Communication by talking is actually a very difficult skill and almost everyone occasionally misses the point or misunderstands when they talk to other people. Sometimes two people “hit it off” almost at once when they meet but very often one really needs to know someone very well indeed to never misunderstand what they mean. Spoken words conjure up images in the brain of the listener that can be totally different from those that were being described by the speaker. Words such as “small” or “better” can change their meaning entirely as they pass between the two. It is obvious that some surgeons, and of course some patients, are going to be better at communicating than others. Comfortable, stress-free conditions and enough time can make all the difference to the value of an interview. Many patients are nervous and embarrassed when they first meet a surgeon and these are barriers to effective communication. The surgeon should be able to relax the patient by a calm and unhurried approach. However good a surgeon is at operating he or she will never get the “Best Surgeon In The World” title if he or she does not make it easy for patients to talk about their problems. If any patient after a consultation feels that they have not been able to say all they wanted to say, or felt that they were being misunderstood, they would be best advised to seek another consultation, possibly even see another surgeon, before they decide whether to have the operation.

At the initial consultation the surgeon will be carefully evaluating the patient's response to his questions and will be trying to decide exactly what the patient is hoping to get out of the operation. The result that the patient expects has to closely match the result that the surgeon is likely to achieve. If the patient is expecting something that is beyond the prowess of the surgeon, or is not a normal result of the operation itself, then disappointment is the likely outcome.

A few patients are disappointed with an operation that has been performed perfectly and where any objective observer would think there is a beautiful result. The problem here is that there has been a failure of communication between the patient and the surgeon. They both need to listen to each other. Photographs of the surgeon's previous patients are a great help because the patient can gain a good impression of what the operation can do for them and the surgeon can observe the patient's response. If these responses are inappropriate this is a warning sign to the surgeon. If the patient feels that the results shown in the photographs are disappointing because they fall short of what they are expecting then the patient must be warned that their expectations are probably unreasonably high and they must be advised not to proceed. If any patient forms the view in consultation with the surgeon that the surgeon's results will not please them then they would be foolish to go ahead.

Occasionally a patient changes his or her mind about the desired result during the course of the treatment. Whereas at the initial consultation they swear that they are so bothered by their problem that they will accept any result, so long as it is an improvement, afterwards they are disappointed because the result is not perfect. The surgeon has done his best and come up with what the patient said would be acceptable but afterwards the patient has become more ambitious and then finds that a simple improvement is not enough.

The surgeon should be forthcoming about the negative side of the operation such as scarring or the possibility of the result changing with time. Any patient is likely to be disappointed if they did not know that an inevitable result of their operation is significant scarring for example. This is not always the fault of the surgeon; some patients simply do not listen when the operation is explained to them or they assume that their case will be different or that the surgeon is trying to put them off for some reason.

All cosmetic surgeons occasionally see patients who they feel will not be happy afterwards. Some will plainly want an operation that either does not exist, or will not work in their case. Others will make the surgeon believe that however successful the operation is technically, it will not give them the result they want such as ensuring a major modelling contract or even attracting home an errant husband. Patient selection, that is only agreeing to operate on good candidates, is an important part of the surgeon's responsibility.

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