Abstract Background Cosmetic surgery is shaped not only by physical concerns but also by psychosocial factors such as body perception, self-esteem and relationship satisfaction; however, despite the increasing demand, the interaction of these factors is not sufficiently explained in the literature. This study aims to examine the mediating effect of self-esteem and relationship satisfaction on the relationship between body perception and surgical demand in young adults scheduled for plastic surgery. Methods This cross-sectional and multivariate correlational study was conducted in the Plastic and Reconstructive Surgery Clinic of a public hospital between March 2024 and March 2025. The study was conducted with 547 volunteer individuals. The research was structured within the framework of the Psychosocial Well-Being Model. Data were collected by face-to-face interview technique using the Patient Identifying Information Form and Aesthetic Surgery Acceptance, Body Perception, Rosenberg Self-Esteem and Relationship Satisfaction Scales. Statistical analyses were performed with SPSS and JAMOVI programs. Results Aesthetic surgery acceptance, body perception, self-esteem and relationship satisfaction levels were found to be 89.79 ± 3.41, 82.32 ± 6.15, 26.42 ± 2.09 and 14.62 ± 2.43 points, respectively. According to the results of the parallel equation model, body perception affects surgical acceptance both directly (β = 0.0932, p < 0.001) and indirectly through self-esteem (β=-0.0261, p = 0.021) and relationship satisfaction (β = 0.0169, p = 0.016). Body perception positively affects self-esteem (β = 0.1342, p < 0.001) and relationship satisfaction (β = 0.0952, p < 0.001), while an increase in self-esteem decreases acceptance of surgery (β=-0.1942, p = 0.018) and increases relationship satisfaction (β = 0.1771, p = 0.008). The total effect was significant in the model (β = 0.0840, p < 0.001). Conclusions The level of acceptance of plastic surgery is significantly related to psychosocial factors such as body perception, self-esteem and relationship satisfaction. While body perception directly and indirectly affects surgical demand, high self-esteem decreases surgical interest, and relationship satisfaction increases it. These findings suggest that aesthetic decisions are determined by psychological and social factors as well as physical. Trial registration: Not applicable.
Gülşen et al. (Mon,) studied this question.