<p>The Japanese art of kintsugi—repairing broken ceramics with gold—offers a philosophical framework for reconceptualising aesthetic plastic surgery. Rather than concealing damage, kintsugi uses precious metal to honour an object’s history of breakage, creating beauty through respectful repair. Together with wabi-sabi, the aesthetic philosophy that celebrates imperfection and transience, kintsugi challenges surgical practice to move beyond the pursuit of standardised perfection. This perspective examines how these Japanese aesthetic philosophies can inform contemporary surgical practice, from patient consultation through outcome evaluation. The framework draws on the convergence between kintsugi philosophy, film-maker Guillermo del Toro’s artistic vision, and clinical observations about the psychological dimensions of aesthetic concerns—particularly the role of childhood appearance-related injuries in shaping patients’ relationships with their features. While not all patients carry such histories, deepened consultation practices that explore the context of aesthetic dissatisfaction may improve patient selection and long-term satisfaction. Seven principles adapted from Juniper’s interpretive wabi-sabi framework—including kanso (restraint), shizen (naturalness), and seijaku (tranquillity)—provide operational guidance for surgical planning and outcome evaluation. The metaphor’s value is acknowledged as heuristic rather than literal: surgery modifies tissue, whereas kintsugi preserves structure, but the productive tension between these processes prompts clinically important questions about identity preservation, ethnic authenticity, and the limits of intervention. The framework prioritises ethnic identity preservation and age-appropriate enhancement over beauty ideals driven by social media homogenisation, positioning aesthetic surgery within the broader human project of healing and self-reconstruction.</p><p><i>Level of Evidence V</i> This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a></p>