Abstract
Given the wealth of literature on appearance manipulation generally, it is, perhaps, surprising that cosmetic usage receives so little empirical attention, and perhaps reflects a patriarchal approach to “appropriate” research areas. Incorporating a postfeminist approach, the current study aims to address, in part, this lacuna by providing a contemporary synopsis of the various and diverse motivations for cosmetic usage. Online, written responses to a semi-structured questionnaire were collected. In response to six broad questions, for example, “Why do you currently use cosmetics?”, respondents were encouraged to write, in as much detail as they liked, on their motivations for using cosmetics. Thematic analysis, using deductive and inductive approaches, revealed four main themes: “Multiple selves”—Conformity, Impression Management, and Judgment; Enhancement and Confidence; Fun, Creativity and Well-being; and Signification and Identity. Whilst some of these themes had been anticipated and, indeed, sign-posted in prior literature, the weight of interest in particular areas was unexpected (e.g., in terms of Fun, Creativity, and Well-being), whilst other areas did not receive the expected attention (e.g., in mate attraction). Additionally, and worthy of future research, entirely new areas also emerged (e.g., cosmetics for fun and creativity).
The importance of cosmetic usage with regards to appearance manipulation has, until recently, been relatively under researched. This is perhaps surprising given the scientific interest in physical appearance more generally. For example, there is a large body of literature which considers the advantages of being attractive. In occupational psychology we see that more attractive people have distinct social advantages—in the workplace they are more likely to be hired than their less attractive counterparts (Agthe et al., 2010; Dion et al., 1972; Hosoda et al., 2003) and enjoy greater likelihood of promotion (Ling et al., 2019). In politics they are more likely to be elected and to attract media coverage (Tsfati et al., 2010; Waismel-Manor & Tsfati, 2011). In dating and the research conducted in evolutionary psychology, we see that they are more likely to have higher expectations of their partners (Buss & Shackelford, 2008), and (at least for women) are also more likely to satisfy those expectations (Wincenciak et al., 2015). In educational psychology, research shows that being attractive confers an opposite-sex advantage in scholarship applications (Agthe et al., 2010), and that the attractive are less likely to be perceived as guilty of plagiarism in addition to receiving lesser punishment for it (Swami et al., 2017). Even in crime it pays to be beautiful—research in forensic psychology shows that defendants are more likely to be convicted of sexual harassment or lose a case in a small claims court if the plaintiff is attractive (Wuensch & Moore, 2004; Zebrowitz & McDonald, 1991), whereas they are less likely to be convicted of a crime if they themselves are attractive (Castellow et al., 1990). The attractive are also less likely to receive more punitive sentences, whether in simulated or actual trials, than their less attractive counterparts (Mazzella & Feingold, 1994; Stewart, 1980). The concept is well researched across all sub-disciplines of psychology, and it is well understood—in the seminal paper by Dion et al. (1972), the conclusion reached was that “what is beautiful is good” (p. 285).
The motivation to enhance one’s appearance, then, whether at a conscious or sub conscious level, is clear—significant life advantages may be secured by doing so. But what is “beautiful”? Facial preferences for, for example, sexual dimorphism, averageness, symmetry, skin homogeneity, and youth appear to be universal (Cunningham et al., 1995; Langlois et al., 2000), and the likelihood is that such cross-cultural preferences exist as they provide salient information with regard to underlying health and fecundity—factors highly relevant to mate choice (Grammer et al., 2003; Gray & Boothroyd, 2012; Penton-Voak & Perrett, 2000; Rhodes, 2006; Röder et al., 2013; Thornhill & Gangestad, 2008). Cosmetics may therefore be used to enhance attractiveness through an exaggeration of these cues. Indeed, research does show that cosmetics do enhance attractiveness when professionally applied (Etcoff et al., 2011; Mulhern et al., 2003), are digitally manipulated (Mileva et al., 2016) or are self-applied (Workman & Johnson, 1991).
Attractiveness enhancement through cosmetics may be attributable, then, to an exaggeration of, for example, sexual dimorphism in both facial color contrast and facial feature size, in addition to an exaggeration in those contrasts and feature sizes that decline with age (Jones et al., 2015, 2018; Porcheron et al., 2013; Russell, 2003, 2009; Stephen & McKeegan, 2010). There are, however, some caveats when considering the efficacy of cosmetic usage. For example, the use of cosmetics has a differential effect on perceived age, with older women (40s and 50s) looking significantly younger when using cosmetics but younger women (20s) looking significantly older (Russell et al., 2019). Additionally, variance in attractiveness enhancement may be reduced the more attractive the model (Jones & Kramer, 2016; Osborn, 1996) and, perhaps surprisingly, the attractiveness enhancement effect size has been found to be small for self-applied cosmetics (Jones & Kramer, 2015). Additionally, while male college students rated female peers less favorably for attractiveness when cosmetics free, female peers showed no differential opinion (Cash et al., 1989).
Nevertheless, consistent with the research that in the main supports attractiveness enhancement through cosmetics, both lab and field studies, particularly as conducted by evolutionary psychologists, have shown that women may use cosmetics effectively to enhance their attractiveness. This has been evidenced through more proceptive male behavior in a courtship setting (Guéguen, 2008), increased tipping of waitresses with versus without cosmetics (Guéguen & Jacob, 2011; Jacob et al., 2010), tentative support for increased donations through solicitation from passers-by (Batres et al., 2019), and increased focus on cosmetic use, through time spent and quantity used, when near ovulation (Guéguen, 2012). However, though restricted research suggests otherwise (Batres et al., 2018), it is also possible that the increased usage of cosmetics over ovulation, and change in behaviors of others solicited by such use, may be attributable to self-promotion and advertisement of a less restricted sociosexuality—in other words, cosmetic usage may be perceived by others as an indicator of “availability as a mate” as opposed to “facial attractiveness” (Korichi et al., 2008, 2011; Wagstaff, 2018). It is also possible that the impact of positive self-belief evident when a cosmetics placebo is used may, in itself, support proceptive mating behaviors (Batres et al., 2019). Similarly, cosmetics may be used to facilitate the search for a long-term mate (Wagstaff, 2018), as evidenced by “the lipstick effect” in which cues to economic recession result in increased expenditure on products that increase attractiveness, including cosmetics (Hill et al., 2012; Marzoli et al., 2013).
