Top 4 (Not-So-Obvious) Reasons Why a Plastic Surgeon Won’t Do Surgery

Jager Weatherby on 17 Jun 2014 at 9:00am

Plastic Surgery
Written by Varci Vartanian


Board certified? Check. Extensive library of quality before-and-afters? Check. Glowing RealSelf reviews? Check. With a sigh of relief, you snap your laptop shut. You’ve narrowed your list of plastic surgeons to a select few, and are nervous but ready for your first in-person consultation.

But what you may not realize is that your surgeon also has a checklist for you. If he or she feels you’re not healthy enough to make it through the rigors (both physical and psychological) of major surgery, they may decline (albeit gently) to perform your surgery.

Glaring health concerns — like pack-a-day smoking, out-of-control diabetes, or bleeding disorders — can dash cosmetic surgery dreams, but there also exists a lesser known category of disqualifiers that your doctor is using to assess you. These are a bit harder to broach than your blood pressure, but we’ve got some fascinating insights from behind-the-scenes (aka our board-certified plastic surgeons).


Surgery For The Wrong Reason

Your doctor will likely dig a bit to find out the motivations behind you getting “work” done. Why? It’s a major concern if a consumer thinks having a stronger chin, smaller thighs, or a bump-less nose will usher a cheating ex (or a particular job promotion) into their corner.

Beverly Hills-based plastic surgeon Dr. Richard Fleming says, “I turn down about 30% of people who come in for consultation, not because of their physical health, but they may have unrealistic expectations or are doing the surgery for the wrong reasons.

Surgery For the Wrong ReasonsA 40-something woman wants a facelift because her husband is having an affair with a younger woman. I could do the surgery, and have great before-and-afters, but there’s a risk that she’s not going to be happy because I can’t give her what she wants. She wants her husband back.”

The same “doc logic” can be applied to a particular promotion you’ve pinned your hopes on, adds Dr. David Sarwer, psychologist and clinical researcher at University of Pennsylvania’s Center for Human Appearance.

He tells RealSelf, “We worry about patients who think the surgery will dramatically transform their lives — these are the patients that surgeons need to be proactive about screening. Is the patient doing it for themselves or does the patient have an ulterior motive, like a romantic relationship [they are trying to change] or a promotion that’s eluded them for years?”

Dr. Sarwer says there’s little clinical evidence to show body modifications like silicone, pec implants, or a revision rhinoplasty will lead to significant changes in a social relationship or employment status.

“If a patient is looking at this as an investment or way to make money in the future [...] the data just doesn’t support that. ”


The Solution Isn’t Skin Deep

Your doctor also wants to know how much time you spend thinking about your appearance – is it more than an hour a day? Have you ever skipped a social event to "hide" yourself? And last, have you undergone multiple procedures (from different doctors) to “fix” areas like your hairline, nose, breasts, or belly?

Affirmative answers to these questions may signal a deeper mental health issue, like body dysmorphic disorder (BDD). BDD is characterized by an unrelenting obsession to “fix” a perceived flaw that is often seen as minor or is even undetectable by others.
Solution Isn't Skin Deep
Though the flaws may seem minor, those who suffer from BDD are experiencing real distress over their appearance — and this may drive them to never-ending hours of exercise, layer upon layer of makeup, avoidance (or obsession) with mirrors, and/or the nagging feeling that bigger implants or just one more syringe of Restylane will solve everything. It’s rumored that artist Andy Warhol, poet Sylvia Plath, and — most notoriously — Michael Jackson all suffered from BDD.

Though BDD is a term that is somewhat carelessly thrown around popular culture today (much like OCD) it’s important to note that BDD is a relatively rare condition that affects only 5 to 15 percent of the population. Treatment for BDD happens outside of the operating room, and often includes medications and psychological counseling.

And for those not diagnosed with major mental health issues, Dr. Sarwer reveals that “a number of studies show body image improves and people do feel better about themselves after a cosmetic procedure. That said, cosmetic surgery is not an appropriate treatment for severe depression or BDD.”


You Don’t Know What You Want (Or Maybe You Do)

It’s normal for your physician to ask what brought you in, and if you haven’t really thought it through, that may send a signal to your surgeon.

“I have a patient look in the mirror and ask them their goals for surgery. If they have trouble articulating their goal or ask me what I think they should do, that’s a red flag. I don’t know if I’m going to be able to satisfy them. My first goal is patient safety and then it’s patient satisfaction. If I can’t guarantee that, I’m going to tell them I can’t do the surgery,” says NYC plastic surgeon, Dr. David Shafer.

Expectations Are UnrealisticOn the flip side, being too tied to an unrealistic goal (i.e., thinking that a tiny bit o’ liposuction can erase volumes of sagging skin or that you’ll emerge from surgery looking just like Heidi Klum) is also a concern.

Dr. William A. Wallace, a board-certified surgeon from Jacksonville, Florida, says he often uses a patient’s “wish pics” to weed out those with unrealistic expectations.

“I always encourage patients to bring in pictures of other people with noses that represent the results they desire. More than once I’ve had a patient bring in a picture of a nose that could never be achieved. The greatest source of unhappiness for a patient after rhinoplasty is that of unrealistic expectations,“ says Dr. Wallace. 


You've Likely Discovered a Really Good Doctor

You've Discovered a Good Doctor

Lastly, a surgeon who is candid about saying they aren’t comfortable performing your surgery is probably doing exactly what he/she was trained to do.

Says Portland plastic surgeon Dr. Ronald DeMars, “Our job is to decide if what you want can realistically be done — and be done in a safe way with more chance of success and less chance of failure. Good surgeons turn down patient requests all the time. It's the not-so-good ones who would be willing to do anything for the fee.”

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Photo credits: Justin Bishop/Courtesy of Vanity Fair; Some rights reserved by Ed Yourdon on Flickr; Some rights reserved by Suzy Forcella on Flickr; Helenasirmedspa on Instagram; Brandon Hickman/E! Entertainment © 2014 NBCUniversal, Inc.