The relationship between social networking sites body talk and cosmetic surgery intention of college students: the chain mediating effect of body surveillance and appearance anxiety and the gender differences - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. 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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Psychol . 2026 Mar 7;14:532. doi: 10.1186/s40359-026-04290-2 Search in PMC Search in PubMed View in NLM Catalog Add to search The relationship between social networking sites body talk and cosmetic surgery intention of college students: the chain mediating effect of body surveillance and appearance anxiety and the gender differences Ruicong Yu Ruicong Yu 1 School of Medicine, Southeast University, Nanjing, 210009 China Find articles by Ruicong Yu 1, # , Jiayi Ruan Jiayi Ruan 2 School of Nursing, Anhui Medical University, Hefei, 230000 China Find articles by Jiayi Ruan 2, # , Qian Xu Qian Xu 1 School of Medicine, Southeast University, Nanjing, 210009 China Find articles by Qian Xu 1 , Yunfeng Zhao Yunfeng Zhao 3 School of Health Management, Anhui Medical University, Hefei, 230000 China Find articles by Yunfeng Zhao 3 , Yaqi Mei Yaqi Mei 2 School of Nursing, Anhui Medical University, Hefei, 230000 China Find articles by Yaqi Mei 2 , Cuirong Xu Cuirong Xu 1 School of Medicine, Southeast University, Nanjing, 210009 China 4 Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009 China Find articles by Cuirong Xu 1, 4, ✉ Author information Article notes Copyright and License information 1 School of Medicine, Southeast University, Nanjing, 210009 China 2 School of Nursing, Anhui Medical University, Hefei, 230000 China 3 School of Health Management, Anhui Medical University, Hefei, 230000 China 4 Zhongda Hospital Affiliated to Southeast University, Nanjing, 210009 China ✉ Corresponding author. # Contributed equally. Received 2025 Jul 20; Accepted 2026 Feb 27; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13081278 PMID: 41794767 Abstract Background Although existing studies have explored the impact of social networking sites body talk on negative emotions, the mechanism underlying its influence on college students' behavioral tendency toward cosmetic surgery intentions remains unclear. Therefore, this study proposes research hypotheses to explore the mechanism of action between variables through the similar trends in the correlation between scale survey results and keyword frequencies on real social media. Methods A mixed-methods design was adopted. A survey was conducted among 512 students using the Social Networking Sites(SNS) Body Talk Scale, the Body Surveillance Subscale of the Objectified Body Consciousness Scale, the Appearance Anxiety Scale, and the Acceptance of Cosmetic Surgery Scale. Additionally, 1,139 pieces of actual social media data were extracted to analyze correlations and emotional tendencies, serving as supplementary evidence for the variable relationship model. Results (1) SNS body talk has both a direct positive impact on college students' cosmetic surgery intentions ( β = 0.807, P < 0.001, 95% CI [0.425, 1.189]) and an indirect impact. (2) The indirect impact is achieved through two significant paths: first, a chain mediating path of "SNS body talk → body surveillance → appearance anxiety → cosmetic surgery intentions" (standardized indirect effect, SIE = 0.186, 95% CI [0.100, 0.294]); second, an independent mediating path of "SNS body talk → appearance anxiety → cosmetic surgery intentions" ( SIE = 0.160, 95% CI [0.064, 0.284]). In contrast, the path "SNS body talk → body surveillance → cosmetic surgery intentions" is not statistically significant ( SIE = 0.105, 95% CI [-0.076, 0.297]). (3) Gender plays a moderating role in the direct path from SNS body talk to cosmetic surgery intentions ( β = 1.063, P < 0.05, 95% CI [0.182, 1.945]). Conclusion SNS body talk affects college students’ cosmetic surgery intentions through the serial mediation of body surveillance and appearance anxiety, and gender moderates its direct effect. This study clarifies the complex psychological mechanism between body-related interactions on social media and cosmetic surgery intentions, providing empirical evidence for subsequent research on body image and aesthetic behavior. Keywords: Social networking sites body talk, Body surveillance, Appearance anxiety, Cosmetic surgery intentions, College students, Chain mediation Introduction A statistical report on the medical aesthetic market in 2024 indicates that China is the second-largest medical aesthetic market in the world, following the United States. Notably, 56% of the medical aesthetic population is under 30 years old, and the proportion of men participating in this market is increasing annually. Additionally, young individuals, with an average age of 35, represent a significant demographic within the medical aesthetics sector [ 9 ]. Social platforms have become the main position for medical aesthetics penetration, and users frequently participate in “body talk” through selfie sharing, body image comparison, and interaction on beauty topics, etc. [ 7 , 34 ], and the homogenized “objectification standard” has