Cosmetics may also be used, however, to enhance attractiveness through a form of camouflage. This could be a camouflage in real terms, for example, to disguise perceived “defects” or to simulate better health (as above). For example, in studies by cosmetic scientists, women were shown to use cosmetics as a camouflage for greater asymmetry of the lower face (Korichi et al., 2011). And in evolutionary psychology experimental research showed that women in poorer health were more inclined to use cosmetics than their healthier counterparts (Milroy et al., 2002). They concluded that whilst cosmetics may be used as a signaling system, deceptive strategies may also be employed in the manipulation of apparent health with deceptive signals “piggy-backing” on honest signals (Zahavi, 1975, 1987). Additionally, whilst female facial appearance signals cues to reproductive health, and these cues are deemed to be attractive, the use of cosmetics can mask these cues—a factor presumably of benefit to women of reduced fecundity (Law-Smith et al., 2006).
Additionally, and according to experimental research by social and personality psychologists, cosmetics may be used as a form of psychological “mask” for example, to decrease negative self-perception (Korichi et al., 2008, 2011), to improve mental health in those affected by illness (Lévêque, 1996) or by those with higher social anxiety or public self-consciousness in order to present an outward image of greater social confidence and self-esteem (Miller & Cox, 1982; Robertson et al., 2008). Indeed, the relationship between cosmetic usage and self-esteem has now been fairly robustly established. For example, the frequency and variability of cosmetic usage has been better explained by self-esteem and masculinity than a variety of other aspects of self-concept (Brdar et al., 1996). Additionally, enhancement of self-esteem through the use of cosmetics has been found to positively affect outcomes in academic performance in a simulated university examination with women wearing makeup achieving significantly higher grades than those who did not, as well as significantly higher grades than those assigned to a positive mood intervention (Palumbo et al., 2017). Interestingly, more recent social science research has shown that cosmetics may directly support self-esteem primarily when internally motivated (e.g., “as a mechanism for creativity, mastery, agency and human connection”; Tran et al., 2020, p. 1), but may equally support or undermine both mood and self-esteem when externally motivated. Cosmetics or non-surgical cosmetic procedures may also be used, however, by narcissists in their quest for attention and status through greater adornment, amongst other appearance-related cues (D’Agostino et al., 2018; Vazire et al., 2008; Wagstaff, 2018).
Despite the importance of appearance enhancement through cosmetic usage for whatever purpose, this may not encompass all motivations for its use. Indeed, facial adornment through cosmetics and grooming, or the extended phenotype (Etcoff et al., 2011), is an ancient phenomenon (Walter et al., 1999), employed for a variety of reasons that extend beyond the decorative. These included visible indicators of socio-economic status, religious conformity, gender, well-being and more (Stewart, 2017). And modern usage similarly goes beyond the esthetic. Indeed, signification, or the adornment that “places an individual within society” (Russell, 2010, p. 11) is also an important factor behind personal decoration, and may be relevant too, with regard to the use of cosmetics. Such signification may be to mark class or culture, status or rank, to provide personal information like reproductive status, or even adherence (or otherwise) to cultural norms—in other words, the adornment provides others with a visual demonstration of the user’s identity and may be used in its construction or reconstruction. So, for example, empirical research in occupational psychology tells us that cosmetic usage facilitates perceptions of prestige or dominance in the workplace dependent upon the sex of the perceiver (Mileva et al., 2016). Its usage has been noted as a rite of passage into adulthood by adolescent girls (Fabricant & Gould, 1993; Gentina et al., 2012; Ragas & Kozlowski, 1998) and has been shown to be associated with adulthood specifically (Russell et al., 2019). It has been used to signal gender identity, as, for example, in Indonesia’s Waria, a transgender male-to-female group who use cosmetics to be more like women (Idrus & Hymans, 2014) or to empower women as confident, sexual beings as part of the “lipstick feminism” movement (Walters, 2010), (though signals of identity may be misappropriated. The use of cosmetics by metrosexual men may, for example, lead to assumptions of homosexuality; Hall et al., 2012). A useful, if potentially no longer current, overview of identity construction through cosmetic usage is offered by Fabricant and Gould (1993).
An understanding of the subconscious motivation behind the conscious manipulation of appearance is also useful and can be informed by a postfeminist sensibility. From such a position, the gender order supporting hegemonic masculinity (or the socio-cultural norm which idealizes heterosexual masculinity as the cultural ideal; Connell, 1987; Connell & Messerschmidt, 2005) provides a lens by which we might understand “femininity, embodiment, and empowerment” through a focus on self-regulation, self-surveillance and self-improvement (Riley et al., 2017). It suggests that in order to conform, to ensure that she does not pose a “threat” to the existing order of societal power, a woman’s body, and appearance generally, are regulated by a “dispositif” or apparatus, a multifaceted set of organizations and systems (material or conceptual) which maintain or even enhance that status quo. Specifically, by maintaining a polished femininity, she reinforces the gender order. As such, an understanding of the subconscious desire to manipulate appearance should consider four key postfeminist theoretical frameworks (Riley et al., 2016).
First, Objectification theory indicates the experiential consequences, including habitual appearance monitoring, of living in Western cultures in which women are sexually objectified and in which women are equated to their bodies (Fredrickson & Roberts, 1997). Foucauldian Disciplinary Power similarly considers “looking” but focuses on the socio-historical context through which people understand themselves, the disciplinary power being the outcome as people conform to societal norms whilst believing in their own, personal agency (Foucault & Rabinow, 1984). The “male gaze” extends Freud’s “scopophilia” (Freud, 1949) and considers women in the arts and in literature, in which the “primordial wish [of male heterosexuals] for pleasurable looking” (Mulvey, 1975, p. 9) may be satisfied again, through the depiction of women as sexual objects, creating a subjective power differential between the gazer and the gazed upon (Stack & Plant, 1982). And finally, misrecognition (Skeggs, 2001), the concept that femininity is perceived, understood and misrecognised as an outcome of the premise that the woman is the product of her physical embodiment, highlighting, therefore, the “visual economy” of looks (p. 300). Additionally, Gill (2007, pp. 151–152) argues that post-feminism “represents a shift in the way that power operates: from an external, male judging gaze to a self-policing, narcissistic gaze…one in which the objectifying male gaze is internalized to form a new disciplinary regime,” whereas Riley et al. (2016) conceptualizes it as a “postfeminist” gaze.
