Beyond Screen Time: Distinct Pathways from Active and Passive Social Media Use to Cosmetic Surgery Desire

The influence of social media on individuals’ attitudes toward cosmetic surgery has received significant attention. However, how different patterns of social media engagement influence users’ cosmetic surgery desire and the underlying emotional and cognitive mechanisms remains underexplored. Drawing on a Chinese sample, this study addresses a notable gap in non-Western contexts where social media engagement and cosmetic surgery desire may differ significantly from Western populations. To address this gap, this study employed an online cross-sectional survey ( N = 1,059) to examine how active and passive social media use relates to cosmetic surgery desire, mediated by social appearance anxiety (an emotional pathway) and perceived barriers and benefits of cosmetic surgery (cognitive pathways). Based on the stimulus-organism-response model, this study revealed distinct pathways through which active and passive social media use influence cosmetic surgery desire in the Chinese context. Active social media use was found to trigger cosmetic surgery desire through dual pathways by increasing social appearance anxiety and shaping cognitive beliefs about its benefits and barriers. In contrast, passive social media use primarily influenced cosmetic surgery desire through the emotional pathway of increased social appearance anxiety. These findings highlight the cultural and contextual importance of distinguishing between active and passive social media use in body image research, suggesting social appearance anxiety as a central emotional mechanism linking social media use to cosmetic surgery desire. Practically, this study offers culturally informed, evidence-based insights for developing interventions to reduce appearance-related pressures and enhance digital well-being.