subconsciously influenced people's aesthetic values and promoted the construction of people's ideal appearance. People's construction of ideal appearance, which inadvertently accelerates the medical beauty into the public's view [ 8 ]. As a group sensitive to new things and in the critical period of self-perception formation, college students are easily influenced by social media and peer discussions, overly linking appearance to personal value and success, and viewing cosmetic surgery as a quick way to enhance their appearance. [ 29 , 48 ]. However, cosmetic surgery carries the potential risks of bruising, infection and chronic pain [ 20 ], which is something that the student population cannot effectively deal with, and can instead lead to negative emotions that need to be necessarily brought to the attention of society [ 22 , 23 ]. Existing studies have mostly focused on the direct association between social media use intensity and body dissatisfaction [ 2 ]. However, they often operationalize "social media exposure" as generalized metrics such as daily usage duration and login frequency, rather than specific interactive behaviors [ 7 ], failing to fully explore the mechanism of SNS body talk [ 7 , 34 ] which is inherently different from generalized use intensity. Furthermore, in analyzing the psychological pathways linking social media to cosmetic surgery intentions, existing literature mostly relies on single mediating variables [ 17 ], neglecting multi-stage progressive psychological transmission. Although some studies recognize gender differences in body image distress [ 29 ], against the backdrop of increasing male participation in medical aesthetics, few studies have systematically examined the moderating role of gender in the direct effect of the "SNS body talk—cosmetic surgery intentions" link [ 4 , 47 ]. Therefore, the influencing mechanism of college students' cosmetic surgery intentions remains unclear: existing studies lack a systematic analysis of the differences between generalized social media use and specific body talk, and have not fully explored multi-stage psychological mediating paths or gender differences. With the popularization of online socializing, social media platforms are flooded with a growing number of displays of body shape, appearance, and admiration for "perfect" images [ 15 ]. College students often further confirm the widening gap between their own appearance and mainstream aesthetics during SNS body talk, which exposes them to constant comparative pressure and further leads them to consciously or unconsciously conduct meticulous surveillance of their own bodies. Therefore, in the context of social media, high-frequency body talk may trigger individuals’ body surveillance. Based on Self-Regulation Theory (SRT), individuals adjust their behavior to achieve their goals by continuously monitoring the gap between their state and external standards [ 5 ]. In the context of social media, high-frequency body talk may trigger individuals to engage in body surveillance, i.e., to pay excessive attention to, scrutinize, and assess whether their appearance conforms to social expectations from an observer's point of view [ 26 , 45 ]. This kind of surveillance behavior is likely to trigger negative emotional feedback—appearance anxiety, which is manifested as dissatisfaction with one's own image and fear of negative evaluation [ 22 , 23 , 28 ]. If appearance anxiety is not effectively regulated over the long term, individuals tend to seek quick 'correction' methods to alleviate internal unease. Cosmetic surgery, which can significantly alter one’s appearance in a short period, is often regarded as the ultimate means to eliminate 'flaws' and restore self-confidence, thus increasing the likelihood of unnecessary cosmetic surger [ 44 ]. Based on this, this study proposes Hypothesis 1 (H1: SNS body talk is positively correlated with college students' cosmetic surgery intentions,Hypothesis 2 (H2: Body surveillance and appearance anxiety play a chain mediating role between SNS body talk and cosmetic surgery intentions. In addition, Gender as a Moderator Theory (GMT) states that [ 21 ] socio-culturally constructed gender role differences may shape an individual's sensitivity to appearance pressures. In traditional Chinese culture, due to long-term exposure to harsher "beauty discipline," women may exhibit stronger responses in body surveillance and anxiety levels to social media stimuli [ 25 ]. They also experience more prevalent negative emotions related to appearance comparison and body satisfaction, and are more prone to mental health issues such as eating disorders [ 37 ]. However, with the gradual awakening of men's self-aesthetic consciousness, men have also begun to pay attention to shaping a new image with individuality, and the proportion of their consumption in the medical aesthetic industry has been increasing year by year [ 4 , 47 ]. Studies have found that although men exhibit lower explicit body shame than women, content emphasizing "ideal male appearance" (e.g., muscular physique, three-dimensional facial features) on social media can still trigger men’s implicit body anxiety [ 29 ]. Moreover, due to the lack of social support for men’s appearance concerns, this anxiety is more likely to translate into cosmetic surgery intentions [ 3 ]. Based on this, this study proposes Hypothesis 3 (H3): Gender plays a moderating role in the direct path between SNS body talk and cosmetic surgery intentions. Exploring this issue requires not only clarifying the statistical associations between variables but also revealing the interaction logic of behaviors and emotions in real social scenarios, as a single research method has obvious limitations. Therefore, to address the existing research gaps, this study adopts an explanatory sequential mixed-methods design, providing supplementary evidence from text mining data of real social media platforms for the scale measurement data. Objects and methods Participants and procedures This study selected college students from four medical colleges and universities in Anhui Province as research participants, distributing questionnaires online via QQ and WeChat. Invalid questionnaires (with excessively short response times, overly regular answers, or obvious contradictions) were excluded, resulting in a total of 512 valid questionnaires, of which 104 are male and 408 are female; the average age is (20.16 ± 1.28) years old. To reveal behavioral patterns in real social interactions, this study conducted an online survey of social media data, including 1,139 posts, comments, and interactions related to body image. Themes associated with body image were identified by reading the posts or comments, and natural language processing (LDA) was used to extract body image-related keywords and analyze the correlations between them. Finally, a sentiment analysis tool (SnowNLP) was employed to analyze the emotional tendencies of the posts or comments. Research instruments SNS body talk Social Networking sites Body Talk Scale was compiled by Jones & Lee to measure an individual's level of SNS body talk [ 16 ]. Wu et al. [ 41 ] conducted translation, back-translation, and structural validation of this scale on a sample from mainland China, ultimately developing a complete Chinese version. Retaining all items and the three-factor structure of the original scale, this Chinese version demonstrated a Cronbach's α coefficient ranging from 0.88 to 0.95, with good test–retest reliability at the six-week follow-up. The scale consists of 5 entries and is scored on a 5-point Likert scale, where 1 = “never” and 5 = “always”, with higher scores representing a higher frequency of body talk on social media. Cronbach's α for this scale in this study was 0.893. Body surveillance The Body Surveillance subscale of the Chinese version of the Objectified Body Consciousness Scale translated by Jackson et al. was used [ 19 ], which consists of eight items to measure the extent to which individuals are concerned about their appearance and think about how their bodies look. The scale is scored on a 7-point scale from 1 (strongly disagree) to 7 (strongly agree). Higher scores indicate higher levels of self-objectification and monitoring of the body. Cronbach's α for this scale in this study was 0.781. The Acceptance of Cosmetic Surgery Scale (ACSS) This scale was developed by Henderson-King & Henderson-King [ 16 ], and the Chinese version was translated and revised by Wu et al. [ 40 ], which is used to measure an individual's willingness to undergo cosmetic surgery. A total of 15 items, categorized into social consideration and intra-personal dimensions, were used to assess attitudes toward cosmetic surgery. The scale was scored on a 7-point scale from 1 (strongly disagree) to 7 (strongly agree). After reverse scoring of item 10, the total mean score was used as the Cosmetic Surgery Acceptance Scale score, with higher scores implying a stronger willingness to undergo cosmetic surgery. Cronbach's α for this scale in this study was 0.946. Appearance anxiety In this study, the Appearance Anxiety Scale in Brief Version (AAS) developed by Dion et al. was used to measure the level of appearance anxiety in individuals [ 10 ]. The scale is scored on a 5-point scale from 1 (never) to 5 (almost always), and the total mean score is used as the Appearance Anxiety Scale score, with higher scores representing higher levels of appearance anxiety. Cronbach's α for this scale in this study was 0.862. Methods for analyzing actual social media data Data collection Based on the core variables of the quantitative study (body surveillance, appearance anxiety, and cosmetic surgery intentions), two social media platforms with high activity among college students—Weibo and Xiaohongshu—were selected. Using the built-in search functions of these platforms, posts, comments, and interactive content published by users were filtered with keywords including "body image", "body anxiety", "medical aesthetics", "cosmetic surgery", and "appearance evaluation" between May 2024 and May 2025. Data screening and collation First, content posted by non-college students was excluded. Second, posts irrelevant to the research theme were eliminated. Third, texts without substantive information (such as pure emojis and duplicate content) were removed, resulting in the