Can You Deduct Cosmetic Surgery On Your Taxes? + FAQs

According to a 2022 National Small Business Association survey, many taxpayers remain confused about medical deductions – including cosmetic procedures.

Under U.S. tax law, you can deduct cosmetic surgery on your taxes, but only in very limited cases where it meets strict medical or business criteria. Most purely cosmetic surgeries are not tax-deductible, except when they are deemed medically necessary or, in rare instances, an ordinary and necessary business expense. In this comprehensive guide, we’ll break down what the IRS considers deductible cosmetic surgery, why most cosmetic procedures don’t qualify, how to claim a deduction if you do qualify, and where state tax rules might differ.

🏛️ Federal vs. State Rules: Key differences between federal law and state tax nuances for cosmetic surgery deductions.
💼 Business or Personal?: When a business-related cosmetic procedure might (rarely) be deductible vs. personal cosmetic expenses that aren’t.
🦷 Types of Procedures: Tax treatment of plastic surgery, cosmetic dentistry, and dermatological procedures – what counts as medical vs. purely cosmetic.
⚖️ IRS Codes & Court Cases: Relevant IRS codes, rulings, and Tax Court cases (from “Chesty Love” to O’Donnabhain) that define the boundaries of cosmetic surgery deductions.
💡 Practical Tips & Pitfalls: Things to avoid, documentation of medical necessity, examples of what is/isn’t deductible, and a quick-reference FAQ with yes/no answers.

What Counts as Cosmetic Surgery (Vs. Deductible Medical Expense)?

Cosmetic surgery for tax purposes refers to any procedure aimed at improving appearance that does not meaningfully promote proper bodily function or treat/prevent illness. The IRS explicitly excludes most cosmetic procedures from deductible medical expenses. In other words, just because something is done by a doctor doesn’t mean it’s a deductible medical expense – if it’s done primarily to enhance your looks, it’s considered a personal expense, not eligible for a tax break.

Under Internal Revenue Code §213(d), “medical care” includes expenses for the diagnosis, cure, mitigation, treatment, or prevention of disease, or treatments affecting a structure or function of the body. However, a special provision, IRC §213(d)(9), carves out “cosmetic surgery” as not deductible unless it meets specific exceptions (we’ll detail those shortly). The IRS’s own guidance (e.g. IRS Publication 502) gives clear examples of non-deductible cosmetic expenses: face-lifts, liposuction, hair transplants, hair removal (electrolysis), teeth whitening, and similar purely cosmetic procedures are not allowable medical deductions. These kinds of surgeries are viewed as personal vanity choices rather than essential health care.

Why this strict rule? U.S. tax law generally disallows personal expenses (via IRC §262). Just as you can’t deduct the cost of a designer suit or a daily hairstyling (even if your appearance is important for work), you typically can’t deduct elective cosmetic enhancements. Cosmetic surgery, in the eyes of the IRS, falls in the same category as personal grooming and wardrobe: it’s usually considered a personal benefit, not a necessary expense of earning income or maintaining health (unless an exception applies). Simply put, the tax code does not want taxpayers to subsidize someone’s nose job or facelift unless there’s a bona fide medical reason.

Defining “Medical Care” vs. “Cosmetic Surgery”

To clarify, let’s break down those key terms from the tax code:

Medical Care (for deduction purposes): Expenses primarily for preventing or alleviating a physical or mental defect or illness. This includes treatments that affect body function or treat a diagnosed medical condition. If a procedure meaningfully promotes proper bodily function or treats a disease, it can qualify as medical care.
Cosmetic Surgery (tax definition): Any procedure directed at improving appearance without a substantial functional or medical purpose. If it doesn’t improve bodily function or treat an illness, the IRS calls it cosmetic. Examples: A purely aesthetic rhinoplasty (nose reshaping) to get a “cuter” nose, a tummy tuck to have a flatter stomach after having kids (with no related health issue), or Botox injections to smooth wrinkles for younger looks. These are considered personal cosmetic choices, not medically necessary care.

Importantly, a procedure being “elective” (i.e. not urgent or not covered by insurance) is not, by itself, the issue – many elective surgeries (like laser eye surgery, knee replacement, etc.) are deductible because they address a functional issue or medical condition. The key test is purpose: Is the main purpose to treat a disease or defect, or just to enhance appearance? If it’s just cosmetic, it’s out.

IRS Stance in Plain Language

The IRS stance can be summed up like this: “Cosmetic surgery expenses generally cannot be deducted.” Unless you can show the procedure was medically needed to fix a deformity or heal a condition, it’s considered a nondeductible personal expense. The burden is on the taxpayer to prove an exception applies. This has been the rule since 1990, when Congress tightened the definition specifically to prevent misuse of the medical expense deduction for vanity procedures. In practical terms, if you’re flipping through your receipts at tax time, most receipts from a cosmetic surgeon or medical spa will not be usable for tax deductions.

Why Are Cosmetic Procedures Usually Not Deductible?

To understand the “why,” consider the purpose of the medical expense deduction: it’s there to provide relief for unavoidable health care costs that strain a taxpayer’s finances. Elective cosmetic surgeries, on the other hand, are generally viewed as voluntary personal enhancements – something analogous to luxury spending. The tax code treats them as personal consumption, not unlike buying jewelry or a vacation.

Policy rationale: Allowing deductions for purely cosmetic work would, in effect, have all taxpayers subsidize individuals’ personal beauty choices. From a fairness standpoint, Congress decided that’s not appropriate. There was also concern about the potential for abuse – without clear limits, people might try to write off everything from facials to fancy toothpaste as “medical.” Thus, the law explicitly draws a line between health-related care and cosmetic indulgence.

It’s also about personal benefit. Tax deductions for business or medical purposes are only supposed to cover costs that are necessary and not primarily personal. Cosmetic surgeries virtually always confer a personal benefit (improved appearance, confidence) outside of any business or medical context. Even if looking better might indirectly help your career or mental well-being, the IRS doesn’t count those indirect benefits as making it a medical expense. The improvement of self-esteem or professional image is too personal and subjective to qualify for a tax break in most cases.

Finally, even in cases where there might be some arguable business benefit (for example, a salesperson believing a facelift will improve sales prospects), the IRS and courts have historically said “no” – the personal benefit outweighs any business rationale. We’ll cover a very rare exception to this in the next section, but as a rule of thumb: If it’s about looking better (and you weren’t disfigured or impaired to begin with), it’s not deductible.

To summarize the why: personal cosmetic expenses = personal responsibility, not a public tax concern. The tax system is not designed to reward personal vanity projects, so it explicitly bars them from deductions.

When Can You Deduct Cosmetic Surgery? (The Strict Exceptions)

Now for the good news: there are important exceptions when a cosmetic procedure becomes deductible because it crosses into the realm of genuine medical necessity. Under federal law, **cosmetic surgery can be deducted if it is “necessary to ameliorate a deformity” arising from:

a congenital abnormality (birth defect),
a personal injury from an accident or trauma, or
a disfiguring disease.

In plainer terms, if a procedure is done to correct or improve a deformity or damage to your body, it’s not considered “cosmetic” for tax purposes – it’s considered part of your medical care. These are the specific scenarios in which the IRS allows cosmetic-related write-offs:

🩺 Repairing Birth Defects: Procedures to correct a congenital anomaly. For example, surgery to repair a cleft lip or palate in a child is often partly cosmetic in appearance, but it squarely falls under medical care because it corrects a birth defect. Similarly, if someone is born with a noticeable deformity (like a significant port-wine stain birthmark covering the face, or an abnormality in limb structure), surgery to fix or improve that condition can be deducted. It’s addressing a condition present from birth.

