It is important to emphasize that we are not talking about extremes. This isn’t about vanity, which I consider to be an unhealthy obsession with appearance. Cosmetic procedures, especially surgery, should not be decided upon frivolously. There’s a broad swath of healthy-minded patients in the middle, but there are a few reasons why their motives may be misunderstood:

• It is sometimes assumed that wanting to make one’s self attractive to others signals dissatisfaction in the relationship. While that is possible, it isn’t necessarily true, and I think most often not. A patient today was telling us how she explained to her husband that she was considering having a procedure: “When I am getting my nails done, I hope you like the color I pick but I pick what I like, not what I think you like.” 
• Not recognizing why plastic surgery is needed. A classic example of this is the boyfriend who says “You just need to work out more instead of having liposuction.” If exercise could reshape body fat distribution, plastic surgeons would be honor-bound to send patients to the gym instead of taking them to the operating room. You can’t “spot reduce” localized fat deposits with exercise. And you could do 1000 sit-ups a day but it won’t tighten skin stretched out from pregnancy.
• Misperception about expected results. A facelift should not look pulled and overdone, and usually, the only breast implants you notice are the few that are intended to be large enough to stand out. A natural look is usually the goal.