PurposeThis article investigates how medical specialists as professionals and elective cosmetic surgery tourists as consumers relationally negotiate decisions within the cosmetic surgery clinic. Drawing on a Goffmanian approach, this article explores the processual social structures that shape consumer logics in the clinic as a social space and as a type of professional institution.Design/methodology/approachThis article is based on ethnographic fieldwork in cosmetic surgery clinics in South Korea.FindingsThis article identifies two genres of professional strategies (spatial arrangements and dramaturgical performances) that are leveraged by medical specialists to assert control over and persuade consumers to purchase cosmetic surgery.Research limitations/implicationsThe valorization of surgery captured in this article suggests that surgical modifications may serve as another vehicle for entrenching class inequality between those able and those unable to afford surgery.Practical implicationsThis article offers recommendations for future policymaking in terms of the regulatory oversight of the consumer profiles eligible for surgery and the marketing practices of clinics.Originality/valueThis article offers a micro-level account of how the high-risk good of cosmetic surgery is sold by medical specialists in charismatic and affective bids to enhance their legitimacy, authority and trust.