This chapter draws on fieldwork data by analysing cosmetic and reconstructive surgery standards with the aim of identifying and analysing the criteria used today to grant or deny certain types of surgical interventions which do not emerge from the medical necessity to address physiological dysfunctionalities. The ethical complexities of bodily modification interventions are intertwined with the medical decision-making capacity of the individual, and the evidence-based approach to surgery is contrasted with those instances in which the surgery aims at addressing psychological states rather than physiological ones. The chapter takes on the topic of how societal norms influence perceptions of physical appearance and how normative standards are often used as a main access point for the surgeon to evaluate the legitimacy of bodily modification requests. A key area is the surgeon’s assessment of whether patients are mentally and emotionally prepared, ensuring they have realistic expectations and are making informed decisions.