded “To me, this advertisement presents an emotional/rational mes-sage” and “The model presented here is a non-celebrity/celebrity.” For each question, seven-point bipolar rating scales were used, ranging from a rational message (1) to an emotional message (7), and from a non-celeb-rity (1) to a celebrity (7).
Additionally, regarding the first (H1a, H1b, H1c) and the third (H3a to H3d) hypotheses, the research checked whether the celebrity was per-ceived as more credible and physically attractive than the non-celebrity. The perceived credibility was tested by a seven-point, Likert-type (strongly disagree/strongly agree) scale. The scale included items relating to the spokesperson’s level of credibility, such as “The model presented here is credible,” “The model presented here is trustworthy,” and “The model presented here is believable” (α = .96).
The physical attractiveness of the spokesperson was also examined us-ing a seven-point, Likert-type (strongly disagree/strongly agree) scale. The scale included items asking about the spokesperson’s level of physical at-tractiveness, such as “The model presented here is attractive,” “In my opinion, the model presented here is good looking,” and “The model pre-sented here is pretty” (α = .96).
The ANOVA for the mean scores of participants’ recognition of spokesperson types showed a significant difference between the two means (Mcelebrity = 6.52 versus Mnon-celebrity = 1.18; F1,141 = 1302.55; p < .01). Likewise, participants’ recognition of message types also showed a statistically significant difference between the two means (Memotional = 5.06 versus Mrational = 2.33; F1,141 = 178.16; p < .01).
The measure of credibility – i.e., which spokesperson (celebrity/non-ce-lebrity) was considered more or less credible – was tested by an in-dependent t-test. The celebrity spokesperson was considered more credible than the non-celebrity (Mcelebrity = 4.66 versus Mnon-celebrity = 2.38; t141 = 9.12; p < .01) based on three combined credibility measuring items. In addition, the physical attractiveness of the spokesperson – i.e, whether a celebrity was perceived as being more attractive than a non-celebrity – was examined. An independent t-test for mean scores of perceived phys-ical attractiveness of spokesperson was significantly different based on three combined physical attractiveness measuring items (Mcelebrity = 5.83 versus Mnon-celebrity = 2.70; t141 = 11.83; p < .01). These results confirmed that the choices of spokesperson and advertisement message were com-parable and helped ensure internal validity.
A multivariate analysis of covariance (MANCOVA) was conducted to test the hypotheses that spokesperson type and message type would affect 1) at-titude toward an advertisement [Aad], 2) attitude toward the advertised clinic [Ab(clinic)], and 3) intent to visit the advertised clinic for a consultation [VI(clinic)]. After controlling for the four covariates, results indicated that the interaction effect between spokesperson and message type on the combined dependent variables was not statistically significant (F3,133 = 1.51, Wilk’s Lambda = .97, p > .05), while the main effects of spokesperson (F3,133 = 21.75, Wilk’s Lambda = .67, p < .05) and message (F3,133 = 18.34, Wilk’s Lambda = .71, p < .05) were statistically significant. This indicates that both spokesperson type and message type affected the three dependent variables. In particular, based on the value of Wilks’ Lambda, the main effect of spokesperson played the most important role in this study.
Univariate analyses of covariance (ANCOVAs) were then performed to assess the effects of spokesperson type and message type on each depend-ent measure. As predicted in H1a, the results indicate the main effect of spokesperson type on attitude toward the ad (F1,135 = 51.64, p < .01), such that participants who viewed the ad with a celebrity showed a more favorable attitude toward the ad than did participants who viewed the ad with a non-celebrity (M = 4.55 versus M = 2.97), supporting H1a. The ad with a celebrity also generated a more favorable attitude toward the ad-vertised clinic than did the cosmetic surgery ad with a non-celebrity (M = 4.48 versus M = 3.03; F1,135 = 50.33, p = .00), thus supporting H1b. Intent to visit for a consultation was significantly higher among partic-ipants who saw cosmetic surgery advertising with a celebrity than among those who viewed the ad with a non-celebrity (M = 3.97 versus M = 2.43; F1,135 = 52.81, p < .01), confirming H1c.
Results testing the next group of hypotheses (H2a,b,c) revealed the ef-fects of message type on all of the dependent measures. Specifically, par-ticipants exposed to the cosmetic surgery ad with an emotional message showed a significantly more favorable attitude toward the ad than did par-ticipants exposed to the ad with a rational message (M = 4.61 versus M = 2.91; F1,135 = 53.68, p < .01), thereby lending support for H2a. Regarding attitude toward the advertised clinic, the results showed that participants who viewed the ad with an emotional message had a more favorable attitude toward the advertised clinic than did participants who viewed the ad with a rational message (M = 4.40 versus M = 3.11; F1,135 = 36.37, p < .01), supporting H2b. The results relating to intent to visit for a consultation were significantly higher among participants who viewed cosmetic surgery advertising with an emotional message than among those who saw the ad with a rational message (M = 3.84 versus M = 2.56; F1,135 = 31.56, p < .01), confirming H2c.
