The plastic surgeon reviews the patient's medical history and asks what they would like changed. You should always to be direct with your plastic surgeon. Ethical plastic surgeons usually do not suggest procedures and try to know exactly what bothers their patients so that they can direct the consultation and specifically address the patient's concerns. They take pictures and review them and use them as a benchmark to see if the surgery was a success or a failure. They discuss the pros and cons of a cosmetic procedure and let their patients decide if they want to go with the surgery or not.