🚑 Treating Trauma and Injuries: Cosmetic or reconstructive surgery following an accident, injury, or trauma. If you were in a car accident and needed facial reconstructive surgery, or you have scars from a burn or other injury, any plastic surgery to restore your appearance is considered part of your medical recovery. Even though it improves appearance, it’s clearly linked to healing a physical injury, so the tax law lets you deduct those costs as medical expenses. For instance, if you needed skin grafts or scar revision surgery after a serious burn, those qualify because they ameliorate trauma-related disfigurement.

🤒 Fighting Disease Aftereffects: Procedures done to address disfigurement from disease. A classic example is breast reconstruction after a mastectomy for breast cancer. Losing a breast to cancer is disfiguring; reconstructive surgery is recognized as part of the treatment process. The IRS explicitly allows deductions for such post-disease reconstruction (this was affirmed in guidance and is even noted in IRS Pub 502). Likewise, if a disease causes bodily changes – say, surgery to improve severe facial skin scarring from an illness, or reconstructive surgery after a flesh-eating infection – those costs are deductible. They aren’t about vanity; they’re about making someone whole after disease.

In all these cases, although the procedure improves appearance, it’s secondary to fixing a physical defect or injury. The tax code views them as corrective rather than cosmetic in the usual sense.

Medically Necessary vs. Cosmetic: The Gray Areas

Beyond the straightforward exceptions above, there are some gray areas where a procedure has both cosmetic and medical aspects. A few noteworthy scenarios and how they’re treated:

Nose Surgery (Rhinoplasty): If you undergo rhinoplasty solely to reshape your nose for aesthetic preference, it’s not deductible. However, many nose surgeries also involve correcting a deviated septum or breathing obstruction. If the primary purpose is to fix a medical issue (chronic breathing trouble, frequent sinus infections), that part of the surgery is medical. In practice, many people get a combined functional-and-cosmetic nose job. The medically necessary portion (septoplasty, for example) can be deductible, whereas the purely cosmetic sculpting portion is not. Tip: Ensure your surgeon’s billing and notes separate the medical necessity component (e.g. “septum repair”) from the cosmetic component, in case you need to substantiate the deduction for the medical part.

Breast Surgery: Breast reconstruction after cancer is fully deductible as mentioned. What about breast reduction or augmentation unrelated to cancer? A breast reduction might be deductible if done to relieve documented medical issues like severe back pain, skin infections, or other health problems caused by overly large breasts. In such cases, it’s often deemed medically necessary (many insurers even cover it with medical justification). Breast augmentation (implants) for purely cosmetic enlargement is not deductible. An interesting nuance: breast implants after mastectomy (to reconstruct) are deductible; but breast implants for aesthetic enhancement are not. In one famous Tax Court case, a set of extreme breast implants was allowed as a business expense (more on that later), but generally purely cosmetic implants are personal expenses.

Weight Loss and Excess Skin Removal: Bariatric surgery (e.g. gastric bypass, stomach sleeve) for obesity is considered a treatment for disease (obesity and related conditions) and is deductible as a medical expense (if you itemize and qualify). Now, significant weight loss often leaves behind excess skin which can be both a cosmetic and health issue. Skin removal surgery (panniculectomy, for example) can be deductible if the excess skin causes health problems (such as infections, rashes, or impacts mobility). Tax experts point out that when excess skin “interferes with daily life or is prone to infection,” its removal is considered part of the health treatment, not just vanity. However, if someone simply doesn’t like the appearance of loose skin but has no medical issues from it, the IRS could view that as cosmetic. Again, documentation is key – if a doctor notes recurrent infections under skin folds, that supports a medical necessity argument.

Dental and Oral Surgeries: We’ll cover cosmetic dentistry in detail later, but note that things like orthodontic braces are often deductible because they primarily correct alignment for oral health (and improved chewing function), even though they also improve appearance. On the flip side, purely cosmetic dental work (like veneers purely to make teeth whiter and more symmetrical when teeth are otherwise healthy) is not deductible.

Psychological and Mental Health Considerations: A tricky area is when a cosmetic procedure is argued to treat a mental health condition (like extreme body dysmorphia or gender dysphoria). Generally, improving appearance for self-esteem alone doesn’t count as treating a disease. However, in a landmark case (O’Donnabhain, 2010), the Tax Court recognized Gender Identity Disorder (Gender Dysphoria) as a legitimate medical condition and allowed deductions for hormone therapy and sex reassignment surgery as treatments for that condition. This case set a precedent that if a procedure is an accepted treatment for a diagnosed psychiatric disorder, it can potentially be considered medical care. (In that case, only the breast augmentation portion of the transition was denied, because the court wasn’t convinced it was essential to treating the disorder, whereas the other surgeries were deemed essential.) Apart from such specific diagnoses, the IRS is skeptical of “it helped my mental health” as a sole argument for a cosmetic procedure. For instance, claiming a facelift cured your depression will not fly. But if there’s a clear, clinically recognized mental health need (and standard medical protocol supports the procedure), it could qualify. This is rare and would likely require solid evidence and possibly litigation to uphold.

The bottom line: You can deduct cosmetic surgery only when it’s effectively part of treating a disease, correcting a deformity, or healing an injury. If you think your situation falls into that category, be prepared to document it thoroughly. A letter from a physician describing the medical necessity, before-and-after medical records, and photos or reports that show the condition being treated can all support your case if the IRS ever asks. When in doubt, consult a tax professional – the stakes are high, and you don’t want to misclassify something as deductible only to face an audit later.

Business vs. Personal: Can a Business Deduct Cosmetic Surgery?

What if your appearance is crucial to your income? Many performers, entertainers, models, or public-facing professionals might wonder if improving their looks can be considered a legitimate business expense. In tax terms, business expenses are governed by IRC §162, which allows deductions for expenses that are ordinary and necessary in carrying on a trade or business. Is cosmetic surgery ever “ordinary and necessary” for one’s job?

In almost all cases, the answer is no – cosmetic surgery is a personal expense, not a business expense. The IRS has consistently held that costs related to personal grooming, attire, and appearance are nondeductible personal expenses, even if your job encourages or informally requires you to maintain a certain look. For example:

A news anchor or TV personality cannot deduct cosmetic dental work, a facelift, or even the cost of professional makeup and hair styling, even though being camera-ready is part of the job. These are considered personal upkeep.
A business executive who gets liposuction to appear more fit and confident in board meetings cannot call that a business expense – it’s personal.
A salesperson who invests in cosmetic procedures to appear more attractive to clients is similarly out of luck; the expense is deemed personal vanity, not a requirement of the sales profession.

The logic: Everyone has an appearance, and nearly everyone could argue that looking better might help them in general in their work or social life. But that doesn’t make those expenses “necessary” for the job in a deductibility sense. Tax courts have a long history of rejecting these kinds of claims – they say the connection to business is too tenuous and the personal benefit is too significant.

The “Chesty Love” Precedent – A Rare Win for Business Deduction

There is a famous Tax Court case that is often brought up in this context: Cynthia Hess, an exotic dancer who performed under the stage name “Chesty Love.” In the Hess v. Commissioner (1994) case, Ms. Hess deducted the cost of her breast implant surgeries as a business expense. These were not ordinary implants – they were extremely large (reportedly size 56N, essentially beyond normal human proportions) and were integral to her adult entertainment act.

