Physical appearance concerns lead to serious health compromising behaviors among women in Thailand. The purpose of this study was to examine differences in physical appearance identity among young women in four regions of Thailand based on 30 physical appearance characteristics generated and validated in two previous samples of young Thai women. Using Q methodology, 200 Thai young women sorted the physical appearance characteristics in terms of importance. Across-region differences exist for the most important physical appearance characteristics. Regional differences in physical appearance identity may explain the variety of behaviors used by Thai women to enhance their physical appearance. Further research should focus on regional factors that contribute to these aspects of physical appearance becoming a dominant source of self-definition so that effective prevention strategies can be developed and targeted to women at high risk.