So, motivations for cosmetic usage, whether conscious or otherwise, are clearly multifaceted and complex. Little research, however, has sought to provide a wide-ranging understanding of these possible motivations, with most research in this area focusing on the roles of particular and highly specific motivators. The current study therefore seeks to provide a contemporary, conceptual overview of the assorted motivations for cosmetic usage from diverse groups of cosmetic users.
Methodology
Much of the current research relating to cosmetic usage considers very specific individual aspects (e.g., workplace advantage—Agthe et al., 2010; mate selection—Röder et al., 2013; attractiveness enhancement—Jones et al., 2018). The focus of this research was to explore the reasons why women use cosmetics, and to gain a deeper understanding of what motivates them to do so. In order to obtain the depth of information to allow us to learn more about people’s customs and habits in this area, it was clear that a qualitative approach would provide the best outcomes, and this was, therefore, our chosen methodology.
Participant were recruited using an online survey, a growing approach when exploring views and opinions in qualitative research, and one in which participants benefit from being able to respond using their own language to open ended questions. (See Braun et al., 2020, for an overview of the advantages of utilizing this method. The online survey followed the format of a semi-structured interview, with the number of questions being an important consideration. Some studies have used as few as four questions (e.g., Frith & Gleeson, 2004) while others have included considerably more (e.g., Braun et al., 2013 with 22). In line with Clarke (2016, 2019) this study included six key questions for participants to respond to. As indicated in the literature review above, the contexts within which make-up is used are many and varied and this was reflected in the questions. For example, we asked respondents to consider both their general reasons for using make-up “Why do you currently use cosmetics?”, as well as more focused reflections on make-up usage “Are there specific times when cosmetic usage is essential, or, conversely, not so important?”, and any temporal changes they may be aware of “How, if at all, has your cosmetic usage changed over the course of time?”. Although, unsurprisingly, the length of participant responses to these questions varied between individuals (some providing just a sentence or two for each one, others full paragraphs of text), in all cases, detailed analysis of the textual data allowed for the identification of different dimensions.
Respondents were recruited using the research recruitment platforms Reddit/SampleSize and SurveyCircle, as well as FaceBook and Twitter sites. They represented a diverse opportunity sample of people over the age of 18, all of whom use or had used make-up. While survey sample sizes for online qualitative studies may be similar to interview samples, they can vary considerably (e.g., Turner & Coyle, 2000—16 participants; Clarke, 2016—99 participants). In the current study there were 47 participants, and while most participants identified as White British (74%), a number of other ethnicities were represented, including, mixed race (6%), Asian (6%), and African American (9%). Importantly, the sample represented a broad range of ages from 19 to 56 (mean age = 31.70, SD = 11.11), and the occupation of the participants was also extremely diverse, including students, office workers, civil servants, teachers, company directors, beauty therapists, a biotechnician, a physiotherapist, an optometrist, a visual effects artist, and retail workers.
While content analysis was considered as a potential analysis for this research, the processes involved in that approach were not deemed sufficiently rigorous to allow any emergent themes to be fully analyzed. Thematic analysis was, therefore, ultimately preferred as the method of choice as it is highly suited to “identifying and reporting patterns (themes) within data…[using] an accessible and theoretically flexible approach” (Braun & Clarke, 2006, p.79). The analysis was informed by a postfeminist sensibility (e.g., Gill, 2007; Riley et al., 2016), the theoretical framework assuming both a realist approach (i.e., the reality of participants) and a constructionist approach (i.e., the way that participants reality is affected by societal discourses). I Additionally, thematic analysis allows for both inductive (top-down) and deductive (bottom-up) exploration of the data, which reflects the need for both existing theory (e.g., Zahavian Handicap Principle, 1975, 1987) to be explored, as well as providing the opportunity for unexpected themes to be identified and explored when addressing the research question.
As well as concerns regarding the approach to the identification of themes, the level at which those themes were identified was also considered. In the current research a latent or interpretative level was employed, as opposed to a semantic or explicit level of identification (Boyatzis, 1998). This meant that the themes reported looked beyond the surface meaning of the data, that is, simply what was reported by the participants, to provide a more explanatory summary of the information provided by participants.
Ethical approval of the project “Behind the façade: Motivations for cosmetic usage by women” was granted by Buckinghamshire New University’s research ethics Committee on May 26th, 2020.
Results and Discussion
The narratives of 47 women were collected and analyzed using Thematic Analysis in accordance with Braun and Clarke’s (2006) method. Findings revealed four main themes, each of which were subsequently broken down into further subthemes as presented in Table 1. Whilst some of these themes had been anticipated through current theory and research, inductive themes were at least as evident, and the focus of understanding regarding the motivations behind cosmetic usage has consequently shifted.
Thematic Categories, Sub-themes, and Sample Extracts.
“Multiple Selves”—Conformity, Impression Management, and Judgment
The appearance management that “places an individual within society” (Russell, 2010, p. 11) had been an anticipated theme within this study, and yet its central significance has, perhaps, been under appreciated in many sub-disciplines of psychology, though more comprehensively considered in the postfeminist literature. Indeed, the socio-historical association between femininity and the manipulation of appearance is deepened through a postfeminist sensibility which encourages appearance enhancement as both normative, feminine behavior (McRobbie, 2007), and aspirational, with women self-regulating their behavior in order to achieve “appropriate femininity” (Riley et al., 2016). The effort and expense expended in so doing is substantial (Evans & Riley, 2013; Riley & Scharff, 2013), and is reflected in the flourishing global beauty industry and the proliferation of a myriad of beauty-enhancing technologies. In the current study, the socio-cultural importance appearance management was highlighted on a global level, with specific regards to conformity to societal expectation, and, of significant importance, to one’s perceived professionalism within the workplace. Additionally, however, the importance of conformity and impression management was discussed in relation to peers, as it was, also, with regard to mate attraction, though the latter appeared to play an unexpectedly less significant role than in other domains.
The public versus the private persona
Although indirectly suggested within the literature, the need to conform to perceived societal expectations of appropriate appearance within specified domains was a factor which emerged in the accounts of many of our respondents. Sometimes this was expressed simply as a need to meet assumed expectations about presentation…
There isn’t really the option of not wearing makeup without looking [un]prepared for the world ( White British Visual Effects Artist, aged 26)
I use cosmetics … to show I care about making an effort with how I look to others (British Office worker, aged 44)
…though the pressure to conform to these expectations might be met or challenged
Only times in my life I have [used cosmetics has] been for things like on-stage performances, media appearances, etc with somebody else doing it and me not having any choice (White agendered (biologically female), disabled and unable to work, aged 45)
Consistent with the literature indicating the power of the “postfeminist gaze” (Riley et al., 2016) and the resultant focus on self-regulation, self-surveillance and self-improvement, in addition to the empirical research indicating that cosmetic usage was positively correlated with conformity and negatively correlated with social confidence (Robertson et al., 2008), the need to conform to perceived societal expectations regarding the use of cosmetics were particularly evident when considering the public versus the private persona.