The Tax Court actually allowed the deduction. Why? The court was convinced that:

The surgery was solely for business purposes – her excessively large breast implants were essentially prop assets for her dancing career. She earned more money by featuring them, and she wouldn’t have gotten them except to enhance her stage act.
The implants were so extreme that they were not considered suitable for everyday use or personal convenience. In fact, Hess suffered physical discomfort from them in normal life and indicated she planned to have them removed/reduced when she retired from dancing. In other words, unlike most cosmetic surgeries that give personal benefit 24/7, these implants were seen as burdensome off-stage and only beneficial in the context of her performances.

The IRS initially argued this was a nondeductible personal expense (or maybe a medical expense which it wouldn’t qualify for either). But the Tax Court drew an analogy to work-related costumes or equipment. They ruled that Hess’s implants were a unique case of a cosmetic enhancement crossing into the realm of a business asset. She was allowed to depreciate the cost of the implants over time, as one would for stage costumes or equipment.

Important: This case is the exception, not the rule. The two-part test that emerged from the “Chesty Love” case for a business-related cosmetic expense was:

The cosmetic enhancement is required by your work (or at least primarily done for your job, with a clear link to earning income).
It is unsuitable for everyday personal use, meaning you derive little to no personal enjoyment or normal-life benefit from it.

Very few situations meet those criteria. In Hess’s case, she essentially sacrificed personal comfort for a career gimmick. Unless you’re making a similar sacrifice, it’s unlikely a cosmetic procedure would qualify. For example, a fashion model might say, “My face is my business – a nose job will get me more gigs.” But that nose job is also something the model personally enjoys all the time, not just when modeling. It doesn’t meet the “unsuitable for personal use” standard. Likewise, a bodybuilder might argue that steroids or implants help in competition (aside from legality issues), but because those changes stay with you off-stage, the personal element is huge.

Tax professionals often joke that unless you’re willing to go to an extreme that makes you look bizarre off the clock, you won’t get a cosmetic write-off as a business expense. It’s just too personal in nature.

Another angle: If a company pays for an employee’s cosmetic procedure (say a modeling agency pays for a cosmetic surgery for a model), the IRS would likely treat that payment as taxable compensation to the individual, not as a deductible business expense for the company. It’s similar to how if an employer buys you a fancy suit, it’s a fringe benefit that’s taxable (unless it’s a uniform that’s not wearable outside work). The tax law doesn’t allow companies to disguise personal perks as business costs without tax consequences.

Bottom line: For 99.9% of readers, cosmetic surgery will not be a legitimate business expense deduction. The one case that succeeded is highly unusual. Unless you truly have a case as unique as “Chesty Love,” attempting to write off cosmetic enhancements as a business cost is risky and likely to fail (and could invite IRS scrutiny). It’s much safer to assume it’s a personal expense – which isn’t deductible in the business context.

Federal vs. State Tax Treatment: Are There State-Level Differences?

Federal tax law governs whether an expense is deductible on your federal income tax return. But what about state taxes? States often piggyback on federal definitions, but there can be nuances:

Most states that have an income tax and allow itemized deductions follow the federal rules for medical expenses. This means if something isn’t deductible under federal law (like elective cosmetic surgery), it’s also not deductible on your state return. For instance, states like California and New York conform closely to federal itemized deductions. If you claim a medical expense on your federal Schedule A, you’ll typically claim it on the state itemized form too. Conversely, if it’s disallowed federally (e.g. a cosmetic procedure that doesn’t qualify as medical care), you can’t turn around and deduct it on the state side either.

Threshold differences: The federal threshold for deducting medical expenses is that they must exceed 7.5% of your Adjusted Gross Income (AGI) in a given year (as of current law). Some states have their own threshold or calculation. New Jersey, for example, allows a state-level deduction for medical expenses exceeding 2% of New Jersey gross income, which is a much lower hurdle than the federal 7.5%. This means Jersey taxpayers who can’t deduct medical expenses federally (because they didn’t exceed 7.5% AGI) might still get a deduction on the NJ return if expenses exceed 2% of NJ income. However, New Jersey defines “qualified medical expenses” as ones that are allowed for federal purposes. So NJ isn’t going to suddenly allow a cosmetic surgery that the feds disallowed – the lower threshold just means you might benefit from legitimate medical expenses at the state level more easily. The type of expense still has to be a valid medical expense per IRS definitions (cosmetic exceptions only).

States with no itemized deduction: Some states (like Illinois or Massachusetts) don’t allow itemized deductions at all, or they handle deductions differently. In those states, you often cannot deduct medical expenses on the state return at all, period. Pennsylvania, for instance, has a flat income tax with very limited deductions – medical expenses aren’t deductible on a PA state return. So, if you’re in one of those states, the whole question of cosmetic vs. medical expense is moot for state taxes because personal medical expenses aren’t a factor in calculating taxable income there.

No state income tax: States like Texas, Florida, Washington, and others do not have a state income tax. If you live there, you don’t file a personal income tax return and thus there’s no opportunity (or need) to deduct medical expenses at the state level. All that matters is the federal treatment.

Separate state definitions: A handful of states sometimes decouple from federal rules on certain deductions. Always check your own state’s tax guidance. But for medical expenses, virtually all states either use the federal definition of “medical expenses” or don’t allow the deduction at all. There isn’t a state that says “we’ll let you deduct cosmetic surgery even though the IRS doesn’t” – that would be very unusual politically and practically.

Special taxes on cosmetic procedures: As a side note, some jurisdictions have tried to tax cosmetic surgeries directly. New Jersey, for example, implemented a “Cosmetic Medical Procedures Gross Receipts Tax” (sometimes nicknamed the “Botax”) in 2004, which imposed a 6% tax on the fees for elective cosmetic procedures. That was a state-level sales tax type of approach, not an income tax deduction issue. (New Jersey eventually phased out and eliminated this cosmetic services tax by 2014 due to its unpopularity and minimal revenue.) While this doesn’t affect your ability to deduct the cost, it’s interesting in highlighting that states sometimes single out cosmetic procedures as luxuries for tax purposes rather than essential medical services.

In summary: When it comes to state income taxes, assume the same rules as federal unless proven otherwise. If your cosmetic surgery wasn’t deductible federally, it won’t suddenly be deductible on your state return, except in the sense that some states might not even allow any medical deductions or might use different income thresholds. Always verify your state’s form instructions – some states require you to recalculate deductions or add back certain items. But there’s no state-level loophole that makes a purely cosmetic tummy tuck deductible if it wasn’t under IRS rules.

For clarity, here’s a quick comparison of how different states handle medical expense deductions and what that means for cosmetic surgery:

State	Treatment of Medical Deductions & Cosmetic Procedures
California	Follows federal rules for itemized deductions (including medical). Must itemize to deduct medical expenses, with the same 7.5% AGI threshold. No special allowance for cosmetic surgery – if it’s not deductible federally, it isn’t on CA return either.
New Jersey	Allows medical expenses exceeding 2% of NJ income as a state deduction, which is easier to meet than federal 7.5%. However, NJ only permits expenses that are allowed federally. Cosmetic procedures still excluded unless they meet the IRS medical exception criteria. (NJ also had a separate 2004-2014 “cosmetic procedure tax” on providers, now repealed.)
Texas	No state income tax. There is no need or ability to deduct medical or cosmetic expenses on a state return. Cosmetic surgery costs might incur sales tax if considered services, but TX does not impose a special tax on them. For income tax, this question is moot.
Pennsylvania	Does not permit itemized deductions for medical expenses on the state return (flat income tax system). No deduction available for medical or cosmetic expenses at the state level. Cosmetic surgery would neither help nor hurt your PA taxes – it’s simply ignored.

