Plastic surgeons for many decades used a mnemonic called SIMON (Single—Immature—Male—Obsessive—Narcissistic) when referring to a particular selection process for those men seeking rhinoplasty. This combination often sought out many surgeons and were subject to many unsuccessful revisions and we were to be wary of these characteristics.
Over my 49 years in practice in a part of the country loaded with engineers, I found many men who fit many of those descriptors who were perfectly fine subjects for surgical procedures. The only part of that mnemonic that was a warning for me was the last— the Narcissist.
The narcissist is often difficult to see at first but the first sign is their ability to charm you and act as if you are the only one who can help them achieve their dreams. When I am suspicious, I will insist on a second interview and try to separate things out looking for other signs. The narcissist is more likely to have signs of Body Dysmorphic Disorder. You cannot surgically extirpate this disease. When I am comfortable enough during the interview process, I will often ask questions about childhood relationships with family. I have learned from my colleague Dr Mark Constantian that one of the root causes of Body Dysmorphic Disorder will have a background of childhood abuse at the hands of adults or older siblings or relatives. they frequently have history of substance abuse in an attempt to self-medicate.
