Cancellation of plastic surgical procedures has several deleterious effects, including emotional distress and economic ramifications. This prospective study, conducted over a 12-month period in a solo practice, reviewed the factors that contributed to surgical cancellations. Cancellations occurred despite many strict measures such as at least two preoperative visits, in-depth counseling and reinforcement by surgeon and staff, laboratory testing done 2 weeks prior to surgery, detailed evaluation of medical background, extensive written and verbal instructions to avoid medications that adversely affect surgery, and thorough discussion of payment plans and insurance coverage, including predetermination of any third-party coverage. Of the 952 patients (667 males, 285 females) scheduled for surgery, 113 experienced cancellation of the operation, either by the surgeon and staff or by the patient. Cancellations were proportionally fewer in male patients (p < 0.025). The total number of scheduled procedures was 1590 (some patients scheduled for more than one procedure); 727 of these were cosmetic (46 percent), and 863 were reconstructive (54 percent). Of the 205 procedures canceled, cosmetic procedures were more likely to be canceled (p < 0.001), since 123 (16.9 percent) cosmetic procedures were canceled in contrast to 82 (9.5 percent) canceled reconstructive procedures. Because of multiple cancellations, there were a total of 119 cancellations for 113 patients. Thirty of the 113 patients were rescheduled at a later date. Of these 30, 24 did undergo surgery, while 6 canceled for a second time. Thirty-two of the 113 canceled patients (28.3 percent) were patients in their fifth decade of life.(ABSTRACT TRUNCATED AT 250 WORDS)