If I am going outside for any reason; uni, work, with friends, doctors, shopping etc, I will also wear makeup. However, if I am just going to a family members house or to a friend’s house I will not always wear makeup…I cannot really leave the house unless I have all of my makeup on (White British student, aged 21)
In some occasions I do feel like it is essential to me, ‘specially if I’m going to a place where makeup is a must (Aged 23)
Certainly, by applying cosmetics in preparation for their “public persona” it appears that women felt it allowed them to face the external challenges of the day, a notion expressed by several respondents:
I often call makeup ‘war paint’ because even if I’m feeling low or not ready to face the world, a little bit of makeup gives me the confidence to get on with my day (White British Student and part-time waitress, aged 20)
…for some unknown reason putting your make up on makes you feel ready to take on the day’s challenges (White British Experience manager, aged 32)
The perceived judgment that would come from non-conformity and explained by the postfeminist gaze (Riley et al., 2016) appeared, indeed, to play a contingent role in the importance of cosmetic usage, with many conforming to the postfeminist sensibility that within this social context they would be judged negatively if they did not present to “the outside world” in the appropriate manner. As McRobbie (2015) puts it, “To gain weight [or to fail to conform to the cultural ideal] is to ‘let oneself down’ to risk social disapprobation, to lose status and self-respect” (p.7). Instead, one must strive for perfection through a heightened form of self-regulation (Riley et al., 2017) …
There seems to be an unspoken rule from both men and other women, that if a woman doesn’t wear make-up then she’s somehow ‘let herself go’ or can’t be bothered. It implies a lack of pride in one’s appearance (again, which I disagree with) (White British mature student, aged 47)
I do like how it gives me more confidence when I’m out, and I think people are less likely to judge how I look negatively (Aged 21)
… and that there would be consequences for not doing so.
If you want people (not people who know you well) to take you seriously (Asian Office worker, aged 21.)
That the public versus the private persona is an important indicator of cosmetic usage is therefore apparent, but the public or societal context may also vary. Novel situations, for example, may be a predictor of cosmetic usage.
I don’t always use them, but in new situations or when meeting new people I would try to cover the worst of my vitiligo patches (White British student, mid-thirties)
…strangers seeing me without it makes me uncomfortable (White student, aged 20)
For many, however, cosmetics appear to be used simply to signify boundaries between home and “out”…
Whilst at home, I never bother wearing make-up, but when going out (to work, uni. or socially) I invariably do (White British mature student, aged 47)
… and “out out” (mixed race student, aged 21), in other words, to signify an event in time or place that warrants special treatment -see “Ceremonial” under “Signification and Identity.”
I don’t think I consciously decide to wear make up for a reason for meeting people, it just kind of goes with getting dressed up when wearing nicer clothes (Caucasian Travel Agent, aged 28)
Professionalism and the workplace
Of significant relevance in the “public” arena, of course, is that of the workplace, and, indeed, professionalism and the workplace proved to be of notable importance to our respondents. And yet, surprisingly, the importance of the visible maintenance of an idealized femininity in the public arena to the value of the woman being “judged,” and the dispositif supporting self-surveillance and regulation (McRobbie, 2015), empirical investigation surrounding the use of cosmetics within the workplace is limited. What research there is has suggested that some women believe that to “get ahead” in professional jobs it may be necessary to play down attractiveness (Cox & Glick, 1986). That said, alternative research has shown that women wearing cosmetics in the workplace are deemed to be higher in prestige when rated by men, or higher in dominance when rated by women, than their unadorned counterparts (Mileva et al., 2016), thus supporting the premise that women may use cosmetics deliberately in the workplace in order to portray a workplace professionalism. Certainly, if cosmetics can enhance a person’s attractiveness, the dividends may be apparent in terms of the likelihood of being hired (Agthe et al., 2010) or promoted (Ling et al., 2019). Given this and the socio-cultural obligation to maintain the gender order by conforming to the cultural ideal of feminine appearance, in addition to the discourse of “esthetic labor” which requires career women to expend time, money, skill, and effort in beautification procedures (Lazar, 2017), it is, perhaps, not surprising that cosmetic usage is essential to many in a workplace scenario, and is, indeed, part of their workplace identity.
Cosmetics are my ‘work face.’ I put on make-up when I go to work (even in lockdown) and I take on my work persona… I would not feel professional without them… I like to mark the difference between the work ‘me’ and the non-work ‘me (White British Occupation Director, aged 56)
And as with the perceived judgment associated with the use of cosmetics and non-conformity in a social setting, it was also evident that there was perceived judgment associated with professionalism within the workplace, consistent with McRobbie’s (2007) “post-feminist masquerade” which dangles the carrot of gender equality in the workplace based on the sexual contract in which the illusion of control and therefore female success is predicated on the achievement of “the perfect,” a realistically unachievable but aspirational ideal…I feel going to work without make up would almost seem unprofessional, comparable to going into work in sportswear or pyjamas (White British Visual Effects Artist, aged 26).
…show other people, employers etc. that you care about your appearance (White European student, aged 21)
Mate attraction
Initially surprising, however, and particularly from an evolutionary perspective, there appeared to be a relative dearth of comment regarding cosmetics as a tool for mate attraction. In view of all the evidence which shows that attractive people are more likely to attract the partners they seek (Wincenciak et al., 2015), and that factors associated with beauty (sexual dimorphism, averageness, symmetry, skin homogeneity, and youth; Cunningham et al., 1995; Langlois et al., 2000) might be manipulated by cosmetics, one might expect more comment on appearance manipulation in relation to attracting mates (though see below with regard to their use in enhancing attractiveness through exaggeration of these cues). That said, given female recognition of the effort and expense expended to achieve an idealized femininity (Evans & Riley, 2013; Riley & Scharff, 2013), evaluation by women (since men would not have that same recognition) holds significant power, against which “the male gaze” becomes less commanding. Similarly, a fundamental of a postfeminist sensibility is the transition from objectification to subjectification in which behavioral practices are evaluated not by the “inner male,” but “through the rhetoric of argentic individualism, choice and empowerment” (Riley et al., 2016, p. 98). As such, the notion that a woman would openly acknowledge (or, indeed, recognize) the creation of an idealized self “for a man” becomes much less likely. Nevertheless, despite this being an area that is potentially difficult to discuss (the exclamation mark in the quotation provided by the Operations Director suggesting that this may be so), some women did include mate attraction within their responses.
