Imagine this scenario. You go to a car lot to buy a car. The car salesman walks up (realizing that car salesmen don't have the best reputation, being just a few notches up from lawyers, politicians, and telemarketers, we'll assume this one is an upstanding sort).

"Hi, how may I help you?"

You answer, "I'd like to buy a car."

"Oh, why do you want to do that?"

You, a bit perplexed, "well, I'd like a car to take me to places that I wish to go." You'd think that would be obvious.

"What about walking? It's healthier, it's better for the environment. You'll save a ton of money. And, it's safer; you can't be hurt or killed in a car accident if you're not in a car."

You, "I can't walk everywhere. Some places are too far; it will take too long."

Salesman- "You could buy a bike. It's a lot cheaper, just as healthy as walking, and also much better for the planet. You can even put a basket on it to carry things, like groceries."

OK, by now you are thinking, is he for real? Am I being "punked"? Where are the cameras? Why doesn't this salesman want to sell me a car? Isn't that what he is here for?

Now, let's take a little leap in imagination and say that instead of a car salesman, you are seeing a plastic surgeon. It took some doing for you to actually get up the nerve to see someone. Now, you are sitting in the office sharing these somewhat embarrassing issues with a total stranger. A professional and doctor, yes, but still a stranger. You state your desires. Perhaps you ask about a specific procedure or procedures, or, as many patients do, you ask the surgeon, "what do I need?"

To your surprise, the surgeon says to you that you don't "need" anything, that cosmetic surgery is elective and not done for medical necessity. It is done because the patient desires this. Then, he begins to ask you questions about your lifestyle, your personal habits (diet, exercise, smoking, etc.), and, as in the above hypothetical example, why you want the surgery in the first place. Shockingly, he begins to tell you why you shouldn't pursue surgery, at least at this time, and begins to suggest things you can to do change your situation without surgery.

Now you are thinking, "what gives?" Doesn't he want to do my surgery? He is a plastic surgeon after all. How does he make a living talking patients out of having surgery?" This is truly confusing.

I don't know how often this scenario plays out but I suspect it doesn't as often as it should. Plastic surgeons are not there to do the bidding of patients, to offer them whatever procedure they are seeking, or, as I have too often heard from patients who have seen other plastic surgeons, to offer them a laundry list of procedures they "need" in addition to whatever they were inquiring about.

Patients often don't think about these things but before we were plastic surgeons, we were physicians who learned all about the human body, the diseases and illnesses that affect it, and how to keep it healthy. Unfortunately, too much of medicine is aimed at treatment of disease and not enough at preventing these in the first place.

Here is the thing, the purpose of the little hypothetical exercise. Don't expect plastic surgery to make you healthy, fitter, or change your life substantially by itself. Some people use plastic surgery as a substitute for a healthy lifestyle, or they use it as a launching pad to make changes after they have had surgery. Both are errors. The former because one cannot substitute surgery for a healthy lifestyle, and the latter because it is putting things in the wrong order. Plastic surgery should be the reward for making healthy changes in your life, not vice versa.

No plastic surgeon is going to be able to do much for someone who smokes, drinks (alcohol) excessively, bakes themselves in the sun, eats a diet of prepared/fast/junk food, does not get enough fluids, is sleep deprived, and/or chronically stressed. We are highly trained surgical specialists, not magicians.

Once you have done everything you can to maximize your health and, by extension, your appearance, by developing healthy habits, then is the time to see a plastic surgeon for the things you cannot change yourself. That's where we come in. We are here to help, and happy to do so.

Richard T. Bosshardt, MD, FACS