retention of valid text data. For the "correlation analysis between user engagement and vocabulary frequency", posts with zero likes, comments, and reposts were further excluded, and the remaining data were used for this part of the analysis. All valid texts were imported into Nvivo 12 software for coding management to ensure the standardization of data collation. Implementation steps of analysis Thematic Analysis: The LDA model in Python was employed for keyword extraction and theme clustering of the texts. First, jieba word segmentation was used for text preprocessing (removal of stop words and punctuation marks). Then, the model was trained with the number of themes set to 4–6 categories. Combining semantic coherence and compatibility with the research theme, the core themes were finally determined. Sentiment Analysis: The SnowNLP tool was used to determine the sentiment tendency of the screened texts. First, the texts were converted into a unified encoding format, and sentiment scores (ranging from 0 to 1) were assigned using the tool’s built-in dictionary. With 0.3 and 0.7 as the cut-off points, sentiments were classified into three categories: negative (≤ 0.3), neutral (0.3–0.7), and positive (≥ 0.7). Subsequently, the sentiment distribution characteristics under different themes were statistically analyzed in combination with theme classification. Correlation Analysis: Standardized scores of likes, comments, and reposts were used as comprehensive indicators of user engagement. SPSS 25.0 was used to conduct Pearson correlation analysis between the frequency of core variable-related vocabulary (body surveillance, appearance anxiety, and medical aesthetics & cosmetic surgery) and engagement indicators. Statistical analysis SPSS 25.0 and PROCESS 3.5 plug-in were used for data analysis. A multi-dimensional identification framework combining the Mahalanobis distance method, residual indicators, and influence indicators was adopted for outlier analysis; variance inflation factor (VIF) and tolerance were used to test for multi-collinearity in the model; the Durbin-Watson (D-W) test was employed to verify the first-order autocorrelation of model residuals; Harman one-way method was applied to detect common method bias; Pearson correlation analysis clarified variable correlation [ 14 ]. Chain mediation and moderated effects were tested using Model 6 and Model 1, respectively, and 5000 samples were simulated by bootstrap method [ 18 ]. The results were significant if the 95% CI did not contain 0, and the test criterion α was set at 0.05. Results Outlier analysis results The maximum value of Mahalanobis Distance was 25.759 (> critical value 18.475), indicating the existence of 1 potential multivariate outlier; however, the maximum centered leverage value of this observation was 0.050 (close to the critical value ≈ 0.047, not significantly exceeding it), the maximum Cook's Distance was 0.016 (much lower than 0.5), and the range of standardized residuals was −2.073 ~ 2.166 (only a few were close to the ± 2 critical value). These results show that it is not an "influential point" and the overall data is not disturbed by significant outliers (see Table 1 ). Table 1. Outlier data analysis results for details Analysis Indicator Minimum Value Maximum Value Critical Value Mahalanobis Distance 0.984 25.795 18.475( df = 7, α = 0.001) Centered Leverage Value 0.002 0.050 0.047(3*(7 + 1)/512) Cook's Distance 0.000 0.016 0.5 Standardized Residual −2.073 2.166 ± 2 Open in a new tab Multicollinearity analysis results The VIF values of all variables were < 2, and the tolerance values were all > 0.65, which fully met the test criteria. There was no severe multicollinearity in the model, and all variables had good independence (see Table 2 ). Table 2. Multicollinearity results of the chain mediating model Variable Tolerance VIF Severe multicollinearity SNS body talk 0.826 1.211 NO Body surveillance 0.715 1.399 NO Appearance anxiety 0.683 1.464 NO Sex 0.935 1.070 NO Grade 0.958 1.044 NO Whether being an only child 0.962 1.039 NO Monthly family income 0.947 1.056 NO Open in a new tab Auto-correlation analysis results The results of the D-W test showed that the D-W value of the model was 1.948, which fell within the "ideal range" of 1.5 ~ 2.5. This indicates that there was no significant first-order auto-correlation in the residuals, satisfying the independence assumption of observations. Common method bias test Harman one-way test [ 46 ] was used to conduct unrotated principal component factor analysis for all the items included in the variables. The results showed that a total of eight factors had eigenvalues greater than 1, and the variance explained by the first factor was 27.44%, which was less than the critical value of 40% [ 36 ], indicating that there was no common method bias problem in this study. Descriptive statistics and correlation analysis of variables The mean, standard deviation and correlation coefficients of each variable are shown in Tables 3 and 4 , which shows that there is a two-by-two correlation between SNS body talk, body monitoring, appearance anxiety and cosmetic surgery intentions, and the correlation is significant. Table 