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Are you a good candidate for cosmetic surgery? (What your plastic surgeon won’t want to discuss with you)

Are you a good candidate for cosmetic surgery? (What your plastic surgeon won’t want to discuss with you)


Plastic surgery in the United States is on the rise. Data is showing that Americans are increasingly caring about their appearance. They are having increased cosmetic procedures from Botox and injectables to eyelid surgery and liposuction. Since COVID the demand for these services have sky rocketed as Americans have shifted many of their purchases away from material objects like cars or jewelry and towards themselves mentally, emotionally and physically. We have seen in this country an increased demand for self-help courses, therapy and even health based services for  weight loss and longevity medicine. It is clear that the demand for plastic surgery has increased but more and more Americans are asking themselves “I want to do something for myself cosmetically but am I a candidate?” Cosmetic surgery is not for everyone despite what every online article or plastic surgeon’s website tells you. On a personal and human level, I want patients who are good candidates to undergo a procedure with me. In fact, most busy surgeons have no interest in someone who is a poor candidate undergoing surgery. The revenue is simply not worth it and frankly most of us are not interested in taking a large chance to have an unhappy patient. Here I review all the qualities that are important for being a good candidate for cosmetic surgery.


Cosmetic surgery or procedures are  a big undertaking. After all, we are doing something to our bodies and altering it. There is a process leading up the surgery such as consultations. There is the cost. There is the day of surgery and undergoing the actual procedure. There is the recovery period . This process is complex for many reasons and is more involved than the stop and shop scenario seen when one goes and picks up lunch or gets their hair done despite what instagram, plastic surgeon websites and online articles tell us. It is important to know ahead of time whether you can undergo the steps of surgery beyond just the physical requirements to have anesthesia and a procedure.


Determining what those components are that are necessary for a patient to have a positive cosmetic surgery experience is what is meant by “Am I am candidate for cosmetic surgery?”. The components  range from the physical requirements to the psychological and emotional state of the patient.


First and foremost. there has to be a physical problem that can be fixed with a cosmetic procedure. If one doesn’t have sagging skin or puffiness in the eyelid, a cosmetic eyelid surgery won’t really help a patient. Additionally, if the problem that the patient has is not fixable with a particular cosmetic procedure that is not helpful either. I have patients who come to my office in Denver who don’t have aging changes of the eyelids but want to change their inherent appearance of the eyelids such as distance the eyes are apart on the skull or change the shape of the eyelids to look like a particular celebrity.  The statistical odds that these changes can be achieved with cosmetic eyelid surgery are low so they would not be a good candidate. Additionally, patients who want their plastic surgery to achieve things beyond what a particular procedure cannot achieve are also poor candidates from a physical perspective. The results are limited by the actual procedure.  A facelift may lift or tighten the skin and muscle of the face giving a better appearance but it doesn’t improve the lost facial volume seen through aging or change the skin quality. A patient with a large amount of sun damage on their face cannot expect that to be improved with a facelift. Additionally, the level of improvement should match the problem the patient has. A patient who has severe sun damage with precancerous lesions all over the face may have a modest improvement with a laser procedure. This is the physical candidacy of the patient which is very easy for the surgeon to determine and review with the patient. It should be worth mentioning that along with the physical aspects of the area being worked on, the health of the patient is also important. An unhealthy person may not be a good anesthesia candidate, may not heal well or may just be too high risk to undergo a cosmetic procedure. This is obvious for most but should be mentioned.


The next candidacy requirements are more nebulous and harder for a surgeon to determine. Really, the patient is the one that has to screen these components themselves. Though i may get to know someone for a short period of time it is important for the patient to analyse “is this the right procedure for me based on what this surgeon is telling me?” “Do I think I am a good candidate?” Often your gut feeling is correct.


