External motivators for cosmetic surgery include the desire to avoid ethnic prejudice; fear of age discrimination; and direct or subtle, indirect coercion by a spouse, parent or boss. Internal motivators include the desire to diminish unpleasant feelings of depression, shame or social anxiety; the wish to alter a specific disliked feature; the yearning for a more youthful, healthy look that signals fertility (usually in women); and the hope to create a strong, powerful appearance that will facilitate career advancement.