Regardless of your state, remember that any federal deduction for medical expenses will flow through to most state returns if you itemize, but only the same qualified expenses. You won’t get a state tax break for an expense disallowed by the IRS as cosmetic. If anything, some states are stricter or offer no deduction at all.

Cosmetic Procedures by Category: Plastic, Dental, Dermatological

Not all cosmetic procedures are created equal in the eyes of the tax law. Let’s delve into different types of procedures to see how they’re typically classified for tax purposes, and highlight any specific quirks:

Plastic Surgery vs. Reconstructive Surgery

“Plastic surgery” covers a wide range of surgical procedures intended to alter or restore the body’s form. Reconstructive surgery is generally a subset of plastic surgery that focuses on correcting abnormalities, restoring function, or fixing disfigurement. For taxes, reconstructive = usually deductible; purely cosmetic = not deductible.

Common Cosmetic Plastic Surgeries (Not Deductible): Facelifts, cosmetic rhinoplasty (nose reshaping for looks), liposuction for body contouring, breast augmentation (implants) for appearance, “tummy tuck” abdominoplasty (post-pregnancy or for a tighter tummy), cosmetic eyelid surgery (blepharoplasty) to remove eye bags, cosmetic ear pinning, etc. These are virtually always personal expenses. Unless you can point to a medical reason (e.g. eyelid lift to improve vision if eyelids were sagging into your field of sight – which can happen), they are not deductible.

Reconstructive or Medical Plastic Surgeries (Deductible): Breast reconstruction after cancer, as mentioned, is allowed. Rhinoplasty or facial reconstruction after severe trauma (say from an accident or injury) is allowed. Surgery to correct a deviated septum (even if the nose shape improves incidentally) is allowed because it improves breathing – that’s a functional improvement. Skin grafts or scar revisions for significant scars (from burns, accidents, surgeries) are deductible; those improve function (skin integrity) or ameliorate trauma. Cleft lip/palate surgery for a child is deductible (congenital deformity). Orthopedic surgeries (even if they use plastic surgery techniques) like fixing a crooked limb or correcting a physical deformity from birth or childhood disease (e.g., correcting polio-related limb issues) are medical.

Mixed-purpose plastic surgery: If part of a surgery is cosmetic and part is medical, as noted earlier, you should divide the cost. Say you have a combined procedure: a medically necessary abdominal hernia repair plus an elective tummy tuck for tightening – the surgeon or hospital may have separate billing codes for each portion. Only the hernia repair would be a medical expense. It’s crucial to get itemized bills and doctor’s notes if you plan to deduct the medically necessary portion. The IRS won’t accept “well, while he was in there, I also got a six-pack abs look” as deductible just because it was done at the same time.

Key tip: Surgeons and hospitals are familiar with this issue. If you tell your provider you’ll be claiming part of the surgery as a medical deduction (or insurance claim) and paying part out-of-pocket for cosmetic, they often can give you a breakdown. That documentation could be invaluable if questions arise later.

Cosmetic Dentistry and Dental Procedures

Dental work ranges from medically essential to purely aesthetic:

Deductible Dental Expenses: The IRS considers most general dental and orthodontic treatments as medical care. This includes tooth extractions, fillings, root canals, treatment of gum disease, dentures, and dental implants (because those all treat or replace a function – chewing, speaking, avoiding infection). Orthodontic braces and treatments to correct misaligned teeth or jaw are usually deductible because misalignment can cause real issues (difficulty chewing, jaw pain, etc.), even though they also improve the smile’s appearance. If your dentist or orthodontist says a procedure is needed for oral health or function, it’s likely a valid medical expense.

Cosmetic Dentistry (Not Deductible): Procedures done solely to improve the appearance of teeth with no medical necessity. Teeth whitening or bleaching is a clear example – whitening is cosmetic, not health-related, so it’s not deductible. Veneers or bonding purely to create a movie-star smile (covering healthy but slightly imperfect teeth) would be considered cosmetic as well. Cosmetic tooth reshaping (for instance, shaving down fangs or adding tooth jewelry) – definitely not medical. Essentially, if the work is just making your teeth prettier but they were functioning fine, it’s not deductible.

Gray area dental example: Suppose you get a set of veneers because your enamel was eroded from a medical condition or medication, causing pain or risk of damage – that could be considered reconstructive or preventive (so deductible). But if you got veneers because you didn’t like the gaps in your teeth, that’s cosmetic. Dental implants often replace lost or rotten teeth – that’s considered restorative and is deductible because it lets you chew properly again. However, if someone were to replace all their teeth with a shiny set for purely appearance reasons (with existing teeth healthy), that would likely be cosmetic (and frankly, ethically most dentists wouldn’t do that without a health reason).

Braces for Adults for minor cosmetic improvement: A lot of adults get braces or Invisalign for cosmetic reasons (e.g., mild crowding they want to fix). Technically, if your dentist/orthodontist will certify that it’s for alignment and bite improvement (even if the improvement is minor), it can be a medical expense. In practice, the IRS doesn’t delve deep into why you got braces – braces are generally seen as orthodontic treatment and they haven’t drawn a line that “only very crooked teeth count.” So those are usually deductible if you itemize. That’s a case where you benefit cosmetically, but because braces are widely considered healthcare, it slides in under the medical category.

Remember also that for both dental and medical, any insurance reimbursement reduces what you can deduct. Only out-of-pocket costs count. Many cosmetic procedures aren’t covered by insurance anyway, but some borderline ones (like a breast reduction for health reasons or reconstructive dental work) might be partially covered; you can only deduct the part you paid.

Dermatological and Cosmetic Skin Treatments

Dermatology spans medical treatment of skin conditions and cosmetic enhancements:

Medically Deductible Skin Treatments: Treatment of skin diseases (acne, eczema, psoriasis, skin cancer removal, etc.) is medical. For example, laser therapy for a severe acne condition that’s causing physical scarring or pain could be considered medical (especially if prescribed by a dermatologist to treat the condition). Surgical removal of tumors or suspicious moles, biopsies – all normal medical. If you have a disfiguring scar or birthmark and undergo laser treatment or surgery to reduce it, that qualifies (falls under correcting a deformity or disfigurement – think port-wine stain birthmark removal, which often is done even in childhood for psychosocial reasons, but it’s allowed because it’s a congenital mark). Dermatological procedures for diagnosed conditions like rosacea, vitiligo, severe cystic acne – deductible because they treat disease, even though part of the benefit is cosmetic (clearer skin).

Cosmetic Dermatology (Not Deductible): Botox or filler injections for wrinkles or fuller lips – not deductible. (Botox is deductible if used to treat a medical condition, like chronic migraines or excessive sweating, but that would be administered by a doctor for those specific diagnoses, not by a medspa purely for crow’s feet). Chemical peels or laser resurfacing to reduce normal signs of aging (wrinkles, sunspots) – not deductible. Hair removal (electrolysis or laser hair removal) for purely aesthetic reasons – not deductible. Tattoo removal for personal reasons (you just don’t want a tattoo anymore) – also a personal choice, not medical.

