Who Should Not Do Plastic Surgery? Key Criteria for Patient Suitability

September 30, 2025 •

4 min read

According to studies, a significant number of cosmetic surgery patients have a history of psychiatric disorders, including depression and anxiety. Understanding who should not do plastic surgery is crucial, as certain medical, psychological, and behavioral factors can compromise safety and satisfaction.

Quick Summary

This article outlines the medical conditions, mental health issues, lifestyle factors, and unrealistic expectations that can disqualify an individual from undergoing plastic surgery, helping potential patients make informed decisions.

Key Points

Medical Conditions: Uncontrolled heart disease, diabetes, and certain autoimmune or bleeding disorders can significantly increase surgical risks and may disqualify a patient.
Body Dysmorphic Disorder: Patients with BDD are typically unsuitable for cosmetic surgery, as procedures do not address their underlying psychological issues and can lead to worsened distress.
Unrealistic Expectations: Believing plastic surgery will solve life problems, create a perfect appearance, or mimic another person's features is a major red flag for dissatisfaction.
Lifestyle Factors: Habits like smoking, excessive alcohol use, and obesity can impair healing and increase complication rates, requiring lifestyle changes or delaying surgery.
Patient Motivation: The decision to undergo surgery should be driven by personal satisfaction, not external pressure from a partner or societal standards.
Aftercare Commitment: Patients must be willing and able to follow all post-operative care instructions, as neglect can lead to complications and poor results.

Critical Factors Determining Unsuitability for Plastic Surgery

Undergoing plastic surgery is a significant decision that requires careful consideration beyond just aesthetic desires. A reputable, board-certified plastic surgeon will thoroughly vet all potential patients to ensure their safety and satisfaction. There are several key reasons why a person might be deemed an unsuitable candidate for an elective procedure. These range from serious health conditions to underlying psychological issues and unhealthy lifestyle habits.

Medical Conditions and Physical Health Concerns

Pre-existing health issues are a primary reason a surgeon may advise against or refuse a procedure, as they can significantly increase the risk of complications during and after surgery. An honest and complete disclosure of your medical history is therefore vital during your consultation.

Serious medical conditions that can preclude surgery include:

Uncontrolled Diabetes: Poorly managed blood sugar can impair wound healing and increase the risk of infection.
Heart and Lung Conditions: Uncontrolled high blood pressure, heart disease, or chronic obstructive pulmonary disease (COPD) can increase anesthesia-related risks. An EKG and clearance from a cardiologist may be required for older patients.
Bleeding Disorders: Conditions like hemophilia or a history of blood clots (DVT) pose a significant risk of excessive bleeding.
Compromised Immune System: A weakened immune system, whether from conditions like HIV/AIDS or certain medications, can hamper the healing process and raise the chance of infection.
Obesity: Many surgeons have a Body Mass Index (BMI) limit, often around 30, for elective surgery. A high BMI increases risks associated with anesthesia and affects wound healing.

Psychological and Emotional Readiness

Plastic surgery cannot fix underlying emotional or psychological problems. A surgeon must ensure a patient is emotionally stable and has realistic motivations for undergoing a procedure. For many, a psychological evaluation may be necessary before surgery.

Psychological red flags for plastic surgery:

Body Dysmorphic Disorder (BDD): Individuals with BDD have an obsessive preoccupation with perceived flaws that are often minor or imagined. Surgery almost never resolves the issue and can even worsen the condition, causing the patient to fixate on a new flaw. Ethical surgeons will refuse to operate on patients with BDD and instead recommend therapy.
Unrealistic Expectations: Patients expecting a complete transformation or to look like a celebrity are often left dissatisfied, regardless of how successful the surgery is. A good candidate understands that the goal is enhancement, not perfection.
Pressure from Others: Seeking surgery to please a partner, spouse, or friend is a poor motivation. Procedures should only be done for oneself.
Significant Stress or Trauma: Undergoing surgery during a time of emotional turmoil, such as a recent loss or divorce, can complicate recovery and potentially worsen psychological distress.

Lifestyle Choices and Post-Operative Commitment

Your habits and ability to follow instructions are critical to a safe recovery and a good outcome. Inability to comply with a surgeon’s instructions or continuing risky behaviors will be a major disqualifier.