According to the MANCOVA results, although the interaction effect be-tween spokesperson and message type on the combined dependent varia-bles was not statistically significant (F3,133 = 1.51, Wilk’s Lambda = .97, p > .05), the individual ANCOVA results indicated significance on intent to visit for a consultation, and thus the hypothesis was partially supported.
Hypotheses 3a, 3b, 3c, and 3d explored whether there were any inter-action effects between spokesperson type and message type on measures of advertising effectiveness, but only with intent to visit [VI(clinic)] was the interaction effect of model and message type discovered (F1,135 = 3.96, p < .05). The result of the interaction effect can be analyzed more accu-rately with mean differences. Participants who were exposed to the ad with the ‘celebrity spokesperson/emotional message’ combination were more likely to display favorable VI(clinic) compared with people who viewed the ‘non-celebrity/rational message’ combination (M = 4.41 versus M = 1.64). An additional t-test measuring mean differences between these two combinations was conducted, and its result was also statistically sig-nificant (t71 = 10.34, p < .01).
In terms of message type comparison with spokesperson type in the de-tailed results, the mean difference between ads with the ‘celebrity spokes-person/emotional message’ and the ‘celebrity spokesperson/rational message’ (M = 4.41 versus M = 3.52) combinations was smaller than the mean dif-ference between ads with the ‘non-celebrity spokesperson/emotional mes-sage’ and ‘non-celebrity/rational message’ (M = 3.26 versus M = 1.64) combinations. This means that the statistical significance of intent to visit was mainly due to message type differences with non-celebrity spokes-persons rather than differences with celebrity spokespersons, confirming hy-potheses 3a and 3d. In addition, hypotheses 3b and 3c, which proposed that the interaction effects between spokesperson type and message type on Aad (F1,135 = .61, p > .05) and Ab(clinic) (F1,135 = 2.19, p > .05) would exist, were not supported. See Table 1 and Table 2 for statistical test results.
Table 1. Multivariate Test Results
Table 2. Results of Between-Subjects Test
This study contributes to the formerly established body of knowledge on message and endorsement through its focus on cosmetic surgery in or-der to investigate the underlying process of the formation of attitudes toward commercial messages based on spokesperson and message type. While previous research examined celebrity endorser and message effects on the advertising of various products, no study has explored those two elements in a context of cosmetic surgery procedures. In addition, al-though there are some studies exploring celebrity endorsement effective-ness in the Korean market (e.g., Baek 2005; La Ferle & Choi 2005), this is the one of the first studies to explore message effectiveness in Korea. This study will initiate research about how marketers and advertisers me-diate spokesperson and message appropriately to generate effective adver-tising messages regarding cosmetic surgery.
As anticipated, a celebrity spokesperson influenced measures of cos-metic surgery advertising effectiveness more positively than did a non-ce-lebrity spokesperson. In Korean society, celebrities are perceived as being more credible than non-celebrities, most likely due to their broad recog-nition and popularity (La Ferle & Choi 2005). The more credible the source is, the more effective the advertising is in influencing consumers’ attitudes and behavioral intentions (Sternthal, Phillips & Dholakia 1978). Therefore, a celebrity endorser has a stronger impact on the formation of positive attitudes toward advertising, advertised brand, and purchase in-tention (Atkin & Block 1983; Freiden 1984).
Findings from this study also illustrate that an emotional message influ-ences the effectiveness of cosmetic surgery advertising’s effectiveness more positively than does a rational message. Because Korea is catego-rized as a collectivistic country with a high-context communication style, which depends on symbols and implicit expression rather than explicit words (Hall 1976), the results showing that Koreans exposed to an emo-tional cosmetic surgery message had a more favorable attitude toward the ad than did those exposed to a rational cosmetic surgery message were to be expected.
The congruence effect, concerning the relationship between spokes-person types and message types, projected interesting findings. Although the multivariate test result was not significant, individual ANCOVA re-sults indicated that the ‘celebrity spokesperson/emotional message’ combi-nation in cosmetic surgery advertising would produce a more favorable intent to visit for a consultation compared with the ‘non-celebrity/rational message’ combination. According to previous cultural studies, the celeb-rity/emotional message combination attracts more customers for cosmetic surgery because the Korean communication style depends on implied ex-pressions, like those found in an emotional message, rather than on direct words, like those found in a rational message (Hall 1976; Hofstede 1984); moreover, Korea is categorized as a country with high uncertainty avoid-ance, which means that Koreans prefer a well-known source rather than an unknown source (Hofstede 1984). Therefore, the celebrity/emotional message combination for cosmetic surgery advertisements is more effec-tive in measuring advertising effectiveness among Koreans than is the non-celebrity/rational message combination.
