Appearance-related media from the United States and other Western nations has been implicated in explanations of increased body images concerns among non-Western women. However, researchers have rarely examined the impact of endogenous appearance media versus Western appearance media on body image issues, particularly within longitudinal research designs. Therefore, in this 12-month prospective study, we assessed associations of experiences with appearance media imported from Western nations versus appearance media from China and other Asian nations on body image concerns and cosmetic surgery interest among young Chinese women. Participating women (N = 1836) completed self-report measures tapping specific sources of appearance dissatisfaction (fatness, facial features, stature), cosmetic surgery interest, and appearance media influences at baseline and a 12-month follow-up. The women reported significantly more pressure from and stronger preferences for appearance depictions in Asian than Western media. Elevations in appearance pressure and preferences from Asian media explained more unique variance in specific body image concerns at follow-up than did complementary Western media influences. Contrary to “Westernization” hypotheses, Asian appearance media influences are more salient for young Chinese women and should be prioritized as targets of interventions to reduce body image disturbances in this group.