Background <p>The increasing use of social media has significantly influenced how young people perceive their appearance and attitudes toward aesthetic interventions.</p> Objective <p>This study aimed to examine the relationship between media literacy and acceptance of cosmetic surgery among young adults and to test the mediating role of body image.</p> Methods <p>This descriptive cross sectional study was conducted in Türkiye between December 2025 and February 2026 with 394 young adults aged 18–24&#xa0;years. Data were collected online using the Introductory Information Form, Media Literacy Scale, Body Image Scale, and Acceptance of Cosmetic Surgery Scale. Pearson’s correlation analysis was used to examine relationships between variables. Mediation analysis was performed using PROCESS Macro (Model 4) with 5000 bootstrap samples.</p> Results <p>The mean age of participants was 22.32±4.47 years; 76.6% were female and 91.4% had a university education. Media literacy was significantly and negatively associated with body image (<i>β</i> = − 0.300, <i>p</i> &lt; .001), indicating that higher media literacy was associated with lower levels of negative body image. Body image was significantly and positively associated with acceptance of cosmetic surgery (<i>β</i> = 0.280, <i>p</i> &lt; .001). Mediation analysis revealed that body image showed a partial mediating role in the association between media literacy and acceptance of cosmetic surgery.</p> Conclusion <p>Higher media literacy was associated with lower levels of negative body image and indirectly influenced attitudes toward cosmetic surgery. Enhancing media literacy may support healthier perceptions of body image among young adults.</p> Level of Evidence V <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>