6 Patient Red Flags Plastic Surgeons Watch Out for During Consultations

When you’re looking for a plastic surgeon, you might be keeping an eye out for certain things, like legit before and after photos and board certification. But similarly, plastic surgeons also have to vet patients, since not everyone is a good candidate for any desired surgery—or a great match for the provider. “It is not as though every person who comes to the office is ready to have surgery—and when I say ‘ready,’ I mean physically, emotionally, and financially,” says Dr. Ryan Neinstein, a board-certified plastic surgeon in New York City.

In fact, depending on the surgery (or surgeries), you might be in it together for the long haul. For that reason, you can think of the first consultation as an interview ahead of a months- or years-long partnership. “Both of us will be committing a huge amount of time, energy, and resources for the next coming years,” says Dr. Neinstein, who doesn’t proceed with operating on roughly 70% of patients he meets with. Los Angeles–based board-certified facial plastic surgeon Dr. Sarmela Sunder, for her part, declines roughly 50% of potential surgeries, with 15% to 20% of that being for reasons besides simply not being a physically appropriate candidate.

With that, these are the red flags among patients that plastic surgeons keep an eye out for during consultations.

You won’t accept an explanation from the doctor

This is often a matter of what your anatomy does (and does not) allow for. Take a lower facelift. Dr. Sunder usually points to Angelina Jolie and Hailey Bieber as examples of what patients are looking for. “But a lot of the results have to do with underlying bone structure, deep anatomy, and how strong their jaw bone is,” she says. “So for someone who has a weaker jawbone or a lot of deep-neck tissue, it doesn’t matter how we tighten the tissues and lift the tissues—if they’re missing that underlying bone structure, it’s not going to drape as well.”

It’s even trickier to navigate if you go for a consultation with a friend, since one of you might have a better underlying bone structure. While some people can accept that, others simply won’t. “They say, ‘Well, how come my friend can? I’ve had lots of friends who’ve gotten this type of result, why can’t I get that?’” says Dr. Sunder. If a patient makes it clear that they don’t understand or won’t accept that there are limits, she’ll decline to operate.

You push for the results you want over the safety recommendation

This comes up a lot with rhinoplasty, since reshaping the nose can affect how well you breathe. And these days, says Dr. Sunder, patients come in asking for smaller noses or a more tapered tip. However, for many people, “their internal airway wouldn’t support that,” she says. “If we got too small with their nostrils or their airway, then they wouldn’t be able to breathe as well. But they’d love the aesthetic outcome.”

Some patients, she says, will simply respond to these concerns with: “Oh, that’s okay, so long as it looks cute.” If they never get to the point of accepting a new nose that’s different from what they initially wanted, then that’s a major red flag.

You frame plastic surgery as a quick fix

A major red flag for Dr. Neinstein—and a common reason he turns down patients—is when “they are not willing to commit the time, energy, and resources to the results that match what my team and I are willing to do,” he says. In other words, the surgery is a long-term investment versus a one-time transaction. To that end, he appreciates it when his patients can supplement the results of his work with clean eating, proper exercise, and a commitment to their recovery program after the surgery. “I seek out like-minded people who share the passion and vision for getting the most out of life,” he says. “This can scare a lot of people away.”

You’re rude to the office staff

Courtesy goes both ways, and while you might expect a good bedside manner from your provider, they similarly expect you to be kind as well. “There are some patients who are just very hostile to the staff,” says Dr. Sunder. And since the support staff, from scheduling assistants to nurses, can be integral during the recovery and post-op periods, this is a major reason that a provider might decline to carry out a procedure.

You’re dealing with a major life event

While this is less common, some people seek out plastic surgery as a way to avoid addressing some other issue in their lives. In this case, it might be a patient who feels as though their appearance is impacting their career or life in some way, and they’re using the change as a crutch. “Plastic surgery is a physical change, but there is a significant psychological and emotional burden that comes along with it—and watching your body change, even for the better, has ripple effects,” says Dr. Neinstein. For that reason, he doesn’t want to start a process during transitional times in one’s life, be it active weight loss, a divorce, a job change, or even moving.

This is mostly to protect the patient’s satisfaction. “It doesn’t matter how amazing their results are—they’re not going to get a desired result because there’s an emotional void that they’re looking to fill with a physical alteration,” says Dr. Sunder. (Think of it as an aesthetic riff on “Wherever you go, there you are”—meaning you’ll still be you after a surgery.) Although she won’t turn these patients down off the bat, she does spend more time with them at the consultation and advises them against booking right away. Or when there’s a clear factor, like a divorce or a layoff, she recommends a second consultation at a later date.

You push back on pre-op protocols

Most people are comfortable with considering their medical history, like a cardiac issue or being on a blood thinner, in the context of a potential plastic surgery. (After all, it’s a safety matter, and that’s paramount when it comes to any procedure, plastic surgery or otherwise.)

However, weight-loss medications like Ozempic have recently added a new wrinkle to this protocol. Due to its potential to cause complications with anesthesia, many providers—Dr. Sunder included—have new rules under which patients have to stop taking the injection (which only works so long as you take it) for anywhere from two to four weeks, depending on the surgery and the dose. “If I get pushback about that, it indicates a bigger compliance issue to me,” she says.