Absolutely. Some patients have unrealistic goals for a very large breast size, for example, in breast augmentation. These patients are definitely turned away. The risk of complications goes up with implant size, and it takes a certain body type to accommodate certain implants. Other patients want "a chin like Brad Pitt" or a nose like "Angelina" and these are also unrealistic goals. Sometimes it simply requires redirecting a patient, while at other times, patients have something called Body Dysmorphic Disorder. BDD is present in about 5-10% of plastic surgery patients, and a smart doctor can assess this finding and make sure to avoid surgery; it is unlikely to help the patient's overall self-esteem, and can actually be dangerous.