Questions to ask before the surgery

David Sarwer, of Penn's Perelman School of Medicine, an authority on mental health issues in cosmetic surgery, offers a course at the annual convention of the American Society of Plastic Surgeons and has drawn up lists of three questions physicians should ask of patients requesting cosmetic surgery and three questions the patients should ask themselves.

For the physicianCan the plastic surgeon really see the defect?

Does the patient report impaired daily function based on his or her appearance? "If they say, 'I'm not dating because of my appearance or I'm not working because of my appearance,' " says Sarwer, "that could be a sign of BDD" (body dysmorphic disorder).

Does the patient have a history of psychiatric treatment? "About 20 percent of patients presenting to plastic surgeons are engaged in mental health treatment."

For the patientDo other people see the feature they're concerned about? Do close friends and family members see and agree with their concern?

Is the interest in surgery internally motivated, coming from a desire to improve their self-esteem, rather than, say, trying to save a sinking romantic relationship? Or get the promotion the person hasn't received?

Is there recognition that the changes are often quite subtle? "People expecting a Cinderella-like transformation may be setting themselves up for disappointment."

   - Paul Jablow