3. Means, standard deviations, and correlation matrix of variables Variable M ± SD 1 2 3 4 1 SNS Body Talk 11.89 ± 4.19 1 2 Body Surveillance 29.04 ± 7.65 .391*** 1 3 Appearance Anxiety 39.85 ± 8.43 .330*** .533*** 1 4 cosmetic surgeryIntention 51.04 ± 17.71 .327*** .265*** .332*** 1 Open in a new tab * P < 0.05, ** P < 0.01, *** P < 0.001. The same notation applies below Table 4. Descriptive statistics and analysis of gender differences Variable Gender M ± SD T-value 1 SNS Body Talk Male 9.68 ± 2.73 6.244*** Female 12.45 ± 4.19 2 Body Surveillance Male 27.14 ± 8.12 2.843** Female 29.52 ± 7.46 3 Appearance Anxiety Male 38.16 ± 9.09 2.289* Female 40.27 ± 8.21 4 Cosmetic Surgery Intentions Male 45.15 ± 19.29 3.845*** Female 52.54 ± 16.99 Open in a new tab Chained mediation effect test SPSS25.0 was used to conduct the chained mediation effect test based on the PROCESS program prepared by Hayes. Model 6 was selected, and the sampling was repeated 5000 times, with SNS body talk as the independent variable X, cosmetic surgery intentions as the dependent variable Y, body monitoring and appearance anxiety as the mediator variables M1 and M2, and gender, whether it is an only child, grade, and monthly family income as the control variables at the 95% confidence interval. The results showed (Table 5 ): SNS body talk significantly and positively influence body surveillance ( β = 0.713, P < 0.001), appearance anxiety ( β = 0.320, P < 0.001), and cosmetic surgery intentions ( β = 0.807, P < 0.001). Body surveillance significantly and positively influence appearance anxiety ( β = 0.520, P < 0.001), and appearance anxiety significantly and positively influence cosmetic surgery intentions ( β = 0.501, P < 0.001). Table 5. Results of tests for mediating effects and moderating effects Variable Body Surveillance Appearance Anxiety cosmetic surgeryIntention cosmetic surgeryIntention β t β t β t β t SNS Body Talk 0.713 9.154*** 0.320 3.826*** 0.807 4.149*** 1.282 7.032*** Body Surveillance 0.520 11.765*** 0.147 1.285 Appearance Anxiety 0.501 4.908*** SNS Body Talk*Sex 1.063 2.371* R 2 0.164 0.320 0.193 0.124 F 19.867*** 39.644*** 17.160*** 23.956*** Open in a new tab All models included co-variates such as grade, whether being an only child, and monthly family income * P < 0.05, ** P < 0.01, *** P < 0.001 The bootstrap method was used to test the mediating effect, and the results (Table 6 ) showed that: the indirect effect value of the path with appearance anxiety as the mediating variable was 0.160 (95% CI [0.064, 0.284]), and the indirect effect value of the path with body surveillance and appearance anxiety as serial mediating variables was 0.186 (95% CI [0.100, 0.294]). The data indicated a serial association between SNS body talk, individuals’ body surveillance behavior, appearance anxiety, and cosmetic surgery intentions. However, the indirect effect value of the path with body surveillance as the sole mediating variable was 0.105 (95% CI [−0.076, 0.297]), with the confidence interval including 0. This suggests that body surveillance alone cannot establish a significant association between SNS body talk and cosmetic surgery intentions; instead, it needs to form a serial path with appearance anxiety to exert a notable correlational effect. Based on the above results, this study meets the criteria for partial mediating effects. Table 6. Results of the chained mediation effect test Path Standardized Indirect Effect Value Standard Error 95%CI Lower Bound Upper Bound Total Indirect Effect 0.451 0.102 0.261 0.654 SNS Body Talk → Body Surveillance → Cosmetic Surgery Intentions 0.105 0.095 −0.076 0.297 SNS Body Talk → Appearance Anxiety → Cosmetic Surgery Intentions 0.160 0.057 0.064 0.284 SNS Body Talk → Body Surveillance → Appearance Anxiety → Cosmetic Surgery Intentions 0.186 0.050 0.100 0.294 Open in a new tab *** P < 0.001; The 95% CI was calculated using the Bootstrap (with 5000 resamplings). A path effect is significant if the interval does not contain 0, and has no statistical significance if the interval contains 0 Moderating effect test Model 1 was used to test the moderating effect of gender in each variable, and the results showed (Table 5 ): the moderating effect of gender on the relationship between SNS body talk and cosmetic surgery intentions was significant ( β = 1.050, t = 2.347, P < 0.05, 95% CI [0.171–1.929]), and the moderating effect on the rest of the path was not significant. The simple slope test was used to further clarify the moderating effect of gender, and the results showed (Figs. 1 , 2 ): In the male college student group, SNS body talk had a significant positive influential effect on cosmetic surgery intentions (simple slope = 2.087, t = 5.241, P < 0.001). In the female college student group, SNS body talk also had a positive influential effect on cosmetic surgery intentions, but the effect was weaker (simple slope = 1.037, t = 5.038, P < 0.001). The sample size of the male subsample in this study was relatively limited (n = 104), which may have affected the statistical test power and the stability of the results to a certain extent. Therefore, the findings of this study can only serve as a reference for