Individuals who are more attractive are thought to show a greater preference for facial sexual dimorphism, potentially because individuals who perceive themselves as more physically attractive believe they will be better able to attract and/or retain sexually dimorphic partners. Evidence for this link is mixed, however, and recent research suggests the association between self-rated attractiveness and preferences for facial sexual dimorphism may not generalise to non-Western cultures. Here, we assess whether self-rated attractiveness and self-rated health predict facial sexual dimorphism preferences in a large and culturally diverse sample of 6907 women and 2851 men from 41 countries. We also investigated whether ecological factors, such as country health/development and inequality, might moderate this association. Our analyses found that men and women who rated themselves as more physically attractive reported stronger preferences for exaggerated sex-typical characteristics in other-sex faces. This finding suggests that associations between self-rated attractiveness and preferences for sexually dimorphic facial characteristics generalise to a culturally diverse sample and exist independently of country-level factors. We also found that country health/development moderated the effect of men’s self-rated attractiveness on femininity preferences, such that men from countries with high health/development showed a positive association between self-rated attractiveness and femininity preference, while men from countries with low health/development showed the opposite trend.