Nip, Tuck, and ... Cry?

Television makeover shows like The Swan and Extreme Makeover portray contestants as delighted with the results of their plastic surgery and ready to begin new, improved lives. But for the millions of cosmetic-surgery patients whose transformations aren't televised, the aftermath of a procedure can be a bit more complicated, including feelings of depression and letdown.

"Some people have this fantasy that if they change their bodies, they'll change their lives," says Ann Kearney-Cooke, PhD. "That perception is reinforced by the media. Unfortunately, it's not that simple and can result in a lot of disappointment for certain patients."

Kearney-Cooke is a psychologist and author of Change Your Mind, Change Your Body: Feeling Good About Your Body and Self After 40.

Third-Day Blues

While research shows that 85%-95% of people who have elective cosmetic surgery are ultimately satisfied with the results and report improvement in their body image, it can take a while to get to this point.

The period immediately following the surgery is a particularly vulnerable time for many patients. Some plastic surgeons, in fact, talk about the "third-day blues," referring to the third day after surgery, when patients have regained some of their physical stamina but are still bandaged and black and blue.

"I don't think a lot of patients understand how banged up and bruised they'll be after surgery," says David B. Sarwer, a psychologist at the Center for Human Appearance at the University of Pennsylvania School of Medicine. "A lot of these patients tend to be busy and active. Recovering from surgery shuts your life down for a few weeks."

Unrealistic Expectations

The majority of patients do feel better, physically and emotionally, after two or three weeks. Those that continue to be unhappy or depressed probably had unrealistic expectations in the first place, Sarwer tells WebMD.

"If you're expecting a Cinderella-like transformation you're likely to feel let down," he explains. "A cosmetic-surgery procedure is not going to save a failing marriage, change your social life, or cure emotional problems."

Sarwer adds that people who want to fix a very specific physical trait -- such as a bump on their nose or love handles -- are usually more satisfied than people who go to a surgeon's office with an attitude of "I'm ugly. You're the beauty expert. Fix me."

Choosing the Right Patient

While there is no standard protocol for screening patients ahead of time, many plastic surgeons, including Miami surgeon Stephan Baker, MD, believe patient selection is critical. He meets with patients three times before operating in order to establish realistic expectations.

"This is not like surgery for appendicitis, where you don't care how the patient feels about it because it has to be done," says Baker, a spokesman for the American Society of Plastic Surgeons (ASPS). "This is emotional surgery and it's very important for the patient to be honest with themselves, to understand the likely outcome, the potential complications, and their own emotional reserves."

Baker asks patients what is driving them to have surgery and what their expectations are. He often turns people away if they think fixing a feature will also fix other problems, or if a patient seems like "one of the Michael Jacksons of the world."

"I am very hesitant to operate on anyone who has had the same feature fixed twice already," Baker tells WebMD.