The decision‐making process underlying cosmetic surgery for esthetic purposes has been rarely investigated. To fill in this gap, we examined the determinants of undergoing plastic surgery among women within a framework that considers that the intentions to undergo and to not undergo surgery are related to different motivational systems that could both contribute to behavior. To do so, we assessed the goals underlying both options and theory of planned behavior constructs (Attitude, Perceived Behavioral Control, Subjective norms) related to undergoing and not undergoing plastic surgery as well as risk perception among a convenience sample of women (N = 265). Results confirmed that undergoing and not undergoing plastic surgery are related to different but not opposite goals. More importantly, both intentions predicted actual behavior but with the intention of not undergoing weighing more than the intention of undergoing plastic surgery. Finally, results supported previous research showing that risk perception does not add to predicting behavior. This contribution, therefore, supports the adoption of a decision‐making framework to provide additional information to individual and social factors that can explain why women are undergoing plastic surgery for esthetic purposes or not.