subsequent research. Fig. 1. Open in a new tab Map of moderating effects of gender in SNS body talk and cosmetic surgery intentions Fig. 2. Open in a new tab The effect of SNS body talk on college students' willingness to undergo cosmetic surgery: a moderated chain-mediated model diagram Actual social media data analysis This study was conducted on the college student forums of Weibo and Xiaohongshu, two major social media platforms in China. By searching for keywords related to “body image”, the system collected and analyzed 1,139 valid data, including posts, comments and interactive content. Thematic analysis Thematic analysis of 1,139 social media posts related to body image yielded the following four major themes: appearance anxiety and body image, medical aesthetics and cosmetic surgery, consumerism and aesthetic environment, and social-emotional experience. Sentiment analysis The results of the sentiment analysis of 1,139 posts using the Chinese sentiment analysis tool SnowNLP showed a positive sentiment tendency (30.6%), a neutral sentiment tendency (17.6%), and a negative sentiment tendency (51.8%), which are shown in Fig. 3 . Fig. 3. Open in a new tab Sentiment analysis chart of social media talk among college students Correlation analysis In this study, the number of likes, comments and retweets were used as indicators of user engagement. After excluding posts with zero engagement on all three metrics, a total of 771 valid posts were included for analysis.Pearson correlation analysis showed that the number of retweets of the same post was strongly positively correlated with the number of comments ( r = 0.483, P < 0.001), and weakly positively correlated with the number of likes ( r = 0.071, P < 0.05); the number of comments and the number of likes were also positively correlated ( r = 0.088, P < 0.05). In addition, the frequency of the social media body conversation category of vocabulary was significantly and positively correlated with the frequency of the appearance anxiety category of vocabulary ( r = 0.349, P < 0.001), with the frequency of the body monitoring category of vocabulary ( r = 0.698, P < 0.001), and with the frequency of the medical cosmetic surgery category of vocabulary ( r = 0.356, P < 0.001); The frequency of words in the physical monitoring category was positively correlated with the frequency of words in the appearance anxiety category ( r = 0.278, P < 0.001) and significantly positively correlated with the frequency of words in the medical cosmetic surgery category ( r = 0.195, P < 0.001); the frequency of words in the appearance anxiety category was significantly positively correlated with the frequency of words in the medical cosmetic surgery category ( r = 0.552, P < 0.001); and a positive correlation with the number of comments ( r = 0.089, P < 0.05). This result is consistent with the findings of the present study, serving as supplementary evidence, but it does not allow for the direct validation of the theoretical model. Discussion This study constructed a moderated chain mediation model to examine the effects of SNS body talk on college students' cosmetic surgery intentions, and also examined the chain mediation roles of body monitoring and appearance anxiety between SNS body talk and cosmetic surgery intentions as well as the moderating effect of gender, revealing the mechanism of SNS body talk on college students' cosmetic surgery intentions. This study found that SNS body talk significantly and positively influence cosmetic surgery intentions, and hypothesis 1 was supported. This result indicates a significant positive correlation between social media body talk and cosmetic surgery intentions. The results of previous studies have suggested that [ 6 ] the main topics of body talk include: ideal appearance, fear of being overweight, eating and exercise habits, and evaluations of others' appearance, all of which show a significant correlation with individuals' internalization degree of ideal body standards and their level of body image dissatisfaction. Social media expands the spread of body talk, and the characteristics of this spread are associated with widespread pressure perception at the social level. Menzel's three-factor model of cosmetic surgery intentions [ 27 ], which suggests that media, peers, and family are the main factors influencing an individual's cosmetic surgery intentions, fits with the concept of SNS body talk. Thus, this study can further reveal that SNS body talk has a significant positive correlation with cosmetic surgery intentions and can serve as an important associated factor for understanding the stress perception related to cosmetic surgery intentions. Hypothesis 2 was supported by this study's finding that body monitoring and appearance anxiety chain-mediated the relationship between SNS body talk and cosmetic surgery intentions. Although SNS body talk can directly influence college students' willingness to undergo cosmetic surgery, the specific mechanisms involved still need to be dissected. According to the self-objectification framework [ 13 ], high-frequency body talk on social media is associated with individuals' body surveillance behavior, and there