A plastic surgery consultation is where goals, anatomy, and expectations meet, and sometimes where the answer is no. In three short interviews, Bryan G. Forley, M.D., F.A.C.S., a board-certified plastic surgeon, explains how he approaches it and what drives him beyond the operating room.
Why does listening matter before a procedure?
Talking to patients, listening to them, and making sure they understand before any kind of procedure is the key to a happy patient. I think of it as education and illumination: showing patients what is possible and understanding them, because people have different motivations and different goals. I try to assess those goals within the whole picture.
It also helps patients to understand more when they can see a change on themselves than when they see it on other people, whose anatomy is different. A change may look fine on someone else but not on this particular person.
When does a plastic surgeon say no?
There are several situations. In general, despite my best efforts with tools like 3D imaging and before-and-after photos, if I have not been able to change a patient’s mind about something I think is unachievable or would not look right on their face or body, I encourage them to rethink it. I do not proceed just because someone is sitting in my office with a strong desire for a procedure.
Several years ago, a 15-year-old came in with her mother and asked for breast implants. I explained that, for many reasons, it was not a good idea at 15. She needed to wait until she was fully developed physically and ready emotionally to make that decision. She was disappointed, and her mother was elated. About five or six years later she came back to thank me. She was grateful I had said no, because she never did it and would never have been happy with what she had been considering.
Who is Dr. Forley beyond the operating room?
I would describe myself as an adventurer because I enjoy exploring all aspects of life, from New York City, where I live, to destinations abroad. I have been to all seven continents, some of them more than once, and I have challenged myself in many ways, from climbing Mount Kilimanjaro to ice diving in the White Sea in Russia. That defines my personality in a way, because although I am well grounded, I like to explore things that give me those kinds of challenges. They are calculated risks that lead to new experiences, and that is always a goal of mine.
What Professional Guidance Says About Saying No
Dr. Forley’s reasoning matches published guidance. The American Society of Plastic Surgeons recommends that candidates for purely aesthetic breast augmentation be at least 18 and have the physical and emotional maturity to make an informed decision, and that they request it for themselves. The FDA lists saline-filled implants as approved for breast augmentation at 18 and older and silicone gel-filled implants at 22 and older. The society also advises patients to discuss the anticipated cosmetic result with their surgeon ahead of time.
Five Questions to Ask at Any Plastic Surgery Consultation
- What are my goals, and what is motivating them?
- Is what I am asking for achievable on my own anatomy?
- Can I see the change on my own photos, and what are the limits of a preview?
- When would you say no, or suggest I wait?
- What are the risks, benefits, and possible complications?
Talk with Dr. Forley
To discuss your goals, or to schedule an in-office or virtual consultation, please contact the office.
Written by Dr. Forley on October 29, 2026
