I enjoyed lecturing on state of the art rhinoplasty and facial rejuvenation at The Royal Society of Medicine in London on Tuesday. I was invited to address the Interventional Cosmetics Group. I was asked by a member of the audience whether I operated on everyone. My clear answer was no. We are first and foremost doctors. If I do not believe rhinoplasty will help a patient I will advise against surgery and will not operate. Helping a patient means many things but especially means that they should be happier because of surgery. If I cannot achieve what the patient wants physically or emotionally therefore I will not operate. Importantly some patients concerns about their nose may reflect a psychological problem such as Body Dysmorphic Disorder which may be made worse by surgery. It is more complicated than just this though. If a patient cannot accept that there are risks or cannot understand that risk cannot be completely eliminated I will not operate. If patients cannot understand that the outcome cannot be precisely predicted I will not operate. This means that a patient must realise there is a chance of surgery not working out as they want or even result in them thinking the nose looks worse in some area. If a patient cannot accept these limitations then their increased potential for unhappiness to my mind makes surgery unjustifiable also and I will not operate. Linda Meredith who has a healthy and beauty clinic in Beauchamp Place, Knightsbridge came to speak to me after my lecture. She is so concerned that patients are having surgery and other cosmetic procedures that they shouldn’t she is writing a book about it.