Complications of patient selection: recognizing the difficult patient.

This article reviews some basic principles of patient selection for facial plastic surgery. There are patients who are not good candidates, independent of the deformity and the ability of the surgeon. Reasons include subtle and not so subtle psychiatric disorders, unrealistic expectations, lack of communication despite multiple visits, and litigious patients. Complications or suboptimal results are not well handled in these patients and often produce an uncomfortable experience for the surgeon and staff in the postoperative period. These patients are best avoided or should be provided a much longer evaluation period prior to any surgery.