Dear Sir,

In our second reply to the comments on our article(1) by Chua and Li,(2) we emphasise that our study indeed compared the difference in responses between junior college and medical school students. There are inherent differences in the ages of the two groups of participants. In trying to study the effect of education level on attitudes towards cosmetic surgery, it is difficult to completely eliminate the confounding effect of age, even with randomisation, which Chua and Li suggested. It is also artificial to attempt to do so, as in Singapore and most of the world, a higher education level is associated with older age. We are of the opinion that careful comparison of the results of our study with that of other studies is hypothesis generating, even though the designs of our studies may carry differences. We have pointed out the limitations of our study in our original article, some of which have been reiterated by Chua and Li in their comments.(2,3) Nonetheless, we hope that the hypotheses generated by our study will inspire other relevant research on this topic.

Yours sincerely,


References
Ng JH, Yeak S, Phoon N, Lo S. Cosmetic procedures among youths: a survey of junior college and medical students in Singapore. Singapore Med J. 2014;55:422-6.
Chua SJ, Li J. Comment on: Cosmetic procedures among youths: survey of junior college and medical students in Singapore: part 2. Singapore Med J. 2015;56:65.
Chua SJ, Li J. Comment on: Cosmetic procedures among youths: survey of junior college and medical students in Singapore. Singapore Med J. 2014;55:552.