Started using when I was 15 as … had started to be interested in the opposite sex and thought it would help! (White British Operations Director, aged 37)
And some respondents discussed the use of cosmetic usage to attract a mate not through appearance manipulation per se but through the increased confidence that wearing make-up gave them.
Cosmetics also gives me more confidence when it comes to talking to guys (Asian-American student, aged 19)
It also gives me confidence when I’m going on a night out and definitely helps with attracting others (White graduate, aged 21)
Some also alluded to the notion, as suggested by Korichi et al. (2008, 2011) and Wagstaff (2018), that cosmetic usage may be perceived by others as an indicator of “availability as a mate” as opposed to “facial attractiveness.”
Year 7 …. was also the age when boys started to become an interest and [you thought you’d get] interest from them if you wore it! (British apprentice engineer, aged 23)
I used to use cosmetics mainly to attract men in my younger days (up until the age of about 21) … now I feel like I wear make up more for myself…(White British Visual Effects Artist, aged 26)
Though some rejected the use of cosmetics as a tool for mate attraction at all.
I’d say my influence on cosmetic use for attracting the opposite sex, changed the more relationships I had where partners complimented me on my attractiveness when not wearing cosmetics (White British Office worker, aged 44)
I’m in a long term relationship so it is not so much to do with attracting others (Caucasian Retail worker, aged 23 – Q5)
Enhancement and Confidence
As with conformity, impression management, and judgment, appearance enhancement and associated confidence was also an anticipated theme within this study. Nevertheless, again, the importance of cosmetic usage in confidence management, and the differing domains within which this was articulated, has been relatively under-recognized in prior literature, with only a few papers identifying the importance of this area. Specifically, it seems that confidence may be achieved from the simple use of cosmetics. Thus, cosmetics may be used as a “physiological mask” to manipulate a more desirable appearance or to mask perceived imperfections (consistent with research by Korichi et al., 2011; Law-Smith et al., 2006) or as a mask to indicators of poor health (Milroy et al., 2002). Consistent with Korichi et al. (2008 and 2011), cosmetics also appear to be used as a “psychological mask” both to decrease negative self-perception, and, as suggested by Miller and Cox (1982) and Robertson et al. (2008) as a way of managing social anxiety or public self-consciousness. It is also possible that the self-monitoring and self-regulation associated with cosmetic usage and a stylized femininity may offer confidence by providing palpable conformity to the postfeminist masquerade, the illusion of “the perfect,” a condition of the “new sexual contract” which promises success, attainment, entitlement and participation to the women that agree to adhere to the new “rules” of engagement in a neoliberalist world (McRobbie, 2007, 2015; Yoong, 2020). Physiological Camouflage and Appearance Enhancement. Cosmetic usage was discussed, albeit rarely, in relation to appearance enhancement in its simplest form.
I don’t use cosmetics every day, … I think I mostly use it to feel more attractive (German student and part-time social worker, aged 22)
Perhaps surprisingly, however, it was uncommon to find reference simply to appearance enhancement. Rather, in the many cases in which appearance enhancement was discussed, associated confidence would be mentioned almost inevitably within the same sentence, such that appearance enhancement and confidence were virtually synonymous. Again, this was acknowledged in terms of positive confidence…
I feel prettier when I wear makeup, it makes me more confident and I feel less embarrassed when I go out with makeup on (White British, working in retail, aged 23)
I feel it enhances my natural features, and allows me to be confident in day to day life (British apprentice engineer, aged 23)
…as well as in relation to the management of more negative emotion
I cannot really leave the house unless I have all of my makeup on because I can notice the difference or I feel that I do not look as good unless I have all of it on (White British student, aged 21)
I think it’s more about enhancement and concealment. I would not feel confident facing people without it. I think quite the opposite, I’d feel self-conscious (White British Counsellor, aged 46)
As suggested by Korichi et al. (2011) and Law-Smith et al. (2006), the use of cosmetics was also recognized as an important tool, however, to mask perceived imperfections in appearance. These could be of a temporary nature,
I also wear it especially when I have spots etc to cover up (Aged 21)
or to cover up more enduring “imperfections.”
I started using cosmetics to cover redness and blemishes on my skin (20 – Q1)
Wearing make-up makes me look healthier (White British Experience Manager, aged 32)
As such, whilst not necessarily apparent to the user, the manipulation of apparent health is consistent with the research by Milroy et al. (2002) suggesting that women in poorer health might use deceptive strategies to signal improved health and associated fecundity. This may be particularly true when cosmetics are employed to manipulate appearance of age (Law-Smith et al., 2006)
I like how they improve my features, smooth out wrinkles (White British Operations Director, aged 37)
Not all women regarded cosmetic usage as a positive tool, however, rejecting the notion that cosmetics should be used for appearance enhancement at all.
I reject the idea of using makeup to meet a beauty standard (White American graduate, aged 22)
Nevertheless, the importance of cosmetic usage for physiological camouflage and appearance enhancement is amply demonstrated by the burgeoning growth of technologies in the industry which facilitate the conscious desire for personalized treatments and products designed to enhance appearance in addition to the postfeminist sensibility encouraging hyper-feminine forms of consumption (McRobbie, 2007; Riley et al., 2016) . There are now apps and devices driven by Artificial Intelligence (AI) which can assess individual skin types and customize treatments or products accordingly. There is Augmented Reality (AR) which allows consumers to experiment virtually with cosmetics and so encourage consumer spending, particularly on more expensive or less popular products, as well as on those with narrower appeal (Tan et al., 2021). Smart mirrors similarly facilitate the opportunity to try different looks. Whether the consumers’ desire for the product drives this technological development, or whether the technological development fuels the normalization of ever greater appearance-related effort, is a matter for future research.
