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Background: This study examined adolescent girls’ willingness to undergo cosmetic procedures and the appearance features they most wanted to modify across four diverse regions: Australia, China, India, and Iran. Despite its potential risks, appearance enhancement procedures have become increasingly prevalent among adolescents. Adolescence is a critical developmental period marked by heightened body awareness of sociocultural ideals of appearance and increased vulnerability to dissatisfaction with appearance (Rapee et al., 2019). Prior research has shown that being unhappy with one’s appearance is associated with a greater willingness to undergo cosmetic procedures (Markey & Markey, 2009). Yet much of the body image literature has been conducted in high-income, English-speaking, Western contexts, limiting understanding of how cultural context shapes adolescents’ attitudes toward appearance enhancement. The present study explored adolescent girls' willingness to undergo cosmetic procedures and the features they would like to modify across four diverse regions: Australia, China, India, and Iran. Methods: Participants were 900 adolescent girls aged 14-17 years living in Australia (n = 184), China (n = 294), India (n = 222), and Iran (n = 200). Surveys were conducted in English, Chinese, and Persian. Data was collected from 2018 to 2020. The survey assessed participants’ willingness to undergo cosmetic procedures in the future. Separately, participants were asked to list and rank the aspects of their appearance they would most like to change through such procedures. Findings: Australian girls reported having the highest willingness to undergo cosmetic procedures, followed by girls in India, Iran, and China. A pattern emerged among participants: a desire to change at least one aspect of their appearance. Girls from China, India, and Iran mostly preferred enhancing facial features, whereas Australian girls were interested in altering both facial and bodily features. Across all countries, nose surgery was the most desired procedure. Some preferences also appeared to be culture-specific. Iranian girls showed greater interest in eye enhancement procedures, girls in India and China reported stronger preferences for laser hair removal, and Australian girls showed greater interest in breast surgery. Discussion: These findings highlight both shared and culture-specific patterns in adolescent girls’ interest in cosmetic procedures. Interest in modifying certain features, such as the nose, may reflect broader ideals of appearance, whereas variation in other preferences may point to the influence of local beauty norms. By examining four distinct cultural contexts, this study moves beyond the Western focus of much existing body image research and underscores the importance of culturally responsive interventions that address appearance concerns in ways that are sensitive to local ideals and pressures. Keywords: adolescence, cosmetic procedures, enhancement, appearance