1. Are you considering cosmetic surgery because a doctor, friend or significant other suggested it?
   Yes    No
2. Are you going through a divorce, loss of a spouse, loss of a job or another major life change right now?
   Yes    No
3. Are you considering a facelift or other cosmetic procedure because you think it will make you more attractive to the opposite sex?
   Yes    No
4. Do you smoke?
   Yes    No
5. Do you have diabetes, circulatory problems or another chronic health condition that could adversely affect your recovery?
   Yes    No
6. Do you expect your life to change drastically after your surgery?
   Yes    No
7. Are you considering cosmetic surgery because you are dissatisfied with a certain aspect of your appearance and would like to look rejuvenated?
   Yes    No
8. Are you willing to apply sunscreen whenever you go outdoors?
   Yes    No
9. Are you willing to sacrifice a week or more of your time to recover, possibly using up vacation time from work, in order to undergo cosmetic surgery?
   Yes    No
10. Can you afford to pay several thousand dollars for an elective prodedure that isn't covered by insurance with no guarantee of the results you want?
    Yes    No

Source:

American Society of Plastic Surgeons. Improving your self-image with plastic surgery. Accessed May 29, 2007. Available at http://www.plasticsurgery.org/patients_consumers/planning_surgery/psychological_aspects.cfm