Psychological camouflage
We have seen then that desire to use cosmetics to support confidence through appearance enhancement is significant. However, the desire to use cosmetics simply to support confidence and not, per se, through appearance enhancement, was overwhelmingly apparent with a large percentage of respondents drawing reference to this sentiment. For some this was expressed in terms of positive confidence,
It’s just how I feel when I wear it and it makes me feel better (White British Experience manager, aged 32)
whereas for others, consistent with the prior literature (Brdar et al., 1996; Korichi et al., 2008, 2011; Miller & Cox, 1982; Robertson et al., 2008), cosmetics are used as a tool to manage more negative emotion.
If I’m feeling particularly self-conscious or nervous about something to do with being looked at (e.g. doing a presentation/ having a photo taken/ being filmed) I’ll wear a full face just because it makes me feel better (White, working in Higher Education, aged 23)
I don’t wear it often now but if I do it’s usually to hide insecurities (White British working in retail, aged 32)
I often call makeup ‘war paint’ because even if I’m feeling low or not ready to face the world, a little bit of makeup gives me the confidence to get on with my day (White British student and part-time waitress, aged 20)
Thus, it appears that cosmetics may, indeed, be employed as much as a form of “psychological mask” as they might a “physical mask,” with the resultant confidence associated with its consumption being inherently associated with both (Fabricant & Gould, 1993; Robertson et al., 2008). Nevertheless, the confidence gained through the wearing of cosmetics and resultant manipulation of outward appearance was not always embraced.
I wish I had the confidence to not wear them. I don’t even wear much make-up, but what I do wear is enough to change my appearance enough that others will notice when I’m bare faced (White British mature student, aged 47)
Fun, Creativity, and Well-being
Unlike previous themes the current theme, fun, creativity and well-being, is a virtually unrecognized, certainly under acknowledged, motivation for cosmetic usage within the existing body of research. Indeed, the only known studies to reflect on cosmetics at least partly in this area are those by Schouten (1991), Fabricant and Gould (1993), and, more recently, Jafari and Maclaran (2014) and Tran et al. (2020). For Schouten (1991), and Fabricant and Gould (1993), cosmetics are shown to be used creatively as a form of identity formation (which we discuss later) as well as a form of self-expression in which women “may engage in identity play… either in imagination or in real situations” (Fabricant & Gould, 1993, p. 540). For Jafari and Maclaran (2014) makeup is recognized as a tool for enriching lives thorough creativity, and for Tran et al, (2020) whilst recognizing “the duplexity of make up use… on self esteem” (p.8), there is explicit recognition of the impact of cosmetics on self-esteem if internally motivated and used as a tool for creativity. Despite this, however, the recognition of cosmetics as tools for fun, creativity and well-being is scarce. And yet, in the current study, this was a clear, emergent theme with many regarding this as an important focus of attention. Additionally, however, the adverse consequences of cosmetic usage are also discussed.
Fun, creativity, and self-expression
Simple, uncomplicated fun was one of the central sub themes to emerge, with many women commenting on the straightforward enjoyment of using cosmetics either in terms of the “end product”…
I like to use cosmetics … for fun and decoration (White British Office worker, aged 44)
…or in terms of the process.
I love how fun and relaxing it is to apply cosmetics (Asian-American student, aged 19)
I find them fun to use (White British student, aged 19)
For others, however, the enjoyment of using cosmetics came from the opportunity to be creative.
I enjoy the application of makeup as well as wearing it as I am quite creative. I like to see the difference in my face with and without makeup (White British Customer Services Advisor, aged 42)
Consistent with both Schouten (1991) and Fabricant and Gould (1993) who suggested that cosmetics might be used as a form of self-expression in the formation of identity, and potentially with Markus and Kunda (1986) who considered the use of cosmetics in the expression of “multiple selves,” a number of our respondents also supported this potential for self-expression through the creative use of cosmetics…
I like the way you can be creative and express yourself through them (White British Headteacher, aged 42)
…for me makeup is a statement piece like big jewellery or bright clothes (White American graduate, aged 22)
…though not all wanted to utilize this potential, feeling that too much “creativity” might draw unwanted attention I don’t like to be very creative, I feel it attracts more attention and I’d rather stay the same (British apprentice engineer, aged 23)
Nevertheless, cosmetic usage for fun and creativity is evident, and it is quite possible that the evolution of digital technologies, as previously discussed, has supported this kind of usage. So enhanced digital technologies facilitate “playfulness” and experimentation with new looks (Wang et al., 2021). Additionally, consumers have moved increasingly online with shopping behavior shifting toward e-commerce, allowing an ease of access to new looks and trends that would not have been as visible a decade ago (Simpson & Craig, 2018). This is further supported by the shift of cosmetics advertising from the possibility that cosmetic usage may be a form of esthetic labor to its recontextualization as a form of fun, by so doing encouraging the willing participation of the women involved. As Lazar (2017, p.64) puts it, and consistent with the message that many of our women respondents are offering, “Beauty work is not about what women should do; rather it becomes what women want to do.”
And it is not just a shift in ease of buying, but a shift in the way that consumers interact, that may be further fueling this apparently new use of cosmetics. Social media, including YouTube and Instagram, have changed the ways that consumers link to brands, either directly through PR and advertising, or indirectly through beauty vloggers as either earned influencers (where the influencer will talk organically about the product because they like or enjoy it), or paid (where the influencer is paid to say something about it). And beauty vlogging, in which women are exhorted to “…sit back, enjoy and let’s play with makeup!” (Phan, in Banet-Weiser, 2017, p.277) is big business for media companies like YouTube where, as Benet-Weiser points out, “beauty” is one of their most searched for categories.
I used to cheer me up when I was struggling with depression so it has definitely become a part of my self care (White, aged 19)
…whilst others were more focused specifically on the therapeutic efficacy of application.
it’s a part of my morning routine that is soothing to start the day (Caucasian Travel Agent, aged 28)
The therapeutic value expressed frequently above should not, however, be such a surprise if, as one woman puts it, “makeup is art for the face” (White, working in Higher Education, aged 23).
