A 2024 American Journal of Surgery systematic review places cosmetic surgery regret at roughly 5—33% depending on procedure type: breast augmentation sits at the low end (5—9%), body contouring at the high end (11—33%). That review does not compute a single cross-procedure average, so we estimate ~10% as a conservative editorial estimate near the lower-middle of that range for elective cosmetic procedures, not a computed midpoint. A companion 2023 PMC narrative summary of the decision-regret literature does not add its own numeric range but corroborates which factors drive regret (see below); the AJS review itself reports rates only. On the inaction side, no large-sample survey directly measures regret about not having cosmetic surgery. General body-dissatisfaction data (37% of Americans per Ipsos) and cosmetic-consideration rates (70% per ASDS) suggest that a non-trivial minority of non-patients harbor lasting appearance dissatisfaction, but the 7% inaction figure is a ceiling proxy — the Ipsos-reported share who say they would be willing to undergo cosmetic surgery to achieve their ideal body — not a measured regret rate or a survey finding about regret.
The pattern runs counter to the classic Gilovich finding. For most life decisions, inaction regret dominates over time: people regret the degree not pursued, the trip not taken, the relationship not attempted. Cosmetic surgery inverts this because the action is irreversible, physically invasive, and financially costly. A rhinoplasty that narrows the bridge too aggressively cannot be fully undone; a breast augmentation that causes capsular contracture is a daily reminder. The 2023 PMC review of the decision-regret literature (not the 2024 AJS review, which reports rates only) identifies inadequate preoperative education, limited use of decisional tools, and postoperative complications as the strongest predictors of regret — suggesting that the action-regret rate is substantially reducible through better screening and counseling.
The main caveat is the asymmetry of evidence. The action side has genuine peer-reviewed systematic reviews with procedure-specific breakdowns. The inaction side has essentially nothing: body dissatisfaction surveys measure a different construct, and ASDS consideration rates conflate casual curiosity with genuine surgical intent. The 7% inaction figure used here is a ceiling proxy — willingness to undergo cosmetic surgery, not a measured regret rate. If a rigorous survey ever asks a representative sample of non-patients “Do you regret not having cosmetic surgery?”, the true figure could be higher or lower — and the direction of the Gilovich pattern could flip. Until then, the delta (0.03) should be read as roughly balanced with a slight tilt toward action regret, not as a precise quantitative claim.