Cosmetic surgery is an extreme form of modern grooming. Its growth and progressive normalisation has been paralleled by increased interest, and frequent alarm, from within the academy. Social historians have located cosmetic surgery's ascendancy within the technological trajectory of medicine, set against a social world fascinated with appearance. Feminists have argued cosmetic surgery is a tool of patriarchy which oppresses and subjugates women, while sociologists have examined cosmetic surgery as a medical discourse and a form of consumption. This study took a grounded approach to engage thirty women through in-depth interview to explore how they chose cosmetic surgery as an option. Their accounts frame a theoretical discussion which proposes cosmetic surgery is initiated within the vulnerable and divisive relationship between the self and its poor body image. Participants dismissed the widely held belief that media is to be blamed for distorting the relationship women have to their appearance, choosing instead to locate the source of their discontent much closer to home. Following the work of the psychoanalyst, Paul Schilder (1950), and the sociologist, Charles Horton Cooley (1962), body image is interpreted as an ongoing process constructed in social interaction with significant others. This study examined the way in which these interactions contribute to poor body image. Poor body image and the attempt at its reparation are examined conceptually through shame and narcissism to expand upon a sociological understanding of body image and its relationship to cosmetic surgery. By engaging data and theorists from multiple disciplines this study found that shame constitutes a framework within which we formulate appearance norms and learn the art of becoming socially embodied. Shame exposes the material body and the ways in which we manage its margins. Shame concerns the self, but it arises in response to perceived social phenomena. Through the evaluation and amendment of body image with cosmetic surgery, notions of self and social worthiness are played out. As this study progressed, the relationship between shame and narcissism emerged as increasingly significant. This study concludes by arguing for a review of the way in which we understand narcissism and proposes that shame is directly implicated in its manifestation