What is really important when it comes to cosmetic surgery is the mind of the patient more than their physical qualities. What plastic surgeons talk about at medical meetings, over glasses of wine and at the gym are the expectations of the patient when it comes to a procedure. A patient with unrealistic expectations is a runaway train on a path for collision with a stone wall. The result will be inevitable and the same every time. No one wants this. To solve this we educate patients and try to ascertain if they are listening and accepting what we are saying. That is very difficult to do with 100 percent success in a consultation though.  Most patients through education can learn what a particular cosmetic procedure will or won’t do for them. The question is whether they accept that information. Some patients will ignore what the surgeon will tell them about how a procedure may improve and to what extent improve a particular problem that they have. There are people who I am sure everyone has met that someone might say “Michael has a mind of his own. You can tell him but he won’t listen.” That also exists in cosmetic world.  This particular patient will hear what they want to hear and though being told the limits of the procedure, will hold onto that belief that the procedure will do more than the doctor is saying. There are complex psychological reasons for this that are beyond the scope of this article but it is important to know that this patient can exist and that patient can be you or even me if I was a patient. The best way to work around this is to look at before and after photos of patients the surgeon provides. If you feel that the photo results of others  “aren’t good enough” or “not something I would be happy with” at the very least this surgeon is not for you. Most likely, this procedure is not for you. Most surgeons put their best results on before and after books or websites so if the results are “subpar” that you see there is a high probability that you will be unhappy. How will you feel if the results aren’t what you expected?


It is also important to think about why you want to have the cosmetic procedure? If you can concretely identify a physical problem that is a great start. Nebulous statements such as “I want to look better” , “ I feel I am getting older” , “dating is hard” are not good starts. The reason they are not good is because cosmetic procedures fix a specific physical  problem. If there is no specific problem and only a general or vague problem the odds that a cosmetic surgery will fix that  issue is low. Notoriously bad candidates are those who have noticed that they are aging and want a particular problem to solve some if not all their aging issues. That is impossible. Often they are dissatisfied not with procedure results but that the surgery has not helped them go back to when they were younger. Cosmetic surgery will not reverse your aging but will help you look the best you at your age. A colleague of mine tells patients the brutal truth “If you want to go back in time, you need a time Machine”. Understanding your “why” is helpful to dissect what your root reason for having cosmetic surgery is. Bringing that into your awareness will help you decide if your reason will be improved if you have the surgery. It is important to be brutally honest with yourself.


Beyond expections, there are things that need to be in line when you are recovering and scheduling the surgery. In this discussion is home and work life for a patient. Candidacy for cosmetic surgery involves also the personal life structure of a patient. How stable is your work and home situation to undergo a cosmetic surgery? First off, you will need someone to come with you on the day of the procedure and maybe for some follow-ups. This is a non-negotiable need. Do you have someone? More importantly do you have someone reliable? What if you need to be seen emergently? These are direct but important questions to ask yourself and the person who will come with you. Taking Ubers to major cosmetic procedures are unfortunately not in  a patient’s interest. It is an unfortunate truth that a social support should be there for a patient mentally and physically but it is the honest truth.


Plastic surgery  also involves taking time off from work to recover for a minimum of a week but sometimes longer. Can you do that? If you need to go for a revision procedure by some chance will that be a problem? How will your work feel about that? Do you have the type of job that allows the time for that? At home do you have the peace and quiet necessary to recover? Often you have to ice and rest in bed. Exertion is particularly not helpful in the recovery period. I have patients who are parents and whose spouse are supportive enough to watch the children and take of their needs while the patient is recovering. Is your spouse ok with that? This involves a discussion before surgery with your spouse, partner or co-parent. Additionally, having a stable home location is important. I would not move homes during the recovery period. Though I have out of town patients and think that it is possible for patients to do well in this setting, it is important to have a stable living situation during the surgery and recovery period. The idea of flying in, staying in a hotel and then recovering 1000  miles away for the next month is not very smart for patients. It works when everything is perfect but everything doesn’t always go perfectly. I don’t think most plastic surgeons who know the risks of delayed complications after surgery would want to take that chance on surgery for themselves. I know I would not. Subsequently, if you are 500 miles away what will you do if you have to come back or need to be treated for a delayed complication immediately? Do you have the resources to fly back , get a hotel , be treated, stay for a while and then return home with someone? Is that ok with your work? Is that ok with your significant other? These are serious questions to answer before travelling to see me or any other plastic surgeon not within some driving range.