Hair Restoration: Generally considered cosmetic. Hair transplant surgery for male or female pattern baldness is not deductible; losing hair is not an illness (though it can affect self-esteem, it’s considered natural aging in many cases). Wigs or hairpieces are not deductible if just for convenience or appearance. One exception: If you lose your hair due to a medical condition or treatment (like chemotherapy for cancer), the cost of a wig can be deductible if a doctor recommends it to help your mental health. The IRS even mentions this: buying a wig after medical hair loss on a doctor’s advice is a qualified medical expense. But getting a fancy toupee because you don’t like your bald spot is not. Also, any treatment for hair loss that’s cosmetic, like special medications or procedures, are typically not deductible (unless treating a disease that causes hair loss).

Skin removal or body contour after weight loss: We touched on excess skin removal in the weight loss section. To reiterate: if it’s done to relieve medical issues, it’s deductible; if purely for appearance, it’s not. This might require a doctor’s note stating issues like rashes or infections.

Cosmetic injections and fillers: Non-surgical cosmetic enhancements (Botox, collagen, hyaluronic fillers, etc.) are all considered personal cosmetic expenses. They’re not treating a disease. The only time Botox becomes a medical expense is when used as an FDA-approved treatment for something like migraines, muscle spasticity, or hyperhidrosis (excess sweating). In those cases, it’s administered in a medical context, and that cost is deductible as medical. But Botox for a fresher-looking face – no.

Laser eye surgery: Not dermatology, but worth noting in this category of elective procedures: LASIK or PRK eye surgery to correct vision is deductible (and often cited as an example in tax guides of an elective surgery that qualifies) because it improves the function of the eyes (vision). It’s not just cosmetic (even though not wearing glasses might have a cosmetic perk, the core purpose is medical: you can see without corrective lenses). This highlights again the function vs. appearance distinction.

In summary, for any type of procedure, ask: “Is there a diagnosed medical condition being treated or a functional improvement being made?” If yes, likely deductible; if it’s purely aesthetic, not deductible.

Here’s a quick table of examples across scenarios:

Scenario	Deductible?
Got a facelift to look younger for work	No. Purely cosmetic – personal expense, not deductible.
Breast reconstruction after mastectomy (cancer)	Yes. Considered medical necessity (correcting disease-related deformity).
Nose surgery to fix breathing (deviated septum), and it also improved shape	Yes (mostly). The portion for medical purpose (breathing) is deductible. Any extra cost for cosmetic reshaping wouldn’t be.
Liposuction purely for body contouring	No. Not treating an illness – personal cosmetic procedure.
Orthodontic braces to correct bite/alignment	Yes. Generally considered medical (even if cosmetic benefit too).
Dental veneers on healthy teeth for a better smile	No. Cosmetic dental work is personal expense.
Hair transplant for hereditary baldness	No. Baldness isn’t a disease; transplant is cosmetic.
Laser treatment for serious acne scarring	Yes. Treats a skin condition (acne is a medical condition; scarring can be considered disfigurement).
Botox injections for frown lines (wrinkles)	No. Cosmetic use – not deductible.
Botox for chronic migraines (prescribed by doctor)	Yes. Here Botox is a treatment for a medical condition, so it’s deductible (this wouldn’t even be seen as cosmetic in the medical context).
Gender affirmation surgery for gender dysphoria	Yes. When treating a diagnosed condition like gender dysphoria, such procedures have been recognized as medical care (per Tax Court ruling), so deductible. (Cosmetic procedures unrelated to treating dysphoria would not be.)
Tattoos or tattoo removal for personal reasons	No. These are personal aesthetic choices – no medical reason.

As you can see, it really hinges on the underlying reason and medical justification.

Key IRS Codes, Terms, and Rulings You Should Know

To navigate this topic like an expert, it helps to be familiar with some IRS references and tax terminology:

IRC §213(d) – The Internal Revenue Code section that defines medical expenses for deduction purposes. Within this:
- IRC §213(d)(1)(A) gives the general definition of medical care (diagnosis, cure, mitigation, treatment, prevention of disease, or affecting a structure/function of the body).
- IRC §213(d)(9) is the critical part that excludes cosmetic surgery unless it’s needed to fix a deformity from congenital issues, injury, or disease. This is literally the text that says “medical care does not include cosmetic surgery or other similar procedures” with the exceptions listed. This was added in 1990 to codify the cosmetic surgery limitation.
IRS Publication 502: Medical and Dental Expenses – This is an IRS publication updated yearly that explains what medical expenses are deductible. It’s user-friendly and contains lists of included and excluded expenses. It explicitly lists cosmetic surgery as generally not deductible, and gives examples (face-lifts, hair removal, etc.) as well as the exceptions (like breast reconstruction after mastectomy). Pub 502 is a great reference for common questions (e.g., it clarifies that teeth whitening is not deductible and that if you just want a procedure for your general health improvement with no specific illness – like joining a gym – it’s not deductible).

IRC §162 (Trade or Business Expenses) – This is the code section for business deductions. Mentioned here because some have tried to use §162 to deduct cosmetic costs as business expenses. But §262 (below) often trumps it.

IRC §262 (Personal, living, and family expenses) – This section flatly disallows personal expenses. It’s why you can’t deduct a lot of things that have personal benefit. Cosmetic surgeries fall under this unless you meet the medical criteria. The IRS and courts often invoke §262 to deny deductions for cosmetic or personal appearance costs, even if someone argues a business connection.
Tax Court and Court Cases: There are a few key cases that have shaped understanding:
- Hess v. Commissioner (1994) – aka the Chesty Love case. Outcome: Breast implant surgery for an exotic dancer was allowed as a business expense (depreciable), due to being an asset for her specific line of work and not benefiting her personally in a normal way. This is a one-of-a-kind outcome and not easily replicated for other taxpayers.
- O’Donnabhain v. Commissioner (2010) – Tax Court case where a transgender woman’s gender confirmation surgery and related treatments were ruled deductible medical expenses (treatment for gender identity disorder), except for a breast augmentation that the court viewed as cosmetic. This case was significant because it recognized a new area (transgender medical care) as deductible and clarified how to apply the illness vs. cosmetic distinction.
- Sparkman v. Commissioner (1940) – An older case often cited in discussions of appearance expenses. In Sparkman, a radio (or stage) performer tried to deduct the cost of dentures (false teeth) that improved his appearance and speaking voice. The court disallowed it, saying it was a personal medical expense, not a business expense. It established early on that even if better teeth helped him perform, it’s fundamentally a personal health matter.
- Numerous other cases in the 1970s-1980s denied deductions for things like hair transplants, cosmetic surgery, makeup, clothing for people in entertainment or media. For example, TV anchors have been denied deductions for wardrobes (the famous Hamper case in Tax Court dealt with a news anchor’s clothes and makeup – disallowed). Similarly, if any attempted face-lift deductions came up, they were shot down as personal. These cases reinforce that the “ordinary and necessary” business expense argument doesn’t work when an expense is inherently personal.
IRS Rulings/Regulations: The IRS has issued regulations (Treasury regulations) under §213 that mirror the code’s language, and a few revenue rulings addressing certain borderline cases. For instance, one revenue ruling clarified that breast reconstructive surgery post-mastectomy is deductible (which aligns with the code exception for disease deformity). Another might clarify something like vitamin treatments or health spas aren’t deductible if not for a specific medical condition. While not specific to cosmetic surgery, they paint the picture that general health or appearance improvements aren’t covered.

