Self respect and confidence doesn't need to be related to looks. Some people is confident and selfrespectful and don't really care that much about their looks. That is also OK.

On the other hand, some people focus so much on how they look, that they become unsecure for the slightess imperfections and doesn't respect themselves enough to say that how they looks is secondary to their character.

Basically, some people just want to be comfortable in their own skin because they know their worth is not about their looks.

It is a choice, just that.