> Everyone looks great if they live healthily and groom themselves.

Not true for everyone. Simply living healthily and grooming, you are still limited by the ceiling imposed by your body. Sometimes it just doesn't live up to the aesthetic demands of the human psyche, used to a superstimulus of attractiveness as the norm.

>Every surgery is risky even medically necessary ones

Most cosmetic surgeries carry very little risk, your overall risk from even being a moderate drinker, commuting to work in a car, being mildly overweight are far higher in aggregate.

My main point is, the human modern social world isn't a perfect arbiter of reward based on whether you are doing all the "right things", by being generally healthy.

Sometimes people get a disease, like cancer, and nothing our body evolved to do can help, but human-invented therapies can actually help. Likewise, you can be perfectly healthy and nevertheless start balding, and no amount of generally being healthy is going to fix it, and no amount of generally being healthy will mitigate the minor albeit real social cost of it.