Background: The relationship between body image and cosmetic surgery represents a new generation of research on the psychological aspects of cosmetic surgery. Objective: This preliminary study intends to investigate the role of distress relating to body image in conditioning the levels of post-operatory patient benefit both the impact of cosmetic surgery on the state of psychological well-being and body image through the analysis of the differences between the pre and post-operative stages. Methods: The study lasted 12 months and it occurred in two stages, a pre-operative stage (N=85) and a post-operative stage (N=85). The patients, subjected to different aesthetic operations, were administered the Body Uneasiness Test, Psychological General Well-Being Index -Short version in both the stages and the Glasgow Benefit Inventory in the post-operative phase. Results: The post-operative patient benefit was conditioned by the existence of clinically significant distress related to body image in the pre-operative stage, in accordance with the degree of severity; the operation had a positive impact on both the state of distress linked to psychological well-being and that relating to body image but, in the latter case, the improvement of distress depends on severity; all the patients with a body image disorder in the pre-operative stage continued to show this even after 12 months. Conclusions: A careful assessment of body image and its disorders in the stage before the operation may allow the identification of patients who may be dissatisfied by the outcome of the operation.