Deciding whether or not to operate is probably more diffficult in rhinoplasty surgery than in almost any other area of aesthetic surgery, for a surgeon. The psychological effects of a nose which is seen to be unsightly by the patients have likely been present for many years, often present in adolescence. Among other factor, the patient may have been teased by peers, or felt rejected emotionally; felt to be ethnically conspicious. Expectations of the operation may run unrealistically high. Because, the effects of the surgery do not appear immediately, disappointment may set and be persistent.