Psychological issues are central to cosmetic surgery procedures. Motivation is driven by the aim of achieving improved psychological and social wellbeing. A poor technical outcome will undermine those aims in the normal population, but for those vulnerable individuals with underlying psychopathology or personality disorders, the risk to their psychological state can be significant. Some patients will always be at psychological risk, whatever the technical outcome, and are less able to make an informed consent to treatment. This paper describes the types of psychological riskassociated with specific procedures, and the psychiatric conditions most commonly found in the cosmetic surgery population. Clinical guidelines are given for both patient and practitioner. Prospective patients are give advice on how to reduce their exposure to psychological risk, and practitioners are given guidelines on the selection of patients for procedures, and ways of developing referral pathways to mental health services where appropriate.