The study investigated gender differences in satisfaction with physical appearance as a domain-specific aspect of self-esteem, and its association with global self-esteem and psychosomatic complaints. The data used was from the Stockholm School Survey, conducted among ninth grade students (15–16 years), with pooled information from six cross-sectional surveys in 2004–2014 (n = 32,117). Girls reported lower satisfaction with their appearance than boys. Satisfaction with appearance was more strongly associated with global self-esteem among girls, while the association with psychosomatic complaints was similar for both genders. There was a tendency towards a decline in satisfaction with appearance at the end of the study period for both genders, albeit more strong for girls. We conclude that satisfaction with appearance may contribute to our understanding of poor mental well-being among adolescent girls.