Background <p>Cosmetic surgery refers to procedures aimed at changing and enhancing external body appearance. This study aims to investigate the correlation between the dark triad personality traits and the acceptance of cosmetic surgery among university students in the Kurdistan region of Iraq.</p> Method <p>This quantitative cross-sectional study was conducted between October and November 2024 using random sampling and self-report questionnaires. The dark triad and acceptance of cosmetic surgery were assessed by using the Dark Triad Dirty Dozen and the Acceptance of Cosmetic Surgery Scale, respectively. Data were analyzed using t tests, Pearson correlations, and multiple regressions in SPSS software.</p> Results <p>A sample of 1321 participants—984 females and 337 males—participated in the study. Descriptive statistics of gender differences revealed that narcissism, psychopathy, and Machiavellianism were significantly higher in males than females, whereas consider the sub-scale of acceptance of cosmetic surgery, which was higher in females. The correlational analysis illustrates that all variables are correlated regarding dark traits and acceptance of cosmetic surgery sub-scales. Narcissism was found to be the most predictable dark triad among applicants who seek cosmetic surgery.</p> Conclusion <p>Individuals with high levels of narcissism are more likely to consider cosmetic surgery. Health professionals should be aware of the effects of the dark triad on cosmetic surgery decisions, and the study recommends further research.</p> Level of Evidence <p>This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>