Most days, when I sit down with a new patient in consultation they will start out by asking me for my evaluation and recommendations. My response is always the same. I smile, telling them that their question is one of the most common that I get, but that I can’t answer their question without first asking a question of my own, “why are you here?” After seventeen years of practice, there is no question that I can look at almost anyone and very quickly come up with a list of options to improve their appearance. The problem with that approach, however, is that often what may be bothering you about your appearance is not the issue that is most obvious to me. In fact I have many patients who come to see me for a second opinion after having surgery elsewhere, They are typically unhappy with their result, but after looking at their preoperative photos it usually turns out that their result was good, the problem was that the wrong operation was done. The patient came in concerned about a particular issue and the surgeon fixed something else. For this reason, I start all of my consultations by finding out what it is that bothers you.