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This article examines the role of cosmetic surgeons as cosmopolitan intermediaries in transnational cultural flows. Drawing on semi-structured interviews with 25 Malaysian cosmetic surgeons and patients, ethnographic observation of surgeon-patient interactions, and observation of plastic surgery professional meetings in Asia, I argue that cosmetic surgeons exhibit aesthetic agency in acting as both medical and cultural gatekeepers to desired physical appearances. Malaysian cosmetic surgeons facilitate the spread of regional cultural forms in selectively interpreting circulating beauty ideals in constructing “looks” for their patients to meet local tastes. These include “Asian,” “Indian,” “Western,” and “Korean” looks. I find that Malaysian cosmetic surgeons act as tastemakers in drawing a symbolic boundary between unnatural “Caucasian” and natural “Asian” beauty ideals. Malaysian cosmetic surgeons engage in translation work to render beauty ideals concrete, and their ability to incorporate knowledge of patients’ physical and religious constraints is a competitive advantage in a transnational industry. The assertion of a pan-ethnic Asian ideal aligns Malaysian cosmetic surgeons with Asian rather than Western cultural and medical trajectories. Examining the beauty industry in transnational context sheds light on regional power dynamics and emerging identities.