Medical Necessity vs. Cosmetic – Documentation: While not an “IRS code,” the concept of medical necessity is crucial. If you plan to deduct something that might look cosmetic, having documentation that a doctor deemed it necessary to treat a condition will be your strongest support. The IRS isn’t going to accept “I felt it was necessary” – it needs to be “Dr. Smith recommended this procedure to address X medical issue.” If you end up audited, they may ask for proof of the condition (medical records, letters, etc.).

Impairment-Related Expenses (for Disabled Taxpayers): One tangential note – if a cosmetic procedure is related to a disability, it could possibly be considered an impairment-related work expense (deductible as a business expense by a disabled individual). For example, if a disfigured individual needs a certain procedure to be presentable enough to work, it might qualify. This is a niche scenario, but the tax law does allow disabled employees to deduct impairment-related work expenses as an adjustment to income. However, that’s usually things like specialized equipment or services, not surgery. Still, it’s good to know such provisions exist for medical issues impacting work.

Knowing these terms and rulings can help you understand where the hard lines are drawn. Essentially, the tax authorities have set a high bar for cosmetic deductions, and these codes and cases are the playbook that bar comes from.

Pitfalls, Red Flags, and Things to Avoid

If you’re considering trying to deduct a borderline cosmetic procedure, tread carefully. Here are some common pitfalls and mistakes to avoid:

Don’t try to disguise a personal cosmetic expense as medical when it clearly isn’t. The IRS has seen it all. For example, deducting your facelift by writing “facial surgery – improvement of breathing” without any credible medical evidence is likely to backfire. Never fabricate or exaggerate a medical justification – not only can the deduction be denied, but falsifying documents could lead to penalties.

Avoid the “it helps my business” rationale for personal beauty expenses. As we discussed, except in the most extraordinary cases, it won’t fly. Claiming your cosmetic procedure was a business necessity (without meeting the extreme criteria) is a red flag. The IRS might not audit every return, but if they see significant unreimbursed medical expenses that include something odd, or business expenses that look personal, you could get pulled for review. They are particularly skeptical of entertainment industry folks who try to write off personal care (since many have tried).

Don’t mix up general health/wellness with medical care. For instance, some taxpayers mistakenly try to deduct things like vitamins, health supplements, non-prescription health store purchases, or cosmetic spa treatments under “medical”. These are not deductible. Only specific, diagnosable condition treatments count. A vitamin regime or a day at a spa, even if it makes you feel better, is not tax-deductible. Similarly, weight loss programs (like diet plans or gym memberships) are generally not deductible unless prescribed by a doctor to treat a disease (like obesity, hypertension, diabetes). Even then, the program must be specifically for the disease treatment – just wanting to slim down for summer is not enough.

Be cautious with mixed-purpose surgeries. If you had a procedure that combined medical and cosmetic elements, don’t deduct 100% of the cost. Only deduct the portion related to medical necessity. A pitfall is just lumping the whole thing under medical. For example, say you had abdominal surgery to repair internal damage and at the same time the surgeon did some abdominal skin tightening for appearance which wasn’t necessary for the repair – make sure you only deduct the medical part. The IRS could have an expert review your medical records in an audit; if they find you deducted more than was medically needed, they will disallow that part.

Overlooking the 7.5% AGI threshold (for personal medical deductions). Some people gather all their medical receipts and think they can deduct them, but if your total medical expenses (including qualifying cosmetic-as-medical ones) don’t exceed 7.5% of your Adjusted Gross Income, they won’t actually provide any tax benefit. For example, if your AGI is $100,000, the first $7,500 of medical expenses are not deductible at all – only the amount beyond that counts. So, if you had one surgery that cost $5,000 and it was deductible in theory, but no other medical expenses, you actually get zero deduction because $5,000 < $7,500. It’s not a “pitfall” in terms of compliance, but it’s something to be aware of so you’re not disappointed. Sometimes people incur a big expense and it doesn’t clear the threshold, so no tax relief is obtained.

Claiming a deduction without itemizing. Remember, medical expenses (including any cosmetic surgery that qualifies) are only deductible if you itemize your deductions on Schedule A. If you take the standard deduction, you cannot separately deduct medical costs. In 2025, the standard deduction is quite high (it has been high since tax reform in 2018), so fewer people itemize. This means many folks won’t benefit from medical deductions at all because the standard deduction gives them a better deal. Don’t try to write medical expenses somewhere else on the tax return – they belong on Schedule A. And don’t think you can double-dip (for instance, using an HSA to pay and also deducting – you cannot double benefit from the same expense).

If you’re self-employed or have a business, don’t run personal cosmetic costs through the business books. Some might be tempted to just have their company pay for a procedure and call it a business expense. That’s risky. Not only can the IRS deny the deduction, but if it’s a corporation paying for an owner’s personal expense, it could be treated as additional taxable income (a constructive dividend or bonus) to you. It’s okay for a business to cover genuine business-related medical exams or even certain cosmetic costs if they’re part of a role (e.g., theatrical makeup for actors, which isn’t surgery but just to illustrate), but something like surgery is beyond the pale unless, again, you’re in that one-off scenario like Ms. Hess (and even she was a Schedule C sole proprietor, essentially).

Not keeping documentation for exceptions. If you do have a medically necessary cosmetic procedure (exception case), keep all related documents. For a deformity or injury-related surgery, keep photos (if appropriate), doctor’s letters, hospital reports, etc. For a disease-related cosmetic surgery, keep the diagnosis documentation and doctor’s recommendation. It’s easier to prove a deduction’s validity when you have third-party evidence. In an audit, the IRS may request those. If you don’t have them, they might disallow the deduction for lack of proof. It’s far better to substantiate it up front.

Forgetting insurance reimbursements or settlements. If any part of your procedure was covered by insurance or paid by someone else (say, an accident settlement covered your reconstructive surgery), you cannot deduct that portion. Only unreimbursed expenses that you paid count. A mistake would be claiming the full cost when insurance paid half. The IRS cross-checks some info with insurance forms, but largely it’s on you to only deduct what was out-of-pocket.

Amending returns for past cosmetic surgeries: Sometimes people learn later that an expense could have been deductible (e.g., “Oh, that breast reduction I had last year because of back pain – I didn’t realize I could deduct it”). You have up to 3 years to amend a return for a refund. If it’s worth enough money, you can file an amended return (Form 1040-X) to claim the medical deduction, provided you itemized or now would itemize. Just ensure you had enough other deductions to itemize and clear the threshold. The pitfall here is missing the statute of limitations – after 3 years, you generally can’t claim a refund. So if you realize you had a large qualifying expense in a prior year, don’t wait too long to amend.

Proposing novel arguments without precedent: Once in a while, someone thinks, “I have a special case that isn’t in the rules – maybe I can convince the IRS or courts.” Realize that tax court cases are expensive and time-consuming. If you’re trying to break new ground (like the first person to deduct something unusual), know that the track record for cosmetic issues is not great. Unless you have a truly compelling medical rationale, it’s probably not worth the battle. (One could argue some future scenario, like extreme body modification for art as a business expense – but good luck with that; the IRS would likely see it as personal choice.)

