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The primary goal of plastic surgery is to achieve a specific improvement with safety in mind. In cosmetic surgery that objective does not change. Plastic surgeons assess the patients’ goals in regard to realistic expectations. In a consultation the next step is to give patients an honest, open understanding of the risks and post operative consequences of the procedures needed to achieve the results expected by the patient. Its inherent in the world of surgery that deals with organic tissue that no procedure is 100% guaranteed. The reality is that the goals are achieved almost all the time, but whether a patient will be happy is not for the doctor to determine, but rather the job and responsibility of the patient who has the choice based on the pros and cons from consultation.