Do Plastic Surgeons Really Care? Why Patient Selection Matters as Much as Surgical Skill
“Plastic surgeons don't really care.”
It is a provocative statement — particularly when it comes from a plastic surgeon.
In a recent discussion, Dr. Rian Maercks responded to a video making the argument that plastic surgeons are primarily motivated by full operating schedules, expensive practices and the desire to operate.
Dr. Maercks' response was clear:
The idea that plastic surgeons don't care about their patients is fundamentally misguided.
In fact, one of the most important parts of being a good plastic surgeon happens before a patient ever enters the operating room.
It is knowing when to operate.
And, perhaps just as importantly, knowing when not to.
The Patient Is Not Just a Procedure
Plastic surgery is different from many areas of medicine because the patient is often actively choosing an elective procedure.
That means the relationship between surgeon and patient matters enormously.
A surgeon isn't simply deciding how to perform an operation.
They also have to determine:
Is this patient an appropriate candidate?
Are their expectations realistic?
Is the requested procedure actually going to address their concerns?
Do the potential benefits justify the risks?
Does the patient's anatomy support the proposed approach?
Do they understand the recovery?
Are they psychologically prepared for the process and outcome?
These questions require judgment.
And judgment cannot be replaced by technical surgical ability.
Why Saying “No” Can Be Good Surgery
One of the points Dr. Maercks makes in the Reel is that operating on the wrong patient can be one of the most costly decisions a surgeon makes.
And “costly” doesn't simply mean financially.
An unsuitable patient can mean:
More complications
More follow-up
More time managing problems
Additional procedures
Emotional distress for the patient
Significant stress for the surgical team
Potential damage to the long-term doctor-patient relationship
A surgeon who simply wants to fill an operating schedule would have little incentive to turn patients away.
But an experienced surgeon understands that not every patient who wants surgery should necessarily have surgery.
The Importance of Patient Selection in Plastic Surgery
Patient selection is one of the foundations of successful cosmetic surgery.
A technically excellent operation can still produce a disappointing result if it is performed on the wrong patient, for the wrong reason, or with unrealistic expectations.
For example, someone may come to a consultation believing they need a facelift when another approach may be more appropriate.
Someone may expect surgery to produce a result that isn't anatomically realistic.
Someone may be seeking surgery because they believe it will solve a problem that surgery cannot actually solve.
These situations require a surgeon to have a conversation — not simply open a surgical schedule.
At The Maercks Institute, facelift candidates are assessed individually, including their health, degree of skin laxity and whether their expectations are realistic for the procedure.
Technical Skill Isn't Enough
Plastic surgery requires years of training and continued refinement.
But technical skill is only one part of being a good surgeon.
There is also:
Judgment.
Experience.
Anatomical understanding.
Communication.
Patient selection.
Aesthetic judgment.
The ability to recognise when something isn't appropriate.
And perhaps most importantly:
The willingness to take responsibility when something doesn't go according to plan.
A surgeon can be technically gifted and still make poor decisions about which patients to operate on.
Conversely, a surgeon who carefully evaluates a patient, establishes realistic expectations and selects the appropriate procedure is already improving the likelihood of a successful experience before surgery begins.
What Happens When Something Goes Wrong?
This is where the doctor-patient relationship becomes particularly important.
No surgeon can honestly promise that every operation will be complication-free.
Even when surgery has been performed appropriately and a patient has been carefully selected, unexpected complications can occur.
The Maercks Institute has previously shared a particularly serious facelift complication involving significant tissue loss and an extended recovery. The practice describes how the patient required ongoing communication, problem-solving and care over an eight-month period.
The lesson is important.
A surgeon should not only be judged by what happens when everything goes perfectly.
What happens when something goes wrong may tell you even more about the surgeon and the practice.
Are they there?
Do they communicate?
Do they take responsibility?
Do they continue caring for the patient?
Are they willing to spend the additional time required to help resolve the problem?
These questions matter.
A Successful Practice Isn't Built by Operating on Everyone
There is another important contradiction in the idea that surgeons simply want to fill their operating rooms.
A successful long-term surgical practice depends heavily on making good decisions.
