Cosmetic surgery has become increasingly popular in the past 15 years, and even seems to be common practice. The overall picture communicates that people profit from these interventions. Generally, people wish to alter their appearance when they are dissatisfied about their body image and when appearance determines their self-esteem to a great extent. Body image disturbances, such as body dysmorphic disorder (bdd), are situated within the extreme dissatisfaction range. Bdd is a serious disorder which is characterised by a preoccupation with an imaginary defect in appearance or an excessive concern about a slight physical abnormality. Patients can be effectively treated with cognitive behavioural therapy or a serotonin reuptake inhibitor, but most of them are convinced that cosmetic surgery is the only answer. Surgery outcome is often disappointing, however. This article aims to summarise the literature about cosmetic surgery and bdd and argues that cosmetic surgery patients should be screened psychologically to detect whether they have bdd. Results of a pilot study are presented to underpin this claim. (netherlands journal of psychology, 62, 34-41.).