Studies show that patients seeking cosmetic surgery are more likely to suffer from depression than is the general population. Thus it behooves the cosmetic surgeon to be familiar with the diagnosis of depression and the unique challenges that it poses to a cosmetic practice. Does depression affect surgical outcomes? Could a surgical procedure improve or exacerbate depressive symptoms? When is referral to a mental health professional warranted? This article attempts to deal with these questions, and in doing so we suggest possible means for managing depression in the cosmetic surgery patient.