Dear Apple The opinion of the patient does matter. However, it is human nature to what more and better. Consequently, patients are often told that they will have to pay something toward the cost of revisional surgery. Policies among surgeons vary and the exact issue also has some bearing. To me, if a patient has had an aesthetic improvement but wants a more dramatic effect, they will be asked to pay for the cost of anesthesia and the facility, and generally, a portion of the surgeons fee. Occasionally, there is some post operative issue. It might be that the incision did not heal ideally or separated while healing. Their might be residual fullness in the eyelid that is beyond an aesthetic issue. Under these circumstances, I often will revise the eyelid at no charge to my patient. I think this approach is very common with other surgeons as well. Obviously, it is possible that the patient and the surgeon are not on the same page. The patient might feel that surgery was very disappointing and yet the surgeon may feel that the result is very acceptable and that the patient just has "unrealistic expectations." On more that one occasion, this has been the basis for a permanent break down in a relationship between the surgeon and the patient. I think that most surgeons are motivate to make their patients happy but recognize that there are limits. If there is no meeting of the minds, then it is probably best to look elsewhere for further aesthetic help. In the process of looking for a new surgeon, it pays to avoid bad mouthing your first surgeon because this will definitely make the new surgeon uncomfortable. It is unavoidable for them to think that it is just a matter of time before you may be talking to another surgeon the same way about them.