may be two associated pathways: first, the characteristic of placing the body as an evaluable "object" in public discussions is positively associated with individuals' degree of internalization of external aesthetic standards and level of perceived body defects [ 33 ],second, the visibility and interactivity of body-related topics are positively associated with the level of social comparison (especially upward comparison, and all three are associated with individuals' tendency to choose cosmetic surgery to bridge the self-gap [ 11 ]. It is worth noting that the influential effect of SNS body talk on cosmetic surgery intentions may be moderated by individual differences. Individuals with a high tendency toward self-objectification, exposure to body evaluation information on social media [ 38 ], and the level of generalized appearance anxiety are all positively associated with cosmetic surgery intentions and behavioral tendencies [ 43 ]. Users with higher media literacy or self-esteem have a negative association between their level of critical cognition and their perceived degree of negative impact from such information [ 24 ]. This also confirms that body monitoring could not partially mediate between SNS body talk and cosmetic surgery intentions in this study, but rather needed to chain mediate cosmetic surgery intentions through appearance anxiety. Studies have also shown that men’s cosmetic surgery motivations are more closely associated with factors such as confidence enhancement and alignment with professional images, rather than mere appearance-focused body surveillance. This may have weakened the direct effect of body surveillance in the overall sample [ 35 ]. Therefore, when addressing the issue of college students' cosmetic surgery, attention can be paid to the detailed changes in their cognitive and behavioral aspects as well as their individual psychological motivations,these two aspects may provide references for selecting the timing of psychological and behavioral interventions [ 42 ]. This study reveals the moderating role of gender in the relationship between SNS body talk and willingness to undergo cosmetic surgery, and finds that the male group exhibits a stronger effect strength compared to females, which is inconsistent with the findings of previous studies [ 1 ]. From a correlation perspective, the correlation state among the repeated exposure of muscle-oriented visual symbols through algorithmic recommendations, male users' participation in body talk, and cognitive conflict may be a relevant factor for the gender difference in effect strength [ 31 , 32 ]. Specifically, the frequency with which men are exposed to idealized body images on social media, their perceived deviation from the social expectation that "masculinity should stem from internal abilities rather than appearance modification," their level of psychological imbalance, and their tendency toward compensatory motivation to achieve body control through cosmetic surgery all show a positive correlation [ 30 ]. This finding challenges the presupposition that traditional objectification theory focuses primarily on female groups, suggesting that the phenomenon of male body objectification in the digital age may be systematically underestimated. Thus, it is necessary to pay attention to male college students' social media information exposure and cosmetic surgery-related psychobehavioral states. However, the findings of this study may also be related to the imbalance in the gender ratio of the subsamples (104 males and 408 females), and further exploration of gender differences is needed in future research. The results of the analysis of 771 actual social media data effectively supplement the conclusions drawn from the survey analysis. The frequency of medical aesthetic and cosmetic surgery-related vocabulary shows a strong correlation with the frequency of body surveillance and appearance anxiety-related vocabulary. This suggests that in the social media environment, there may be a positive correlation among four factors: body talk, individuals' tendency to view their own bodies from others' perspectives, body surveillance levels, and appearance anxiety levels. This is consistent with the study by Wasylkiw & Williamson [ 39 ]. The positive correlation between the frequency of occurrence of words in the body monitoring category and the positive correlation between words in the appearance anxiety category and words in the medical cosmetic surgery category further illustrates the important role of body monitoring in this process. The frequency of individuals' body surveillance, the degree to which they perceive the gap between their own appearance and social standards, their level of appearance anxiety, and their tendency to consider improving their appearance through medical aesthetic cosmetic surgery all show a positive correlation [ 12 ]. Meanwhile, the frequency of appearance anxiety-related vocabulary is positively correlated with the number of comments, which suggests that discussions about appearance anxiety on social media are associated with others' attention and commenting behaviors, and the two may form an interactive cycle. In summary, by