Third there is patience. This cannot be overstated. The healing process of any cosmetic procedures involves gut wrenching patience. This can be as short as 7 to 9 days for Botox to kick in or a year for a facelift results to have settled. If a patient lacks patience, they emotionally wreck themselves waiting for the final results. It is challenging for sure to recover from cosmetic surgery and the waiting game is much easier said than done. After a procedure to your body it is natural to try to analyse it as it heals but being impatient coupled with over analysis is a recipe for disaster. The reality is that the human body does not care if you are impatient or demanding when it comes to healing. You must have the patience to wait things out to give things time. Over analysis during the healing process often leads to rumination about the whether the procedure was worth it, catostrophizing what the worst possibilities are and extreme unhappiness even if the surgery turns out totally great in the end. What are your levels of worry about everyday things? Are you prone to over rumination and anxiety? How will you do in the healing period? It is possible to mitigate this with  education about the procedure, healing and recovery. I give patients a book who are undergoing cosmetic eyelid surgery with me to educate them to help them through this. Often it helps. Sometimes it does not. Some people don’t read the book and then have a flurry of questions and misinformation after the procedure and are dealing with uncertainty and anxiety that could have been easily prevented. Avoiding educating yourself before a procedure is a mistake 100 percent of the time on multiple levels.


Finally there is the innate psychology of the patient. Like any relationship, the relationship between patient and doctor for cosmetic procedures is one that is a two way street. It is an important component of candidacy for a procedure for cosmetic surgery that no one talks about. There are whispers of it in break rooms or after an unhappy patient leaves an office. This has to do with the baseline unhappiness of the patient. We have all met people who have been described by others such as “Susie is never happy with anything”. They may go to a restaurant and have a constant stream of complaints from service to seating to lighting to the food to anything during their meal. These patients are often rude to the staff but nice to the surgeon. The transparent truth is that this person is flat out an awful candidate for cosmetic surgery. The odds that they are satisfied is almost zero. Often but not always these are the patients who write reviews that say “I was completely dissatisfied with the surgery and Dr Smith said everything looks great. What a  jerk!”. (To be fair, there are some surgeons who are just jerks). In this conversation are also the group of patients with high anxiety who overanalyse everything, ruminate on things and expect everything to go wrong. Unhappy people make unhappy patients very often. The terrifying  reality is that often unhappy people, impatient people, anxious people have extremely poor insight into how they are and believe that in fact that they are normal or fine. As you know, they may even become angry if someone points out that their behaviour is outside the standard deviation of normal . It maybe difficult for a surgeon to detect during a consultation. They may routinely hide this part of their personality in the early stages of the consultation because they are used to keeping it hidden early in any relationship. Susie may not yell at the waiter on the first date but routinely does it starting at week 8 of dating. These are qualities that should give one some pause before a cosmetic surgery. Some patients who have mental health problems may need for those to be optimised before a cosmetic surgery or even discuss with their therapist, psychologist or psychiatrist if undergoing a procedure is a good idea for them in their current mental health state.


This article serves are an insightful and transparent review of what it means to be a “good candidate for plastic surgery”. As you can see it is complex but the fact that you are reading an article like this means that you are an insightful person which is great. In my office in Denver I see patients routinely who are not good candidates that I need to discourage to have surgery with me or anyone else. A consultation is a time for not only the patient to determine if myself and whatever procedure I am performing is for them but also for me to determine if I want to pursue a further relationship with them as well. This information I hope allows you to determine the parts that are difficult for me to see in a consultation as being problematic. A fair discussion with your surgeon will always give you the best options and results even if it means taking a pass on the surgery or procedure.

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