Not everyone's a good plastic surgery candidate

ATLANTA, Georgia (CNN) -- "If it sounds too good to be true, it is." Remember that axiom if you're considering cosmetic surgery. A nose job, tummy tuck or breast lift may change your appearance, but it probably won't fundamentally change your life.

And that's why even though cosmetic surgery is at an all-time high, some people simply should not get this type of work done, at least not until they've fixed some other things in their lives.

There are two groups of patients that fall into the "do not pass go, do not go under the knife" scenario: those with medical problems and those with psychological problems.

The first rule of when not to have plastic surgery is if the doctor doesn't want to do it, advises Dr. Richard D'Amico, president of the American Society of Plastic Surgeons. "If you have been turned away by a board-certified plastic surgeon, please don't ignore their advice. "

They have their reasons.

First it may be a matter of health concerns. If you have one or more of the following conditions, you should first talk to your primary physician or specialist to make sure plastic surgery is safe:

1) heavy smoking/drinking

2) diabetes

3) high blood pressure

4) a bleeding disorder

5) heart or lung disease

6) obesity

7) severe allergies

8) high cholesterol

9) arthritis

No surgery is risk free, notes D'Amico, but cosmetic surgery in most cases is elective, or not medically necessary. "At the end of the day, we need to make sure we minimize the risks," D'Amico says.

Some risks are greater, as we recently saw in the case of Donda West, mother of rapper Kanye West. While nothing is conclusive about what happened to West, who died after undergoing cosmetic surgery, experts suspect that there were medical complications that might have been detected by her regular physicians.

But perhaps even more a factor than medical conditions are psychological concerns. D'Amico puts these in the category of "management of expectations." Or in plain English, to make sure the patient knows the limitations and risks of any cosmetic procedure. One way doctors can assess expectations is through psychological testing. There are some clear warning signs that might indicate that an individual is a bad candidate for plastic surgery.

A big red flag should be raised if a patient is going through a time of emotional crisis.

For example, D'Amico tells of a 62-year-old woman who came to him, dressed in black, who wanted extensive surgery. During the consultation and psychological review, it turned out that she had recently lost her husband and now desperately wanted to look younger. D'Amico suggested she wait since she was in the midst of the grieving process and her thinking might not be that clear. She ended up waiting a year and then decided to go ahead and have the surgery.

Given the nature of the surgery, where so much is based on subjective interpretations of the final product, a patient might be unhappy with her, or his, new appearance even though the result was entirely predictable.

Other red flags might be raised if the patient is going through a divorce, has just given birth or is going through menopause. While these circumstances don't always rule out surgery, they do necessitate professional screening to make sure the patient is in the right frame of mind and understands the risks and the most likely outcomes.

Some patients bring unrealistic expectations that can't be shaken, for example someone who is determined to have "Angelina Jolie's nose." While it's fine for her to want to look like Jolie because she thinks she'll look better, the patient must understand that other qualities don't go along with it -- she's not going to become famous or wealthy. D'Amico will not operate on a patient who expresses such a sentiment. "I would first send them to get more counseling," he says.

A less-apparent psychological problem is an obsession with correcting a minor flaw.

The medical term is BDD, or body dysmorphic disorder. A person with BDD might get up at 4:30 a.m. to spend hours applying heavy makeup to hide a small scar that most others would never notice. Those people, D'Amico says, should definitely not have cosmetic surgery. First, D'Amico says, he or she probably will never be satisfied with the results. And second and more important, the doctors cautions, "The problem is between their ears."

Finally patients suffering from depression need careful assessment before having a cosmetic procedure, to make sure they don't think their surgery is going to magically change an unhappy life into a happy one.

An individual with a history of severe depression, particularly if medication is used, should first resolve his or her issues, usually through counseling, before attempting surgery.

Board-certified plastic surgeons are taught early on to make sure their patients are ready for surgery, both physically and mentally. Making sure the right procedure is done at the right time could mean the difference between happy and miserable, healthy and ill, and possibly even between life and death. E-mail to a friend