The quick answer is quite often. There can be countless reasons for this, but they can probably best be grouped into two main categories:
Exploring the first option, “risk outweighs benefits,” there are endless possibilities here. Someone in less than good health should not be receiving elective cosmetic, plastic surgery in my opinion. Fortunately, almost all of the patients that I see are in good health. However, every once in while, someone comes to me with a load of medical issues and I will tell them that they should not be getting these procedures. I am also quick to point out that I don’t make any money by sending them away and that if they shop around, someone will probably perform their surgery, but I have to share my honest medical opinion. Of course, there are many procedures that can performed in the office with just local anesthetic – meaning they involve less risk. However, this does not mean that everyone is a candidate for a particular procedure. There are still risks. Sometimes it is obvious that someone should not be doing a procedure. Other times, it takes surgical judgement and experience to know this.
With regards to the second category, “unrealistic expectations,” I sometimes find that while the procedure can be carried out safely, there is a reasonably high possibility that even if the procedure goes as planned, the expectation of the patient is greater than what I can achieve on average. This is why the initial consultation is so important. It lets the surgeon explain what he/she can achieve on average and to confirm that this is commensurate with what the patient is expecting. Even if the patient gets the best result that has ever been obtained, if they wanted even more, they will be dissatisfied.
Along the same lines, it is important to discover if there are secondary, hidden goals. As an example, a woman came to me many years ago for a breast augmentation (BA). It became clear to me during the consultation that she was satisfied with her breast size and shape. What truly brought her was that her husband was having an affair and she hoped that the augmentation would solve her marriage issue. I don’t think she was aware of this at the time of her consult. I told her that I would not perform the procedure on her because what she really wanted was a repaired marriage and that was NOT going to be fixed by altering her breasts. She would inevitably been dissatisfied with the results of her surgery since it would not have achieved what she wanted from the procedure. Sometimes, patients are aware of these hidden goals and sometimes not. We have to discern them from our consultation.
If you’d like to discuss any concerns you have, please do contact my office to schedule a private consultation with me.