What do Surgeons Look for in Cosmetic Surgery Candidates

When I sit down with a patient considering facial cosmetic surgery, my first goal is to understand their vision. What’s bothering you? What are you hoping to achieve? And—importantly—why now? Surgery isn’t a casual decision, and the way someone thinks about it tells me a lot about what I need to know.

Most people know that cosmetic surgery isn’t magic. But if we’re being honest, there’s always a little bit of magical thinking involved. The hope that this will be the catalyst that finally makes all the difference. That’s not a bad thing—but it also means we have some real conversations ahead of us…

That’s why I focus so much on mindset. Think of it like committing to a serious fitness plan. A great trainer isn’t just going to throw you into an intense workout without first asking: Are you fueling your body properly? Do you understand what it takes to get results? It’s the same in surgery. If someone wants a major transformation but doesn’t have the right expectations—or isn’t prepared for the preparation and recovery process—it’s like signing up for a marathon while living on donuts and frappuccinos. Sure, you can do it, but will it be pleasant? Will it be a success?

Another kicker: Unlike a bad workout, there’s no undoing surgery. Yes, there are revision procedures, but the goal is to get it right the first time. That’s why the best surgical results start long before the actual surgery—with a conversation, a plan, and the right mindset.

So, what do I look for in patients considering cosmetic surgery? Here are the top five areas I’m (not-so-secretly) noting during a consultation—though, of course, there are plenty of subtle factors beyond the scope of this blog.

#1. The Big One: Realistic Expectations

“Realistic expectations” is a phrase that gets thrown around often in cosmetic surgery, but what does it actually mean? Does “realistic” mean natural? Does it mean possible? Who gets to say? One surgeon’s definition of “realistic” might not be the same as another’s. Some set the bar lower; others push the boundaries of what’s achievable. So when I talk about realistic expectations, I need to clarify: what does realistic mean to me?

For me, realistic expectations inspire outcomes that both the surgeon and patient agree are natural and beautiful. A disagreement here sets the stage for a disappointing journey. You’ve probably heard the saying, “Subtlety may make the difference between elegance and excess.” This applies to cosmetic surgery just as much as it does to interior design. Subtlety isn’t about how much surgery you need—it’s about how much change is achievable, given your starting point.

“Natural” is also a term that gets thrown around quite a bit. Natural results don’t just happen by accident; they take planning, precision, and may even require more surgery—not less. The face ages globally, so how natural is it when one area is refreshed while the surrounding features remain aged and out of balance? This is why mismatches are easy to spot. I see them everywhere: in cafés, supermarkets, airports. And I know my patients see them too, because they often tell me this is exactly what they don’t want. Achieving success in facial rejuvenation requires a strategic “forest-over-leaves” approach, ensuring that the face is natural, and as a consequence, beautiful as a whole.

Many patients come in hoping to “look like myself, only younger,” which is an excellent mindset. It means we’re working with their starting features—refining, rather than reinventing. Then, there are those who say, “I want to look like her,” bringing in photos of an influencer, a celebrity, or a highly filtered version of themselves. This is where I pause. What about this person inspires you? Why her? Why this photo?

Patients who use photos of others as inspiration and truly hope to wake up with vastly different features are gently guided toward a more realistic understanding of what surgery, in my hands, can achieve. Sometimes, unrealistic expectations show up in the belief that a single procedure can do it all or perform beyond its true capabilities. They can also stem from a reluctance to consider other treatments that may be necessary to achieve the goal.

A surgical consultation is meant to clarify the full scope of treatments that will address your concerns in order to deliver a mutually-agreed upon natural outcome. Ultimately, the choice of what to pursue lies with the patient, but understanding the implications of those choices is imperative. It’s essential to know what you're committing to and what might be left behind in the process. A responsible surgeon will decline to perform any surgery if a patient is fixated on achieving someone else’s look or insists that one procedure will over-deliver due to a fundamental misunderstanding. Seeing eye-to-eye on realistic expectations is at the heart of this entire process.

A portrait of a beautiful woman. It’s tempting to bring in photos and request someone else’s specific feature or look, but many of these images are retouched and perfected—poreless skin, erased fine lines, and enhanced symmetry. In today’s world, what we see in photos isn’t always reality.

#2. A Positive Consultation

I always strive for a great consultation—but what does that really mean? To me, meeting a patient who has chosen me for professional advice is a privilege I take seriously. I prepare thoroughly—reviewing medical history, past procedures, cosmetic questionnaires, photos, and any submitted records—because I want to step into my patient’s shoes and ensure nothing is overlooked. But just as important as preparation is listening—really listening. A consultation should never feel like a checklist or a monologue. The best ones have a natural rhythm, where conversation flows openly, without hesitation or missing key details. After nearly a decade in private practice, I have a high sensitivity radar for when a discussion is easy and when it’s strained.