To stay safe, when in doubt, assume it’s not deductible. It’s better to be pleasantly surprised that something qualifies than to stretch the rules and risk penalties. If the IRS disallows an improper deduction, you’ll have to pay the additional tax and possibly interest and penalties on that amount. Accuracy-related penalties can be 20% of the underpaid tax if they deem you were negligent or had no reasonable basis.

A quick Pros and Cons perspective might help illustrate the considerations:

Pros of Deducting Qualifying Cosmetic Surgery	Cons / Risks of Trying to Deduct Cosmetic Surgery
Tax Savings: If you truly have a qualifying procedure (medically necessary), you can reduce your taxable income and potentially get a significant tax break, offsetting some of the cost.	Strict Criteria: Very few cosmetic procedures meet the IRS’s strict criteria. Most attempts to deduct elective procedures will fail, so there’s a high bar to clear.
Financial Relief for Serious Medical Needs: When cosmetic surgery is part of treating a deformity or disease, the deduction provides relief for what is often a traumatic and necessary expense (e.g. rebuilding after an accident).	Audit Red Flags: Large medical deductions, especially those including cosmetic-sounding procedures, can attract IRS attention. You risk an audit if you push the envelope on what’s deductible.
Precedents Exist (Rare Cases): Tax Court has allowed certain cases (e.g. gender dysphoria treatment, extraordinary business-related surgery), giving you some legal footing if your case is similar and well-documented.	Personal Benefit = Not Deductible: If you derive personal enjoyment or benefit from the surgery in daily life (which is almost always true), the IRS will likely deem it personal. The personal aspect can nullify your deduction even if there’s some ancillary business or confidence benefit.
Health & Business Alignment: In the off-chance your situation genuinely overlaps health needs and business (like a documented medical need that also helps your work), you might deduct it safely.	Penalties for Improper Deductions: If you claim a deduction you’re not entitled to and the IRS catches it, you’ll have to pay back taxes, interest, and possibly a 20% penalty. If they suspect fraud (rare, unless it’s egregious), penalties are much worse. It’s not worth risking for a nose job.
Documentation Can Justify It: With strong medical documentation, you can feel confident claiming the deduction for an allowed expense (peace of mind).	Hassle and Complexity: Even if allowed, cosmetic-related deductions might require extra paperwork (doctor letters, allocating costs). And you still only get a tax deduction, not a full reimbursement – which may not be worth the hassle unless the expense is large.

As you can see, the cons of attempting to deduct non-qualifying cosmetic surgery far outweigh any pros. Essentially, only go down this road when you firmly fall in the “allowed” camp.

How to Claim a Cosmetic Surgery Deduction (If You Qualify)

Suppose you’ve determined that your cosmetic procedure does meet the criteria for a medical deduction (or even the rare business expense). How do you actually claim it on your tax return, correctly and in the most advantageous way?

For personal medical expense deductions (Schedule A):

Gather all medical expenses for the year: Make sure you include all qualifying medical and dental expenses, not just the surgery. This includes doctor visits, prescriptions, hospital bills, other surgeries, etc., plus travel costs for medical care, medical insurance premiums (if not pre-tax), etc. It’s the total that needs to exceed 7.5% of AGI. The cosmetic surgery cost will be part of this total.
Ensure the expense is unreimbursed: If insurance or any other party paid for part of the procedure, only your out-of-pocket portion counts. Use the net amount you paid.
Include it on Schedule A (Form 1040): On Schedule A, you will list your total medical and dental expenses on the appropriate line. You do not list cosmetic surgery separately by name. It’s just lumped into the total. The IRS doesn’t see a breakdown when you file – they only see the sum of medical expenses. However, keep your receipts and documents in case of questions later.
Apply the 7.5% AGI threshold: Tax software or the Schedule A itself will calculate the deduction as the amount over 7.5% of your AGI. For example, if your AGI is $100,000 and you had $12,000 of qualified medical expenses (including a qualifying surgery), the deductible portion would be $12,000 – $7,500 = $4,500. That $4,500 is what actually counts as an itemized deduction. (The rest is essentially not deductible.)
Maintain documentation: Because a cosmetic surgery that qualifies might look suspicious, it’s wise to keep a copy of your medical records, a letter from the surgeon, or any evidence that the procedure was medically necessary. You don’t send this with your return. You just keep it on file. If the IRS sends a letter or audits you, then you present this documentation. Typically, you’d have to substantiate if asked: the nature of the procedure, why it was necessary (maybe a doctor’s note referencing the condition), and proof of payment.
If only part was deductible: Let’s say you had a mixed procedure and decided, for example, that $3,000 of a $5,000 surgery was for medical purposes and $2,000 was purely cosmetic (non-deductible). Only include the $3,000 in the medical expenses total. If you’re ever asked about it, you’d need to show how you arrived at that allocation (e.g., an itemized bill or a letter from the provider). It’s not common for IRS to nitpick that deeply unless the numbers are big, but be prepared.
State returns: If you itemize federally and you’re in a state that uses federal itemized deductions, your medical deduction will usually carry over to the state form. Just be mindful of any differences (like in New Jersey, you’d recalc based on their 2% threshold and list it on NJ Schedule). Follow your state’s instructions. If you took a deduction federally and it’s allowed, it will often be allowed on state, but you might have to enter the amount separately or provide additional info.
HSA/FSA note: If you paid with a Health Savings Account (HSA) or Flexible Spending Account funds, you already got a tax advantage (those contributions were pre-tax). You cannot deduct again from Schedule A because that would be double-dipping. So exclude any amounts that were paid via an HSA or FSA. For example, if you had $5,000 of surgery costs and you paid $2,000 of it out of your HSA, only $3,000 can go on Schedule A (the other $2k was tax-free via the HSA distribution).

For business expense (Schedule C or corporate return):

Schedule C (for self-employed individuals): If you are a sole proprietor or single-member LLC, you report business income and expenses on Schedule C. In the extremely unlikely event you have a legitimate business cosmetic surgery expense (again, think Chesty Love scenario or some kind of special performance-related cost), you would list it as a business expense on Schedule C, likely under “Other Expenses” with a description (e.g., “Specialized performer props (breast prosthetics)” or something along those lines that accurately describes it). Note: labeling it clearly might even ward off confusion. Hess in her case depreciated her implants over several years (considered a capital asset). You might have to do the same if it’s something with a multi-year useful life. Depreciation would go on Form 4562 in that case, not to get too granular here.
Corporation or Partnership: If a company is deducting it, it would be on the entity’s return as some kind of business expense. But again, if it’s tied to an individual’s personal benefit, it could instead be treated as compensation. If you’re a business owner considering paying for something like this through the company, consult a CPA – structure it correctly or be ready to justify it.
Document the business purpose thoroughly: For a business deduction, it’s even more critical to have documentation because the default assumption will be that it’s personal. Keep contracts, show evidence of increased earnings due to the surgery, evidence that it was part of your professional performance or brand, etc. In Hess’s case, she had booking contracts showing she earned more with her enhanced figure, and evidence of the extraordinary nature of her implants. If you were going to attempt a business deduction, you need analogous proof that the expense was directly tied to income and not something any person would just do for themselves.
Expect scrutiny: A return with a weird business expense like “cosmetic surgery” might get flagged. The IRS audit manual literally has examples of disallowing personal grooming claimed as business expenses. So if you ever go that route, be prepared to defend it calmly and with evidence.

