Some plastic surgeons charge for consultations, some offer free consultations and some apply the consultation fee to the eventual cosmetic procedure, should the patient decide to proceed. Differences in policy are due to many factors, including whether the plastic surgeon is aggressively building business, the specific market where the practice is located and others.
On some websites you'll see the policy on consultation fees right up front, but this is not required. Your best bet is to ask about the consultation fee and make sure it's clear when you schedule your appointment.
Consider this example. Rhinoplasty is a difficult and demanding operation -- the consultation and examination are very important in evaluating the patient. And then a thorough explanation of what was found and what can be done is provided. I spend an average of 30 - 45 minutes of personal time with a patient doing just that. Sometimes surgeons who do a "free" consultation spend five minutes with the patient and then allow their staff to fill in the gaps. In my view, there is nothing of value which is really free in this world.
Elliot Jacobs, M.D.
New York Plastic Surgeon