Unreasonable expectations of reconstructive patients affecting rehabilitation.

Common difficult and recurring problems develop which make the demands of certain cosmetic surgical patients appear reasonable or not reasonable to the people operating upon them. In spite of careful preparation and repeated instruction, a number of patients continue to entertain fixed and elusive ideas about themselves, their body images, and the results they desire from surgery. These wishes are often not logical, and derive from personal experiences of the patients, and are not related to the actual degree of deformity or the objective reactions that other people have to these defects. while it is generally true that more gross deformities force a more realistic perspective upon the patients and their families in contrast to many normal-looking persons who seek cosmetic surgery, this is not always the case. The authors attempt to examine and describe several specific cases of these problems, along with the psychological mechanisms which underlie them, and present possible ways in which such behavior can be managed by the aesthetic surgeon. An attempt is also intended to be as practical as possible about the use of the busy surgeon's time in these situations.