You’ve done your research, saved your money, and found a board certified plastic surgeon to perform the procedure you’ve been longing for. You show up to your consultation prepared to learn the details of surgery, the length of the recovery period, and the potential risks. What you probably weren’t expecting to hear? The word ‘no.’
It is not uncommon for aesthetic surgeons to refuse to perform a procedure on a patient or suggest an alternative course of treatment. We spoke to board certified plastic surgeon Richard J. Brown, MD, and board certified facial plastic surgeon Jason D. Bloom, MD, about the main reasons why a provider may choose not perform a patient’s preferred cosmetic procedure.
1. You Want What You Can’t Have
The top reason a surgeon may turn down a potential patient: unrealistic expectations. There is nothing wrong with coming to a cosmetic surgery consultation with photos of a celebrity, influencer, or even a friend, so long as you are prepared to learn why the exact look you covet may not be possible for you.
“I have to constantly remind people that this is surgery,” Dr. Bloom says. “I’m going to work towards a goal, but it’s not robotic. It’s an art.” As he explains it, surgeons must take into account the relationship between what he or she can actually do, what the patient’s anatomy is, and how the patient is going to heal before moving forward with a procedure.
“I tell patients, ‘Here’s where you are. Here’s where I think you can be,’” Dr. Brown, author of The Real Beauty Bible, adds. “If you can’t either meet me somewhere in between or come down to what I think is realistic for you, then you’re not a good fit for me for this operation.’”
2. You Have a Health Condition
There are a number of health and lifestyle factors that might make a surgeon refuse to perform plastic surgery — or at least to delay an operation. If a surgeon suspects that a surgical procedure may be unsafe, patients may need to undergo certain pre-operative tests, make lifestyle changes, or sign additional paperwork before scheduling a procedure date. According to our experts, some of the most common factors include:
- Smoking: Nicotine constricts blood vessels, which can lead to complications (like black, necrotic skin) during the recovery and healing process. For Dr. Brown, a positive nicotine test on surgery day is a dealbreaker because he feels it’s just not worth the risk.
- BMI: Someone with a high body mass index (BMI) is at risk for both healing issues and anesthesia complications. Overweight patients are prone to blood sugar issues, which can hinder recovery, Dr. Brown says.
- Medical Conditions: Certain chronic health issues, such as diabetes and thyroid conditions, can lead to post-op problems. While they’re not necessarily deal breakers, Dr. Bloom says that these issues do influence whether or not he takes on a particular patient.
- Medications: Immunosuppressants and blood thinners are two categories of pharmaceuticals that increase the risk of infection and bleeding/hematoma — even when the patient stops taking the drug prior to surgery. Plastic surgeons evaluate these patients on a case by case basis.
3. You’re Doing It for the Wrong Reasons
Cosmetic surgery can do wonders for a patient’s outlook and self-esteem, but only when it’s what you truly want for yourself. “Surgery is serious and not without complications, so why would you ever put your life at risk to try and please someone else with your body,” Dr. Brown asks. “Mindset is everything.”
He steers clear of patients who are obviously wanting to change their appearance to please a spouse, family member, or friend. “When you have surgery for someone else, you are not in the mindset to be your best and surgery won’t fix that,” he says. “Surgery does not fix relationships or make them better. If you are not doing something for yourself, it's not worth doing.”
4. You’re Not Ready Yet
Both of our experts agree that patients should be within 10 pounds of their ideal weight prior to having any procedure — even facelifts. Dr. Brown, who performs a significant amount of breast and body work, is passionate about helping patients achieve their body goals prior to going under the knife or needle. “This has nothing to do with body shaming or me wanting them to look a certain way,” he explains. “If a tummy tuck patient has too much visceral (internal) fat because they still have weight to lose, then I can’t possibly plicate the rectus muscles and tighten them up and make them flat. They’re still going to have bulging.” Instead, he spends a lot of time educating patients: “I tell them, ‘Look: you’re going to spend all this money to have a great operation, but you’re going to have a suboptimal result.’”
Rather than turn patients away, Dr. Brown seeks to foster a long-term partnership. “With our wellness center, we’re able to set them up with a nutrition coach to help them with their diet and a mental coach to help them with their body image,” he shares. Eventually, he plans to offer a prepared meal service as well as trainers to help craft exercise regimens. If a patient isn’t willing to undertake the wellness journey, he or she won’t be a good fit. “They can just go find another surgeon,” he says.
5. You Don’t Hit It Off
Relationships are a two-way street. Patients may be surprised to learn that their prospective plastic surgeon is also interviewing them during a consultation. After all, the relationship between patient and surgeon can potentially last a lifetime, if you factor in pre-op, recovery, maintenance, and any future procedures. “Sometimes they’re not a good fit for me personality-wise,” Dr. Brown explains. “I may turn them down because I don’t think that we’re going to mesh and they’re not going to be happy.” And, remember, this works both ways. If the two of you aren’t vibing during the initial consultation, feel free to say, “thank you, next.”
6. You Need a Different Kind of Care
During a consultation, plastic surgeons are not only evaluating your anatomy, your aesthetic goals, and your physical fitness for surgery. They are also considering your psychological health. “I certainly feel like I’m a counselor at certain times while talking to patients,” Dr. Bloom admits. While a certain level of insecurity is commonplace, a fixation or obsession is a red flag for any plastic surgeon. Patients who are overly preoccupied with a perceived flaw may never be satisfied with any surgical outcome and will most likely be refused any plastic surgery procedures. If a surgeon suspects that a patient might have a mental health condition, like body dysmorphic disorder (BDD), they may refer them to a therapist.
7. You’ve Got It Wrong
Despite all of the time and effort you’ve put into researching procedures, you did not earn an honorary MD on Google and Instagram. You may think you need a certain procedure, product, or device to meet your goals, but only a board certified plastic surgeon can make the call. “My job is to give patients the right products for the right reasons,” says Dr. Bloom, who sees patients ask for products by name because of pervasive marketing. “I tell them: ‘How about I do something that’s going to give you better results, maybe even cost you a little less, and you’re going to be happier? How does that sound?’”
Both Dr. Brown and Dr. Bloom find that most patients who come into a consultation with preconceived notions end up being very receptive to their expert opinion. “I’ve never had a patient insist on a particular procedure once I’ve spent time educating them,” Dr. Brown says.
Dr. Bloom agrees, telling armchair MDs: “You might know a little bit, but you certainly don’t know as much as I do when it comes to this topic. So let me do what’s in your best interest to get you the results that you want.”
At the end of the day, it is in everyone’s best interest to achieve a stellar outcome, which means finding the best surgeon to perform the right procedure on a fit candidate. “In elective surgery, why would you take on any less than a perfect client with the most optimal opportunity to have a good result,” Dr. Brown says.
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