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We read with great interest Ng et al’s(1) reply to our letter. It is true that Javo and Sørlie’s(2) study cohort did have differences in age and maturity, but the study used the method of randomisation in selecting the participants in order to reduce the effect of age and maturity as confounding factors. On the other hand, a direct comparison between junior college and medical school students was drawn in Ng et al’s study.(3) Besides that, Javo and Sørlie’s(2) study cohort only included females, making it difficult to compare with Ng et al’s study,(3) which included both genders, as different genders have different perceptions toward cosmetic surgery.(4) We would also like to note that according to a statement by the Ministry of Education, Singapore, universal education (i.e. compulsory education) is only provided up to secondary school,(5) after which the levels of education can differ greatly. These differences can be seen in the Statistics Singapore March 2013 report, “Educational Profile of Singapore Resident Non-Students, 2002–2012”.(6) The study sample by Ng et al(3) focused on junior college and medical school students (i.e. after secondary school).