Cosmetic surgery has real health and emotional benefits for patients. However, in spite of plastic surgery's increasing popularity, it's not a good option for everyone. In 2004 the American Society for Aesthetic Plastic Surgery (ASAPS) warned that "some individuals seeking cosmetic surgery are considered poor candidates because of specific lifestyle factors that can seriously impact their safety in the operating room and during recovery."

These factors may lead plastic surgeons to delay or even deny treatment to some patients.

Patient Evaluation Is Necessary Before Plastic Surgery

Dallas plastic surgeon Dr. Fred Hackney explains that a discussion of lifestyle factors and medical history is an important part of the patient evaluation process.

"Board certified plastic surgeons are concerned foremost about patient safety," Dr. Hackney says, "Lifestyle factors like smoking, lack of exercise, diet, weight and their preexisting medical problems effect a person's overall health and can increase the possibility of complications after surgery."

Lifestyle factors that might affect a surgeon's recommendation include:

• Smoking habits – including exposure to secondhand smoke. Nicotine and carbon dioxide impair the body's healing ability by decreasing the blood supply to the skin and deeper tissues. They also affect pulmonary health, which can lead to surgical complications. Many plastic surgeons require patients to stop smoking for a certain period before surgery.

A 2002 survey from the University of Texas Southwestern Medical Center found that about 45% of board-certified plastic surgeons limit the types of procedures they perform on smokers.

• Current weight and history of weight fluctuations. A good candidate for surgery is within 30% of his or her ideal weight. Another measure of fitness for surgery is the body mass index. (BMI). A BMI of 30 is considered obese. Obesity may affect healing both before and after surgery.

• Alcohol consumption. Excessive alcohol consumption can affect liver function and increase the likelihood of surgical complications. Alcohol consumption can also affect overall appearance. A 2009 study of twins' physical appearance by Cleveland plastic surgeon, Dr. Bahman Guyuron, found that "the twin who avoided alcohol looked significantly younger."

• Sun exposure. Like alcohol consumption, sun exposure can affect physical appearance and skin health. The same study by Dr. Guyuron found: "The more time a twin spent in the sun, in outdoor activity and without sunscreen, the older she looked." Sun exposure can affect the long-term results of cosmetic surgery; it's important for patients to protect their skin before and after a procedure.

• Sleep patterns. Americans are chronically sleep-deprived, according to the U. S. Centers for Disease Control and Prevention. That has wide-ranging health consequences and affects a patient's suitability for plastic surgery.

According to the CDC, "Not getting enough sleep has been tied to mental distress, depression, anxiety, obesity, hypertension, diabetes, high cholesterol and certain risk behaviors including cigarette smoking, physical inactivity and heavy drinking."

A plastic surgeon may refer a patient for treatment of sleep disorders - such as sleep apnea and chronic insomnia - before scheduling cosmetic surgery.

• Stress levels and coping mechanisms. Chronic stress affects a person's physical and mental health. The Mayo Clinic lists a number of physical conditions that can result from stress, including: heart disease, high blood pressure, and decreased immunity. It's important for patients to find healthy ways to manage and reduce stress before surgery.

Board-certified plastic surgeons will discuss all this and more before scheduling cosmetic surgery. It's an integral part of determining whether the requested procedure will be safe and effective. During your consultation, remember that no one is being judgmental.

Instead, your doctor is simply doing his job: making your health and safety his first priority.