Abstract

When plastic surgeons meet with new cosmetic surgery clients, they routinely try to get patients to `sign up' for elective surgery without forcing or pressuring them to do it. On rare occasions, they face a prospective client who, in the course of interaction, signals possible legal or medical risks, thereby calling on the surgeon to screen the client more vigilantly to determine whether embarking on cosmetic surgery will be reasonable. Grounded against nine-month field work at a cosmetic surgery center, combined with 30+ hours of videotaped data of initial consultations, this article investigates a unique situation in which a 74-year-old woman seeking rhinoplasty and rhytidectomy is perceived as a difficult customer. Why this moment was interpreted and emerged as difficult is the analytic focus of the article. Using action-implicative discourse analysis, the analysis describes five communication challenges the plastic surgeon faced in the course of the 60-minute encounter. In the article's conclusion, I reflect on what seems to be a central issue for plastic surgeons: to act as gatekeepers of a fully elective and pricy surgery in a service-oriented business.