One more route to mention: Impairment-related expenses for employees (for disabled individuals as mentioned earlier). If you’re an employee (not self-employed) and you have an impairment that requires certain expenses to work, those can be deducted as an adjustment to income (above the line) under certain conditions, and they’re not subject to 7.5% threshold. But cosmetic surgery would rarely fall there, except perhaps if you had a disfiguring condition and got surgery that’s needed for you to be accepted at a workplace (that’s a stretch; usually it’s about equipment or attendant care). Still, if someone is in that situation, consult a tax advisor because the tax law does favor some accommodations for disabilities separately from medical itemizing.

Lastly, if in doubt, get professional tax advice. A qualified CPA or enrolled agent can tell you in five minutes if an expense is likely deductible or not. If you have a complex case (like gender affirming surgery, or a combination of personal and business factors), a tax pro can help you document it right or suggest alternative tax strategies (maybe using an HSA or FSA to at least get a pre-tax benefit if deduction isn’t allowed).

Real-Life Court Cases: Lessons Learned

It’s one thing to talk theory; it’s another to see how these issues have played out in actual cases. We’ve mentioned a few throughout, but let’s recap the outcomes of notable tax cases involving cosmetic surgery deductions:

Case (Year)	Outcome & Precedent
Hess v. Comm’r (1994) – “Chesty Love” exotic dancer case	Allowed – The Tax Court permitted an exotic dancer to deduct (depreciate) the cost of extreme breast implant surgeries as a business expense. Key reasons: implants were essentially stage props and not for personal use, and they were proven to enhance income. This case is a unique exception; it underscores that only in extraordinary circumstances will cosmetic enhancements be deemed work-related deductions.
O’Donnabhain v. Comm’r (2010) – Gender affirmation surgery	Allowed (mostly) – The Tax Court allowed a transgender taxpayer to deduct hormone therapy and sex reassignment surgery costs as medical expenses to treat gender identity disorder. This established that treatments for a diagnosed medical condition (even if involving surgeries altering appearance) can be deductible. However, the court disallowed the cost of breast augmentation in this case, viewing it as a cosmetic add-on not necessary for treating the disorder. The case affirmed the disease vs cosmetic distinction: treatments deemed necessary for health (physical or mental health in context of a recognized disorder) were allowed; purely aesthetic procedures were not.
Sparkman v. Comm’r (1940) – Performer’s cosmetic dental work	Not Allowed – A performer tried to deduct the cost of dentures (which improved appearance and speaking ability) as a business expense. The court denied it, considering it a personal medical expense. Precedent: Even if an expense helps in your job, if it’s fundamentally personal health or appearance, it’s not deductible as a business cost. This early case set the tone that personal benefit trumps any ancillary business benefit for things like appearance.
Multiple Cases (1960s–1980s) – Actors, Models, Professionals	Not Allowed – Courts consistently struck down deductions for face-lifts, hair transplants, liposuction, and similar purely cosmetic surgeries even when taxpayers argued they were for career purposes. For example, cases involving TV personalities deducting wardrobe or cosmetic enhancements were denied, citing the IRC §262 personal expense rule. These cases reinforce the principle that general improvement of appearance (to look younger or more attractive for work) remains a personal expense. The only successful deductions in this realm had very specific justifications (like a scar-removal being part of injury treatment, etc.).

The overarching lesson from the courts: They apply the law strictly. While sympathetic in some cases (like the trauma or medical ones), they rarely let emotion sway them on someone simply wanting to look better. In the O’Donnabhain case, the court had voluminous medical testimony to establish that gender dysphoria is a serious condition and that the treatments were medically indicated – they didn’t just take the taxpayer’s word for it. In Hess’s case, the taxpayer’s situation was so outlandish and singular that it proved the point – no one would undergo that surgery except for a professional reason.

If you think you have a novel situation, be aware that tax court litigation is not for the faint of heart. It’s usually easier to not push the deduction in the first place. But these cases serve as guideposts so you don’t have to test the IRS yourself.

FAQ: Deducting Cosmetic Surgery (Quick Answers)

To wrap up, here’s a FAQ section addressing common questions on this topic. Each answer is a concise “Yes” or “No” with a brief explanation:

Q: Can I deduct a purely cosmetic procedure (like a facelift or tummy tuck) on my taxes?
A: No. Purely cosmetic procedures for improving your appearance are not tax-deductible medical expenses under IRS rules.

Q: Is plastic surgery ever tax-deductible?
A: Yes, but only if it’s to treat illness or correct deformities from birth, injury, or disease. Elective aesthetic plastic surgeries are not deductible.

Q: My cosmetic surgery was recommended by a doctor for my mental well-being – can I deduct it?
A: Maybe. If it treats a diagnosed mental or physical illness (not just general self-esteem), it might qualify. Otherwise, it’s not deductible.

Q: Can a small business owner write off cosmetic surgery as a business expense?
A: Generally no. It’s almost never considered an “ordinary and necessary” business expense unless it’s an extreme, work-specific case (very rare).

Q: I’m a professional model – can I deduct cosmetic enhancements I get to maintain my career?
A: No. Even in appearance-focused careers, cosmetic enhancements are considered personal. The IRS views them as benefiting you personally outside of work, so not deductible.

Q: Are costs for gender confirmation surgery deductible as medical expenses?
A: Yes. Treatments related to gender dysphoria (including surgery and therapy) are deductible as medical expenses, per Tax Court precedent, as they treat a recognized medical condition.

Q: If a cosmetic procedure also fixed a medical issue, can I deduct it?
A: Yes (partially). You can deduct the portion of the procedure related to the medical issue. The purely cosmetic portion of the cost is not deductible.

Q: Can I use my Health Savings Account (HSA) to pay for cosmetic surgery tax-free?
A: No. HSAs follow the same rules as deductions. Funds can only be used tax-free for qualified medical expenses (cosmetic surgery isn’t qualified, barring the medical exceptions).

Q: Are dental veneers or teeth whitening costs tax-deductible?
A: No. Cosmetic dental procedures like whitening or veneers purely for appearance are not deductible. Dental work must be medically necessary to qualify.

Q: If my state has a lower threshold for medical deductions, can I deduct cosmetic surgery on my state taxes?
A: No. States still require the expense to be a qualified medical expense under IRS definitions. A lower threshold helps only if the expense is deductible in the first place.

Q: I had surgery to remove excess skin after major weight loss – is that deductible?
A: Yes, if removing the excess skin was deemed medically necessary (to prevent rashes/infections or other issues). If it was solely for appearance with no health impact, then no.

Q: Do I need to send proof of medical necessity with my tax return for a cosmetic surgery deduction?
A: No. Don’t send documentation with your return. Just keep it on file. Provide it only if the IRS asks for support later.

Q: Can I claim a tax deduction for cosmetic surgery I got abroad (medical tourism)?
A: Yes, if it otherwise qualifies as a medical expense. Location doesn’t matter. Ensure you have proper receipts and proof it was medically needed by IRS standards.

Q: Are hair transplants or treatments for baldness deductible?
A: No. Hair transplants for natural baldness are considered cosmetic and are not deductible medical expenses.

Q: Does insurance coverage affect my ability to deduct a cosmetic procedure?
A: Yes. Only out-of-pocket costs are deductible. If insurance (or any other source) paid for part of it, you can’t deduct that reimbursed part.