Turning plastic surgery patients down can be difficult but should be considered in certain situations. The first group of patients that are turned down are the medically unhealthy ones: the heavy smokers with coronary stents and uncontrolled diabetes.  In these situations, the risks of surgery outweigh the benefits.  Sometimes, patients are able to optimize their health if they see a medical specialist beforehand and then can be re-considered for plastic surgery in the future.

Another group are those with unrealistic expectations.  It could be a woman entering the office requesting to have surgery to make her belly button look exactly like Kim Kardashian’s.  Or it could be someone who wants to have a tummy tuck but asks to leave out any scars.  In these cases, I make it clear that these expectations are unreasonable or impossible, and that there’s a good likelihood that they would be disappointed after surgery.  If they persist, I’d explain to them that I wouldn’t feel comfortable doing their surgery and unable to achieve their goals.

Also, about 1 in 50 people have a psychiatric condition called body dysmorphic disorder (BDD).  In this condition, a person overly obsesses on a perceived flaw that may be minor or imagined.  They often seek plastic surgery to fix their problem.  Red flags would be that they spend many hours during a day evaluating themselves in the mirror, avoid social situations or photos because of their perceived flaw or constantly compare their appearance to others.  These individuals should not have plastic surgery, as it would not fix their underlying problem.  Instead, they should be guided towards counseling and psychiatric evaluation.

Other red flags to look out for are patients who don’t know what they want.  The ideal patient should have an idea about what they want fixed with reasonable expectations.  They should be able to articulate their goals, whether it’s to reduce a hump on their nose or lift their sagging breasts after having 3 children and breastfeeding.  Often, I encourage patients to bring in “wish pics” of what they’re trying to look like.

Finally, it’s important to identify patients who want plastic surgery for the wrong reason.  They should be doing it for themselves and not for an ulterior motive.  If a 44 year-old woman wants a facelift in order to win back her cheating husband from a younger mistress, it would be a red flag.  Obviously, doing a facelift here would not address the underlying problem.  As highlighted in these examples, turning plastic surgery patients down in certain situations can go a long way in avoiding disappointment and bad results.