The mean age of Americans is increasing, and more and more Americans are living longer and more productively. It follows, therefore, that an increasing number of elderly patients will be seen by the cosmetic surgeon. These patients are often in the surgeon's office to negate or erase the physical effects of old age, which serve as social cues expressing inadequacy and inability. The plastic surgeon can "turn back the clock" as it relates to physical appearance for these patients; however, not every patient seen by the surgeon is an ideal candidate for surgery. Normally, the surgeon is used to dealing with the physical possibilities of surgical procedures and how they relate to surgical results, but what about the mental health of the elderly patient? In this article we seek to help the plastic surgeon identify the elderly patient who poses potential problems in the preoperative and postoperative periods because of inadequate or unstable mental health.