Why do people consider cosmetic surgery? Based on the terror management theory, the present research identifies an existential motive: Through cosmetic surgery, people can symbolically defend against their death anxiety. A correlational study and an experiment showed that death terror, whether operationalized as individual differences in fear of death or experimentally manipulated mortality salience, was associated with stronger acceptance of cosmetic surgery. This association was absent among participants who did not consider physical appearance important, and weaker among those who were satisfied about their appearance. Also, this association was particularly strong among those with high explicit self-esteem. This concurs with the recent theoretical development about the role of self-esteem in symbolic defenses against death terror.