I've met too many people, females in particular, who limit their views of
body modification to the basics.
Piercing,
tattoos, and a little
scarification are all that make it onto their lists. Show them a
porn magazine full of females with $15,000 worth of surgery invested in them and they just pass her off as if she was a
prostitute.
Many piercing artists and tattoo artists claim to work "in an art of the flesh", but never consider pornography to be a part of that, despite the proficiency of many porn stars in the arts of manipulating flesh. Breast implants are considered trivial by many body mod artists, as if they're only for whores.
Not all body modification is done in a studio just for tattoos and piercings. Cosmetic surgery surely qualifies as body modification, by both the most literal definition and the commonly used definition. Not all people who choose to get a nose job or hair plugs are doing them because they are insecure or somehow not at peace with themselves, many just don't want to look the same way for too long. It would be a bit absurd to accuse everyone who dyes their hair for fun of being insecure, or finding a gray hair, freaking out and trying to hide it with purple streaks. Just as not everyone with dyed hair is trying to regain their youth, not everyone with a nose job is insecure. Not everyone with breast implants is a whore, not everyone who gets liposuction is at war with themselves.
Of course, many of these preconceived notions come from stereotypes which have some basis in reality. I don't think there is some illuminati group out there trying to fuck up the lives of everyone who gets cosmetic surgery. Some people definitely do have a cosmetic procedure because they are uncomfortable with how they look and present themselves.
Consider transsexuality relative to this. Many pre-op transsexuals feel not just slighty ill-at-ease when people look at them, but physically ill, scared and often extremely depressed to the point of contemplating suicide. The concept of pointing fingers at people who surgically alter themselves gets left very far behind for me when I remember that for some people the difference between having cosmetic surgery and not having cosmetic surgery is the difference between life and death (though the term "cosmetic surgery" trivializes the necessity of this type of sex reassignment surgery, I feel that the comparison is valid, because the amount of daily stress relieved by a transsexual undergoing gender reassignment surgery is comparable to the amount of daily stress relieved by someone with an unsightly bump on their nose having it removed by way of rhinoplasty).
Consider also, pregnancy as a form of body modification. I can think of no other modification to ones body as beautiful as pregnancy. It's completely natural and alters so much of your body's chemistry and physical appearance that I'm surprised more people don't consider it to be at least something of a modification. Not all body modifiers are girls with shaved heads and extensive kanji tattooed on their necks, many are unpierced and ink-free.