There is, after all, a wealth of literature that recognizes the relationship between the creative arts and well-being, both physical and emotional (McMurray & Schwartz-Mirman, 2001; Melchionne, 2017; Mundet-Bolos et al., 2016; Reynolds, 2010; Reynolds & Prior, 2003; Stuckey & Nobel, 2010). For example, in terms of the visual arts (noting that creative arts may also encompass music, dance and writing amongst other forms of expression), there is recognition that self-expression through art may support the reconstruction (or construction) of a positive outlook after a cancer diagnosis (McMurray & Schwartz-Mirman, 2001; Reynolds & Lim, 2007). Art may also provide a means of escape from the emotional turbulence of, and preoccupation with, an illness (Collie et al., 2006; Reynolds & Lim, 2007) or be of general assistance in therapeutic practice, facilitating expression of emotion or being utilized as a form of catharsis (Sholt & Gavron, 2006). The therapeutic efficacy of cosmetics as a form of facial art is therefore both logical and cogent, though under researched.
Adverse consequences of usage
The use of cosmetics, however, though evidently having the potential to be utilized as a therapeutic tool, is not unequivocally appreciated. Not all, for example, subscribed to the view that cosmetic usage was, necessarily, either fun or of value to their positive well-being, with some indicating that what might once have been fun was no longer so.
Years ago, experimenting with make-up was fun, but now it seems to have turned into a chore (White British mature student, aged 47)
Others expressed the more insidious feeling of being trapped by the need to continue using them consistent with McRobbie’s (2007, 2009, 2015) multiple works on striving for “the perfect” and the creation of idealized femininity.
I don’t like the pressure of perfection that the industry [is] causing (White British Experience manager, aged 32)
This pressure, though not widely expressed, was deeply felt by some, and the complexity of their relationships with cosmetics, both for the good and the bad, was sometimes expressed.
I am addicted and I don’t see myself abandoning them any time soon. It’s a complex relationship (White British student, aged 21)
Whilst Robertson et al. (2008) and Fabricant and Gould (2003) recognize the connections between anxiety, social confidence and cosmetic usage, there is generally a dearth of literature in this area. Indeed, the negative relationship between social confidence and cosmetic usage assumed previously to be causal, that is, depressed social confidence predicts elevated levels of, and greater need for, cosmetic usage (Robertson et al., 2008), is not supported by the respondents comments, which suggest the possibility of a causal relationship in the opposite direction, that is, that the use of cosmetics (and growing need to maintain that usage) may, in fact, be the cause of anxiety and lack of social confidence. Indeed, Fabricant and Gould (1993) also report that while women who habitually wear make up say that they could go out without it, “they expressed that this caused them varying levels of discomfort” (p. 537).
The use of cosmetics as a source of discomfort and not as a response to it may, however, potentially be understood through a postfeminist lens. From this perspective, normative enforcement of the gender order is actualized through overt, or, indeed, excessive expression of femininity—as McRobbie’s (2007) conceives it, the “post-feminist masquerade” in which “top girls” must “endlessly work on a perfectible self” as part of the new sexual contract (p. 718), as apparently evidenced in the quotation by the 32 year old Experience manager above. There is evidently a need for more research in this area.
Signification and identity
The final theme identified is that concerning signification and identity and considers the construction or reconstruction of identity, the changing importance of cosmetics over time, and the ceremonial importance of cosmetics. So, cosmetics may be used as a deliberate tool to construct or reconstruct the user’s identity (Mileva et al., 2016) through signifying the sometimes-changing membership (or rejection) of cultural or social groups. Lifespan changes in roles, whether societal or personal, may also generate changes in the importance of cosmetic usage, none more so, perhaps than the “rites of passage” from adolescence and into adulthood discussed by so many of our respondents when considering the initiation of cosmetic usage, and as recognized in prior research (Fabricant & Gould, 1993; Gentina et al., 2012; Ragas & Kozlowski, 1998). And lastly, cosmetics are seen to be used as signification of the observance of the rituals and expectations associated with religious or public ceremonies (Chaudhri & Jain, 2009; Khan & Alam, 2019; Power, 2010).
Identity construction, maintenance, or reconstruction
So, cosmetics are clearly seen to be employed by women in the construction of their identity, its maintenance or, indeed, its reconstruction (Fabricant & Gould, 1993).
[It’s] less about a fashion look and more about my identity…. (No demographic information provided)
For example, cosmetics were clearly being used to construct a “socially-desired” age, or, in other words, in the construction of an identity which would support their “rightful occupation” of a particular social or occupational niche. In view of the fact that cosmetics have been shown to have a differential effect on perceived age, with younger women in their 20s looking significantly older when applying cosmetics and older women in their 40s and 50s looking significantly younger (Russell et al., 2019), it is clear how cosmetics may be a useful tool when creating an image consistent with societal expectation.
As a young teacher I feel it makes me look more mature and find parents treat me differently if they think I look young. (White British teacher, aged 27)
Started wearing makeup at 16. This was to look older in my first job. (White British civil servant, aged 50)
Whilst this was overtly recognized by many, some (specifically associated with older age) were unhappy with the perceived “requirement” to construct, maintain or reconstruct an identity that was not consistent with their reality
So many outlets that scream ‘don’t wear this if you’re over 30!,’ ‘How to look 10 years younger!’. The message is that if you don’t project a certain image, then you should be shunned. (White British mature student, aged 47)
Paradoxically, however, it seems that cosmetics may also be used to signify “the real self” to others—to display, for example, the successful transition from child to adult, or, as Schouten would put it, from one state of being to another (1991). Such signification is inherently associated, of course, with conformity and the need to follow perceived societal expectations regarding the use of cosmetics. Thus, we see here that conformity has extended beyond the public versus the private persona to conformity across the lifespan. Specifically, it seems, the largest impetus to wearing cosmetics is conformity to the societal norms of at least Westernized cultures in which cosmetics are perceived to be part of a more adult persona. Thus, the socialization process in which cosmetic usage is located could be seen as a “rite of passage,” with the most cited route in the current study unequivocally via conformity with peers. Indeed, of all the women who participated in the study, around half cited the influence of peers as the main initiator of their cosmetic usage.
My reason was probably peer influenced, everyone was wearing it, I was not any good but I was just glad to be involved (Mixed race student, aged 21)
Started using cosmetics in my teens because of …. (possibly) peer pressure; everyone else was using them, and those who didn’t were somehow considered less mature (White British mature student, aged 47).
Such is consistent with Fabricant and Gould (1993), who found that the “…related socialisation process involves a number of avenues: (a) Opinion leaders, such as peers, (b) media, and (c) other objects” (p. 535). They also stated that mothers and sisters were cited as role models, and this we also found, though with less consistency than with peers.
