Appearance-based Rejection Sensitivity (Appearance-RS) is the dispositional tendency to anxiously expect, readily perceive, and overreact to rejection based on one's physical appearance. The present research examined associations among Appearance-RS, self-reported symptoms of Body Dysmorphic Disorder (BDD), and motivations underlying acceptance of cosmetic surgery among a sample of American college students. Appearance-RS predicted greater self-reported BDD symptoms and endorsement of cosmetic surgery for both intrapersonal and social reasons. Results remained significant even after controlling for appearance satisfaction, fear of negative evaluation, general rejection sensitivity, and depressive symptoms. This research therefore highlights the importance of considering individual differences in sensitivity to appearance rejection when examining body image disturbances, such as self-reported symptoms of BDD, and reasons for endorsing cosmetic surgery.