analyzing measured variables and social media post data, this study illustrated the close association between SNS body talk, body surveillance, appearance anxiety, and cosmetic surgery intentions, providing strong empirical support for an in-depth understanding of the influencing mechanism of college students' cosmetic surgery intentions. Limitations and future directions Although this study revealed the association and influencing mechanism between SNS body talk and college students’ cosmetic surgery intention through a mixed-methods research approach, it still has certain limitations. This study adopted cross-sectional survey data, which can only verify the correlational, mediating, and moderating relationships among variables but cannot clarify the causal direction between them. Future research should adopt a longitudinal tracking design to explore the dynamic influence trajectory of variables. The samples were selected from students of 4 medical colleges and universities in Anhui Province, with an imbalanced gender ratio, which may affect the representativeness and generalizability of the results. Subsequent studies need to expand the scope of sample sources and balance the sample distribution across different genders, majors, and regions. This study initially tested common method bias using Harman’s single-factor test; however, this method has limitations and cannot fully eliminate such bias. Future studies may adopt more robust methods like the confirmatory factor analysis (CFA) marker variable method to further improve data validity. Additionally, social media data only covered platforms such as Weibo and Xiaohongshu, excluding commonly used platforms by young people such as Douyin and Bilibili. Future research can expand the channels and scope of data collection. Conclusions The study found that SNS body talk not only has a direct positive association with college students’ cosmetic surgery intention but also exerts an indirect association with it through the serial mediation path of “body surveillance → appearance anxiety.” Gender plays a moderating role in the direct path between SNS body talk and cosmetic surgery intention, with a stronger associative effect observed among male students. These findings not only provide a new media-level interpretation for objectification theory and expand the regulatory association mechanism of self-regulation theory in the non-achievement goal domain but also suggest that colleges and universities should implement social media literacy education and add appearance anxiety counseling services. Social media platforms need to optimize algorithms and promote diverse aesthetics, while families and society should guide comprehensive self-cognition and regulate medical beauty publicity, jointly helping college students establish healthy aesthetic perceptions and self-cognition. Acknowledgements None. Abbreviations AAS Appearance Anxiety Scale (Brief Version) ACSS Acceptance of Cosmetic Surgery Scale CFA Confirmatory Factor Analysis D-W Durbin-Watson GMT Gender as a Moderator Theory LDA Latent Dirichlet Allocation SIE Standardized Indirect Effect SNS Social Networking Sites SRT Self-Regulation Theory VIF Variance Inflation Factor Authors’ contributions Conceptualization: Ruicong Yu and Jiayi Ruan; Methodology: Yaqi Mei; Formal analysis and investigation: Cuirong Xu; Writing – original draft preparation: Ruicong Yu and Jiayi Ruan; Writing – review and editing: Ruicong Yu and Jiayi Ruan; Supervision: Cuirong Xu and Yaqi Mei. All the authors have read and agreed to the published version of the manuscript. Funding The present work was funded by the Provincial College Students Innovation and Entrepreneurship Training Program (S202210366082), Key Projects of Research of Anhui Provincial Department of Education Higher Education (2022AH050720), the Research Incubation Program of College of Nursing, Anhui Medical University (hlpy20210020), and the Key Medical Research Project of Jiangsu Provincial Health Commission ( ZD2022057). Data availability The data that support the findings of this study are available on request from the corresponding author. Declarations Ethics approval and consent to participate This study was approved by the Bioethics Committee of Anhui Medical University (No. 83242377). All procedures conducted in this study strictly followed the institutional and/or national research committee and respected the principles of the Declaration of Helsinki. Before data collection, we provided the participants with written informed consent, including a brief description of the research project, and informed the participants that any information provided would be kept confidential and their names would not be recorded. This study was conducted in accordance with the Declaration of Helsinki, and participation in the research was voluntary. Participants' answers would only be used for research purposes, and they could stop participating at any time without punishment. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Ruicong Yu and Jiayi Ruan contributed equally to this work. References 1. Adams KE, Tyler JM, Calogero R, et al. 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