A study claims as many as 10% of those seeking facial plastic surgery are mentally ill and doctors should refuse. But many surgeons don't spot the problem.
Dallas therapist Lori Vann says that's too many.
"This research study is quite alarming that so many are able to get through the system and get their plastic surgery."
Vann says it's an ethical issue for these doctors.
"If you know someone may have a psychological issue; that their perceptions, their reality is skewed and you know they need psychological treatment, do you do the surgery because you care more about the money than the patient's mental health?"
But Vann says she realizes it's difficult for a surgeon to tell a patient he or she is crazy. Vann says let that be on another surgeon's conscience.
"Most clients are not going to respond well if you say 'hey I would like you to do an evaluation before we proceed with this surgery; I think there are some things we need to evaluate to make sure this surgery is successful.'"
It's called body dysmorphic disorder and some think it explains some of pop superstar Michael Jackson's plastic surgery.