I first started using make up when I was in year 7 (?) - my older sister was wearing make-up which I thought was cool and mature (British apprentice engineer, aged 23)
I first started using cosmetics as a young teenager. I saw my older sister and my Mum using cosmetics and I wanted to seem more grown up (White British Occupation Director, aged 56)
The media and “other objects” (Fabricant & Gould, 1993) suggest children’s toys, including Barbie dolls) do not, in the main, appear as relevant in our respondents’ rites of passage, though social media is sometimes mentioned as part of an ongoing life narrative on cosmetic usage.
I do [think] my views of cosmetics has been heavily influenced by growing up alongside the rise in social media (White British teacher, aged 27)
No women, however (and perhaps surprisingly), discussed this in any length; nor did they mention “other objects” in any respect.
Change over the lifespan
That cosmetics are seen to be used in the construction, maintenance and reconstruction of identity also hints at the possible changes assigned to the importance or reason to use cosmetics over the lifespan, and this was, indeed, what was evidenced. Again, inherently linked to conformity, it is apparent that as women age their relationship with cosmetics may change fundamentally. For some, (but not all, as might be anticipated when considering the evolved male preference for youth; Dunn et al., 2010) greater reliance is associated with older age and the preference to present a younger, perhaps more “vital” impression
I feel like I look healthier …less tired, more dewy / glowing skin… (20 – Q1)
[Cosmetics are] only absolutely essential when there is a dramatic change in appearance i.e ageing (White British Beauty Therapist, aged 27)
For others, however, greater reliance is recognized, but not necessarily understood
It has become more important the older I’ve gotten, unsure why (White student, aged 20)
Aging was not unequivocally related to such increased reliance, however, with other women discussing an alternative trajectory of reduced reliance.
I believe there was a time where cosmetics were important to me to a point where I felt uncomfortable without them. I feel I have a healthier relationship to them now (White, cisgender female, aged 19)
Others also reported a reduced reliance as a result of changed circumstance.
When I was much younger, I wore cosmetics more to be attractive to males, and I wore more of it. Now that I am much older, it is not as important. I don’t wear it solely to feel attractive to others and I don’t wear as much anymore (African-American Doctoral student, aged 51)
Whether an increased or decreased usage was described, however, most respondents noted changes in the course of that usage over their lifespan, and therefore the fluidity of this relationship should be recognized as a fundamental in any understanding of the motivations to use cosmetics.
Ceremonial
The last sub-theme to emerge, as an extension of the “public and private self” is that of the ritualistic or ceremonial use of cosmetics. In other words, alongside clothing, cosmetics may be used to signify observance of rituals and recognition of the societal norms around religious or public ceremonies (Chaudhri & Jain, 2009; Khan & Alam, 2019; Power, 2010). This goes beyond, then, the need to “dress” for going “out out” (17—Q3),
Cosmetics is essential for weddings and religious events because nearly every female wears makeup in these events…. (Asian Office worker, aged 24)
Special social occasions feels essential for use of cosmetics, weddings etc. (White British office worker, aged 44)
The need to wear cosmetics to these ceremonial events is seen by some as a mark of respect for the occasion, or to the celebrants or attendants at the ceremony.
Special occasions like a wedding - makes others feel that you value them if you make an effort (White British Headteacher, aged 42)
Whilst most appear to conform to the societal norms associated with ceremonial display, a few overtly reject the notion that such ceremonies should require you to follow such social conventions. Despite this rejection, however, their personal choice remains to conform, signifying the strength of the cultural norm to do so.
I do not generally think that cosmetics are essential for “life events” (like graduation, anniversaries, weddings etc.) but for me they would be. (White, cisgender female, aged 19)
Limitations
The current study has provided us with the opportunity to explore a diversity of motivations for cosmetic usage that have been given by women, allowing us to “speak back” to the rather limited literature which has tended to focus on specific pre-determined factors. It is, however, limited to the discourse of women, and should not be extended, therefore, to the potentially dissimilar motivations for cosmetic usage by men, or, indeed by transgendered women. With a sample of predominantly White British women, one should also be careful not to generalize to other potentially dissimilar cultural groups. There is clear scope, here, for future research in these areas.
Conclusion
We are indebted to the women who took part in our study who have allowed us such insight into the diverse motivational factors behind their use of cosmetics. They have shown us that, whilst many of the themes discussed have been considered in prior literature, there are also themes which have been less well researched and are deserving of further attention. For example, the management of multiple selves, the public versus the private person, and the need to conform to societal convention were of fundamental importance, and yet, perhaps, not fully recognized in much of the mainstream psychological literature. Nevertheless, by adopting a postfeminist perspective one can more fully appreciate the motivations behind cosmetic usage in this particular socio-cultural arena. So, too, the importance of cosmetics within the workplace and the association with professionalism has been shown to be of significant relevance. This finding is consistent with the comprehensive empirical literature indicating the importance of attractiveness in the workplace, as well as the postfeminist literature on “esthetic labor” (Lazar, 2017). This requires that career women engage with the beautification process to create “the perfect,” and also that they must strive for the immaculate as part of the new sexual contract in the “post-feminist masquerade” (McRobbie, 2007).
On the other hand, it appears that whilst mate attraction was discussed, this was of much less significance to our respondents, at least as directly reported, than the literature might have pre-supposed. A more nuanced consideration, however, of this apparent and generalized omission, may be understood when considering evaluation by women of the effort involved in achieving ultimate femininity, against which the importance of “the male gaze” may be reduced, if not negated.
Similarly, whilst we anticipated the central and well documented themes associated with enhancement and confidence, linked as they are to both psychological and physical camouflage, the association with fun, creativity and resultant well-being is largely unrecognized in the literature and also merits future consideration, particularly with regard to its potential therapeutic applications. In addition, the adverse consequences of cosmetic usage are also under researched and warrant further attention as a counterbalance to consideration of its therapeutic efficacy.
Lastly, that signification and identity has been considered in prior research is evident, but the fluidity of a woman’s relationship with cosmetics has also become apparent. Thus, one should not regard cosmetic usage as fixed and immutable, but more reflective of changing roles and place within society over time and place.
There is clearly much that remains to be investigated in this fascinating area which is of such fundamental importance in the daily lives of our respondents. It is hoped, therefore, that future research will prove enlightening and enable greater understanding of the benefits, as well as the “darker side,” of this form of visual manipulation.
Footnotes
Author’s Note
The manuscript conforms to the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, and was approved by the Ethics Panel at Buckinghamshire New University on 30th September, 2019.No committee approval numbers are given.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