Interestingly, the individual ANCOVA results go against the logic of the Dual Mediation Hypothesis (MacKenzie, Luts & Belch 1986), since only one measure of advertising effectiveness – intent to visit for a con-sultation – was significant. However, this can be explained by ‘multiple roles for source attractiveness’ from the ELM (Petty et al. 1987). For some objects, such as aesthetic products, endorser’s attractiveness driven by credibility is an important determinant of likelihood under high involvement. In general, intent to get a consultation after exposure to a cosmetic surgery advertisement requires a high level of involvement com-pared with psychological reactions such as measuring attitudes toward the advertisement or toward the brand. Thus, in this case, source attractive-ness plays a stronger role in measuring intent to visit than in measuring attitude toward an ad and a brand. As a rational support, the first hypoth-eses can be elaborated under the same explanation. Although all three ANCOVA results showed the significance (all p-values were p < .01) of celebrity spokesperson effects on measures of advertising effectiveness, the higher F-value for intent to visit (F = 52.81) showed the stronger im-pact of an attractive celebrity spokesperson compared with the other two measures of advertising effectiveness.
Despite the exponential rise in popularity of cosmetic surgery proce-dures, there has been little growth in cosmetic surgery advertising in the industry; consequently, there has been a paucity of literature regarding the best message strategies for encouraging positive attitude formation and in-tention to get cosmetic surgery. However, based on the experimental results described in this study, advertisers and marketers are better off using celebrity endorsements for cosmetic surgery because celebrities have more credibility than non-celebrities and the credibility of advertising is the main factor in forming a positive attitude. This suggestion is further bol-stered by the fact that regardless of the product category, Koreans show a more favorable attitude toward ads using celebrity endorsement (Yoon & Chae 2004). Moreover, employing an emotional message rather than a rational message for advertising in the Korean cosmetic surgery industry is a strategy that advertisers and marketers should pay attention to be-cause, based on their cultural typologies, Koreans are more attracted to emotional messages than to rational messages. Thus, these two di-mensions – celebrity endorser and emotional message – seem to provide the strongest strategies and results for the cosmetic surgery industry.
In regard to global marketing strategy issues, the results also suggest that for Asian countries that share similar cultural backgrounds with Korea, such as China and Japan, the same message and endorsement strategies can be used to promote cosmetic surgery procedures. Employing a celebrity and an emotional message in a cosmetic surgery promotional message will attract potential and about-to-purchase custom-ers in Asia countries. This is evidenced by the current phenomenon of Chinese and Japanese women pursuing and undergoing cosmetic surgery in Korea. Because they share similar cultural characteristics, such as be-liefs about ideal beauty, it is likely that their attitudes toward cosmetic surgery would be similar; thus, their information processing for cosmetic surgery promotional messages depends on the same components of celeb-rity and emotional message.
However, in the case of low-context communication countries, such as the United States and many European countries, more careful execution of the message strategy is required. Unlike Korea, those countries highly depend on low-context communication styles (Hall 1976), Further re-search should be conducted to explore how individuals from low-context communication countries react to cosmetic surgery promotional messages. Nonetheless, using celebrity endorsers can be thought of as a global strat-egy for promoting cosmetic surgery procedures. Regardless of cultural characteristics (e.g., low-context vs. high-context communication styles or individualistic vs. collectivistic countries), individuals show similar atti-tudes and evaluations toward celebrity endorsements, and this celebrity endorsement rule is applied to almost every product, including cosmetic surgery.
Limitations and Suggestions for Future Research
These contributions notwithstanding, this study has limitations that could be addressed in future research. For more accurate experimental de-sign, one more dimension should be added to manipulation check measures. Based on the celebrity’s credibility measure, this study looked at two dimensions out of the three proposed by Ohanian (1990) – trust-worthiness and attractiveness – because the main celebrity attribute influ-encing consumers was ‘credibility’ transferred from attractiveness or vice versa. Therefore, another dimension – expertise – was left out of the study. However, as expertise is one of the dimensions of celebrity endors-er credibility, it should be included in future study.
Another limitation lies in the generation of the message. Message does not represent only one characteristic. Every message has two character-istics – emotional and rational. Yet studies have not found a clear boun-dary between these two message types. Nevertheless, it is necessary to cre-ate messages that convey the same content using different characteristics.
Future research is needed to investigate this phenomenon in a broader scope. As this study shows, cosmetic surgery has not been studied enough in the advertising industry, especially given the dramatic increases in these surgeries each year. Although this is the one of the first studies to put cosmetic surgery advertising under the academic microscope, it em-ployed only two advertising elements – endorser and message type – that have been widely used in other product categories. There have been stud-ies measuring advertising effectiveness based on many other variables, so adding these variables to the ones used in this study could strengthen the findings related to cosmetic surgery advertising. In addition, replicating this study using males may be interesting since cosmetic surgery proce-dures are also gaining popularity among males. Moreover, this study should also be conducted in other countries and cultures, since social and cultural factors influence perceptions of ideal beauty (Hueston, Dennerstein & Gotts 1985).
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