The use of cosmetic surgery and procedures has sharply increased in recent years. This paper outlines an object-relational framework for understanding the unconscious fantasies that may drive the pursuit of body modification and proposes three categories of such fantasies. For some individuals, the pursuit of “beauty” through cosmetic surgery provides a psychic retreat from the reality of dependency as the self retreats into believing that it can create itself (the self-made fantasy). For others, it is a means for creating a felt-to-be ideal self thereby averting the pain of the loss of an object that would love and desire the self (the perfect-match fantasy). For still others, it may be the only means of expelling an object felt to be alien or polluting that is unconsciously identified with the body (the reclaiming fantasy).