Operating on a patient with unrealistic expectations can create problems.
Operating on a patient who isn't an appropriate candidate can create problems.
Performing a procedure that doesn't address the patient's actual concern can create problems.
And complications can require significant additional time and resources.
In other words, good patient selection isn't opposed to a successful surgical practice — it is part of building one.
Why Unrealistic Expectations Matter
One of the biggest challenges in aesthetic medicine is that patients don't always arrive with realistic expectations.
Social media has made this even more complicated.
Patients are exposed to:
Heavily edited photographs
Filters
Carefully controlled lighting
Selective before-and-after images
Viral transformation videos
Celebrity results
“Perfect” faces presented as achievable standards
A consultation is therefore about much more than discussing an operation.
It is an opportunity to establish what surgery can realistically achieve.
A good surgeon should be able to explain what is possible — and what isn't.
Sometimes the most appropriate recommendation may be a different procedure.
Sometimes it may be a less invasive treatment.
And sometimes the right answer may simply be:
“I don't think surgery is appropriate for you.”
That isn't a failure.
It is judgment.
The Doctor-Patient Relationship Doesn't End in the Operating Room
A patient's relationship with their surgeon should not be thought of as ending when the procedure is complete.
The postoperative period can be just as important.
Patients need to understand what recovery may involve, what is normal, what should prompt concern and how they can contact their surgical team.
And if something unexpected happens, they need to know that their surgeon is still there.
This is particularly important in facial surgery, where patients are understandably highly invested in the result.
The emotional impact of an unexpected complication can be substantial.
Having a surgeon who remains engaged throughout the process can make an enormous difference.
What Should Patients Look for in a Plastic Surgeon?
When researching a plastic surgeon, don't only look at their before-and-after photographs or social media presence.
Ask deeper questions.
What is their training?
Understand their residency and specialist training.
What are they board certified in?
Make sure you understand what their certification actually represents.
How frequently do they perform the procedure?
Experience with your specific procedure matters.
How do they select patients?
A surgeon should be willing to explain why they believe you are — or aren't — a good candidate.
What are their expectations for your result?
Be wary of anyone who promises perfection.
How do they handle complications?
Ask what happens if something doesn't go according to plan.
Who will care for you after surgery?
Understand the follow-up process and how accessible the surgical team will be.
Do you feel heard?
This may sound less technical, but it is incredibly important.
You should feel comfortable explaining your concerns and asking difficult questions.
Caring Is More Than Being Nice
When Dr. Maercks talks about caring for patients, it isn't simply about being friendly during a consultation.
Caring about a patient means taking responsibility for the entire process.
It means taking the time to understand them.
It means assessing whether surgery is appropriate.
It means considering their anatomy and expectations.
It means caring about the outcome.
And when something goes wrong, it means being willing to invest the time and energy required to help make it right.
That is a much deeper definition of patient care than simply having a pleasant bedside manner.
The Surgeon You Choose Matters Before You Ever Have Surgery
Choosing a plastic surgeon isn't simply choosing someone who can perform a procedure.
You are choosing the person who will evaluate whether you should have that procedure in the first place.
You are choosing someone whose judgment you are trusting.
And you are choosing the person you will rely on if your recovery doesn't follow the expected path.
That is why the relationship between surgeon and patient matters so much.
At The Maercks Institute, Dr. Maercks describes his approach as deeply focused on patient care, surgical outcomes and long-term relationships with patients.
The Bottom Line
Are plastic surgeons motivated by their businesses?
Of course. Surgical practices have teams, facilities, technology and significant overhead.
Do surgeons want to operate?
Many surgeons chose their profession because they love surgery.
But neither of those things means that surgeons don't care about their patients.
In fact, caring deeply about the patient is inseparable from good surgical judgment.
Because sometimes caring means operating.
Sometimes caring means changing the surgical plan.
And sometimes caring means saying:
No.
The most important part of plastic surgery may not be what happens when the surgeon picks up the scalpel.
It may be everything that happens before they ever do.
Patient selection. Judgment. Communication. Trust. Responsibility.
Those aren't extras.
They are part of the surgery.
Comments