As cosmetic surgery booms in this country, many of those seeking a more youthful appearance are repeat customers. But when a patient wants a complete "change of face" the problem may be deeper than it appears.

The quest for a firmer face, a narrower nose and a tighter tummy, are just a few of the reasons why people are flocking to plastic surgeons, to get several body parts altered at once.

According to the American Society of Plastic Surgeons 36 percent of cosmetic surgery patients are repeat patients. They've had something done before, and 34 percent are having multiple procedures at the same time.

Plastic surgeons say they have to be very careful about who's going under the knife, how often, and why. Some surgeons say if someone has had a multitude of surgeries then it's clearly an emotional issue that cannot be operated away.

The Aesthetic Surgery Journal recently published a survey about BDD, Body Dysmorphic Disorder. It's an excessive preoccupation with an imagined or slight defect in appearance. It's believed two percent of patients seen for an initial consultation suffer from BDD.

In considering cosmetic surgery experts advise you do it for the right reasons and have realistic expectations, which means a natural look rather than a change of face.