Ultimately, both the patient and I need to decide if we’re the right fit to work together. Surgery is as much about skill as it is about understanding who the patient is and what will serve them best. I’m not just performing a procedure—I’ll be guiding them through recovery, follow-ups, and any unexpected hurdles along the way. Not all recoveries are smooth, and some patients need more support than others. That’s why trust is non-negotiable. If there’s doubt in the consultation—whether in me, the plan, or the process—it will only make the journey harder. No pilot takes off without knowing their emergency systems are in place, even if they hope never to use them. That mutual trust at the consultation level is the emergency backup system of surgery.

Another key aspect of a positive consultation is curiosity—the patient who isn’t just focused on the end result but is genuinely interested in the process. This means wanting to hear and understand not just what surgery can achieve, but also its limitations, risks, and alternatives. It means asking about recovery, aftercare, and being open to why one approach may be better suited than another. The best outcomes come from patients who see surgery as a thoughtful, informed decision rather than just something to check off a list.

Trust and transparency are everything. Withholding medical history, previous procedures, or lifestyle habits only creates unnecessary risk, and the best consultations happen when patients feel comfortable sharing everything that could impact their outcome. The consultation isn’t about getting to “yes” on surgery—it’s about making sure that, if surgery is the right choice, it’s built on a foundation of understanding, preparation, and shared decision-making.

My consultation process is the most crucial part of the journey. If you’ve met me in the office, you’ve likely heard me say I want to avoid “complications of consultation.” I won’t move forward until my patients fully understand what’s involved—what we can achieve, what to expect, and the risks. Every procedure, surgical or not, carries risks. Ignoring them is like boarding a plane and expecting to take off without a life vest.

#3. Health Stability

Stable health is a must for any surgical candidate. Chronic conditions? Those can be managed—as long as they are stable and optimized. But smoking? That’s a different story. Nicotine use is a major risk factor for complications, and for almost all cosmetic procedures, it’s a firm no. Patients must be willing to quit all nicotine products—cigarettes, vapes, patches, gum—for at least two months before and after surgery. This isn’t a casual suggestion; it’s a necessity for proper healing. Quitting isn’t always easy, and for some, it may take medications, counseling, or structured programs. That’s why certain consultations happen a year before surgery—so patients have the time to prepare and meet these requirements safely.

Emotional health is just as important as physical health. Many patients are on antidepressants or anti-anxiety medications, which help regulate mood and maintain their baseline. But even with medication, surgery can be a major emotional event. Healing takes time, and the temporary swelling, bruising, and social downtime can feel overwhelming. There’s a well-documented phenomenon of post-surgical blues, where patients experience temporary mood dips—or in some cases, post-op depression. I take this seriously. I often request clearance from a patient’s prescribing doctor or psychiatrist, and I encourage them to have standing therapy appointments scheduled for after surgery. Support systems matter, and having a plan in place can make a real difference in how smoothly recovery goes.

The ideal candidate for facial cosmetic surgery is in excellent overall health. Patients with uncontrolled chronic conditions, ongoing severe medical issues, smoking or excessive alcohol use, or bloodwork indicating poor organ function are not suitable for elective procedures. I always recommend planning well in advance—ideally at least six months before surgery—to optimize diet, blood sugar levels, supplements, hydration, and overall wellness for the best possible outcome.

#4. Motivations Matter

Another critical thing I consider when meeting a patient is why they want surgery. I touched upon this in the #1 thing, but here I’ll elaborate further. This is another dimension. The best results (or interpretation of the results) happen when the motivation comes from within—when someone is choosing a procedure because it aligns with their own personal goals, not because a partner asked them to do it, a friend had something done, or social media made them feel like they should have done something. Surgery is a commitment, and the decision has to be yours and yours alone. When someone is pursuing surgery for the right reasons, the process is safer, the recovery is more enjoyable, and the results are more satisfying in the long run.

Another dimension is that facial cosmetic surgery can enhance features, restore youthfulness to the face, and enhance a naturally occurring feature like the nose, but it cannot resolve deeper emotional struggles or fill gaps in self-worth. If someone believes a procedure will completely transform their happiness or change how others treat them, we need to have an honest conversation about that. Surgery should never be about gaining external validation—it should be about feeling more comfortable in your skin. On rare occasions, I have had to talk a patient out of having surgery because I suspected an outside force acting upon a patients’ decision making. In the long-run, I was right. My job, as much as it is about operating and creating change, is ensuring that your decision is a positive, empowering choice—not a reaction to outside pressures or issues with self-worth.