Smoking: Nicotine constricts blood vessels, severely hindering blood flow and healing. Most surgeons require patients to quit smoking for several weeks before and after surgery.
Excessive Alcohol or Drug Use: Heavy substance use can interfere with anesthesia, increase bleeding risks, and affect healing.
Inability to Adhere to Aftercare: Recovery involves rest, activity restrictions, and proper wound care. Patients unable or unwilling to follow these instructions are not good candidates.
Financial Instability: The financial burden of surgery, including follow-up care and potential revisions, can cause significant stress. A surgeon may inquire about a patient's financial stability.

Age and Life Stage Considerations

Age is another factor, though not a strict one. A reputable surgeon will consider a patient's physiological and emotional maturity.

Being Too Young: Some procedures are unsuitable for patients whose bodies are still developing. While parental consent may be an option for some, surgeons will still assess the individual's mental and physical maturity.
Upcoming Pregnancy: Women planning to have children in the near future are often advised to postpone certain procedures, like tummy tucks or breast augmentations, as pregnancy and breastfeeding can alter results.

Comparison: Ideal Candidate vs. Unsuitable Candidate


Factor	Ideal Candidate	Unsuitable Candidate
Physical Health	Good overall health, controlled chronic conditions (like diabetes), stable weight.	Uncontrolled chronic illnesses, obesity (high BMI), active infections.
Psychological State	Emotionally stable, positive self-perception, realistic goals.	Body Dysmorphic Disorder (BDD), severe depression, seeking surgery for external validation.
Expectations	Views surgery as an enhancement, not a cure for all life's problems.	Expects a perfect, celebrity-like result, believes surgery will fix personal issues.
Lifestyle	Non-smoker, moderate alcohol use, maintains a healthy diet and exercise.	Active smoker, excessive alcohol/drug use, neglects diet and exercise.
Motivation	Pursuing surgery for personal satisfaction and confidence.	Pressured by a partner, friends, or societal beauty standards.
Aftercare Commitment	Prepared for recovery, has a strong support system, follows all instructions.	Inability or unwillingness to follow post-operative care instructions.

Conclusion: Prioritizing Safety and Realistic Outcomes

Ultimately, a qualified plastic surgeon's priority is the patient's well-being over simply performing a procedure. The decision of whether or not to proceed with plastic surgery is a collaborative one, involving an open and honest conversation between the patient and surgeon. By carefully screening for disqualifying factors, such as underlying medical conditions, psychological distress, and unrealistic expectations, surgeons ensure patient safety and increase the likelihood of a positive, satisfying outcome. Choosing the right time and being the right candidate are just as important as choosing the right surgeon. For more resources on patient safety in plastic surgery, consult reputable sources like the American Society of Plastic Surgeons.

Frequently Asked Questions

No, most plastic surgeons will not perform elective surgery on active smokers. Smoking hinders blood flow, significantly affecting wound healing and increasing the risk of complications. Surgeons typically require patients to quit smoking for several weeks or months before and after surgery.

The BMI requirement varies by surgeon, but many draw the line at a BMI of 30 for general anesthesia procedures, as obesity increases surgical risks and affects outcomes. It's best to consult with a surgeon who has experience with higher BMI patients if necessary.

Ethical plastic surgeons will typically refuse to operate on patients diagnosed with BDD. Surgery does not cure BDD and often leads to increased dissatisfaction, prompting patients to seek more procedures. These patients are better served by a referral to a mental health professional.

Unrealistic expectations can lead to significant post-operative dissatisfaction and psychological distress, even if the surgical results are technically successful. A surgeon will discuss realistic outcomes to ensure the patient's goals are achievable and aligned with their physical and emotional well-being.

No, elective surgery is not recommended during pregnancy due to health risks for both the mother and baby. Furthermore, pregnancy and breastfeeding can alter surgical results, so surgeons often advise waiting until at least six months after delivery.

Yes, chronic, uncontrolled medical conditions such as diabetes, hypertension, and heart disease are often contraindications for elective surgery. These conditions increase the risk of anesthesia complications, infection, and poor healing. They must be well-managed and cleared by a primary care physician beforehand.

A strong support system is crucial for recovery, especially for major procedures. Patients who cannot arrange for assistance with aftercare, wound management, and daily tasks may not be considered good candidates due to the increased risk of complications.