'A psychiatrist with a scalpel" is the way Mark Solomon describes himself.
Solomon, who has been performing cosmetic and other plastic surgery for 26 years, said judging patients' expectations is just as important as operating skill.
"If I can't deliver, my answer is, 'I'm not doing it,' " said Solomon, whose practice is based in Bala Cynwyd. He estimated that he rejects up to 30 percent of prospective patients, most because their expectations are unrealistic.
Jesse A. Taylor, a plastic surgeon with Penn Medicine, said he turns down an even higher estimated number, up to 40 percent.
"The surgeon's most important job is to figure out what the patient's concept is of what they want changed," Taylor said. "It's challenging. It's sitting down and getting to know somebody. Listen to the quality of the questions they ask."
Taylor said he will not operate on anyone until he has seen them at least twice for an office visit, with the visits spaced several weeks apart.
"You're taking a healthy person with no medical problems and doing something invasive that has known risks," he says. Even when the surgeon tells a patient, for example, that a face-lift could result in postoperative bleeding, "they may not be listening really well. You have to repeat it."
While new technologies like lip fillers and Botox have made it easier and in some cases more affordable to change one's appearance, that doesn't necessarily mean transformation is a good idea.
Surgeons say patients often have exaggerated ideas about what the procedure can accomplish, or may want surgery for the wrong reasons.
"Surgery should be for the patient, not the patient's boyfriend," said Chris Tzarnas, a plastic surgeon with the Temple University School of Medicine.
In some cases, surgeons say, unrealistic expectations are fueled by movies, makeover reality shows, or the Internet.
Eva Ritvo, a Miami Beach psychiatrist who treats many patients considering cosmetic surgery, speaks of women wanting "Angelina Jolie lips" even though the change might not go with their other facial features, or wanting tummy-tuck surgery that is premature because it could make it harder to lift their baby.
"The Internet is one of our banes," said Solomon. "People will go and find somebody in South Korea who does something we don't even do here" because it hasn't met the "safe and effective" requirements of the U.S. Food and Drug Administration.
