Social media addiction, self-esteem, body appreciation, and acceptance of cosmetic procedures among adolescents: A serial mediation analysis

Background: Social media use was linked to greater acceptance of cosmetic procedures. However, the mechanisms of this association remain unclear especially in adolescents. This study examined the direct and indirect effects of social media addiction on the acceptance of cosmetic procedures, exploring the mediating roles of self-esteem and body appreciation. Methods: A cross-sectional study was conducted among a sample of randomly selected Egyptian adolescents from seven secondary schools in Minia City between November 2023 and May 2024. Participants completed questionnaires on social media addiction, self-esteem, body appreciation, and acceptance of cosmetic procedures. Data were analyzed using structural equation modeling (SEM). Results: A total of 967 adolescents were included. The average age was 15.75±0.69 and 66.0% were females. Higher social media addiction was directly associated with lower self-esteem (β=−0.223, p<0.001) and greater acceptance of cosmetic procedures (β=0.183, p<0.001). Self-esteem predicted greater body appreciation (β=0.487, p<0.001), which in turn negatively predicted acceptance of cosmetic procedures (β=−0.151, p<0.001). Mediation analyses indicated a significant total indirect effect of social media addiction on acceptance of cosmetic procedures (Effect=0.025, 95% CI: 0.007–0.045). The serial mediation pathway through self-esteem and body appreciation was significant (Effect=0.016, 95% CI: 0.007–0.027), while the independent mediation effects through self-esteem alone or body appreciation were non-significant. Conclusions: This research indicates that the regulated use of social media may protect against the rising concept of acceptance of cosmetic procedures. Self-esteem appears to be a key protective factor, enhancing greater body appreciation and diminishing unnecessary acceptance of cosmetic procedures.