OBJECTIVE: To explore, among middle-aged women, the relationship between having ever had cosmetic surgery and the frequency of use of other health services. DESIGN: Retrospective analysis of cross-sectional survey data from the Women's Health Australia (WHA) study. SETTING AND PARTICIPANTS: A nationally representative sample of the "mid-aged" (45-50 years) cohort of women who participated in the 1996 WHA baseline postal survey. Responses were received from 14 100 women (a response rate of 54%). RESULTS: Seven per cent of women reported ever having had cosmetic surgery. After adjusting for demographic variables, multivariate analysis confirmed that women who had had cosmetic surgery were significantly more likely to use health services more frequently (eg, surgical procedures, consultations with specialists and alternative healthcare providers). Cosmetic surgery was also associated with a greater number of chronic illnesses and use of medication for anxiety and sleep problems. CONCLUSION: Further research is needed to determine whether cosmetic surgery is directly related to health conditions or to attitudinal or psychosocial variables. Such research should examine whether alternative interventions may be more cost-effective in dealing with the issues that motivate women to seek cosmetic surgery.