Western ideals of beauty already permit individual to endure intense physical pain in order to achieve sexual gratification  The idealization of physical beauty within American and European culture has created a demand for increasingly interventionist forms of cosmetic enhancement. Women and men are prepared to pay hundreds of thousands of pounds to have their faces, breasts and genitals maimed and modified by surgeons, to have their skin bleached or their facial muscles temporarily paralyzed by “beauticians” and to be badgered, bullied and blackmailed into complying with restrictive diets and extensive regimes of physical exertion by domineering personal trainers. Except in the most extreme and obvious cases of emotional or psychological disturbance, adults are automatically assumed to be capable of consenting to these acts.  Further, the western ideal of physical beauty is closely associated with the cultural norms that influence and control sexual attraction, compatibility and enjoyment. The erotic is almost inextricably linked with the aesthetically idealized. The intense pain and extensive physical injuries that individuals endure in the pursuit of physical beauty are also endured in the pursuit of sexual gratification.  The risks inherent in invasive cosmetic treatments are poorly explained. The expense of these products and services and the pervasiveness of idealized physical forms combine to create parallel markets comprising cheaper, poorly regulated forms of “beauty enhancement”, including intensive tanning and skin bleaching lotions.  The ultimate objective of these physically painful and dangerous activities is sexual pleasure. Even if the heightening of sexual pleasure that results from physical modification is less direct than in a sadomasochistic encounter, many cosmetic surgery patients find the aesthetic pleasure attendant on successful surgery to be satisfying too.  It seems hypocritical and perverse for a supposedly liberal system of law to allow individuals who are openly pursuing a sexual objective to consent to the harms and risks of cosmetic surgery, while limiting the legality of sadomasochistic acts. Both activities have the same underlying purpose, and both produce dangerous externalities. Rational, consenting adults should have as much freedom to engage in S&amp;M play as they currently have to submit to cosmetic surgery.