Its part of my role to turn people down for surgery. It often disappoints them but I can and do assure them that this is done with their very best interests at heart. There are several reason why I would do this. Pretty much all are centred around the welfare of the patient, be it physical or psychological. Occasionally, they will want a procedure I do not perform. I believe surgeons that restrict themselves to procedures they are comfortable performing are far safer and have more expertise than those that will perform every procedure under the sun. Practice does indeed make perfect!
In the main though, the patients unrealistic expectation or well-being is the main reason for turning a patient down. Recently, I saw a patient that I just didn’t think needed surgery! With a bit of counselling and explanation I was able to make her realise that the facial procedure she wanted was not a good idea at her stage in life. It would certainly be worth revisiting in the future but not at that stage in her life.
Not everyone will take the advice given by honest surgeons. Some will seek a surgeon that WILL perform the surgery. Please always remember that the advice given from a good surgeon will always have the patient at the forefront of the picture, not any commercial consideration or the need to hit a target.