Following the death of hip-hop artist Kayne West’s mother Donda West , after a tummy tuck and breast reduction procedure , the onus is once again on the risks of plastic surgery and who can be considered fit to undergo it.

According to experts in the field, there are two groups of patients most at risk- those with medical problems and those with psychological problems.

“The first rule of when not to have plastic surgery is if the doctor doesn't want to do it,” advises Dr. Richard D'Amico. He is president of the American Society of Plastic Surgeons. "If you have been turned away by a board-certified plastic surgeon, please don't ignore their advice”, he stresses.

According to D’Amico it could be primarily be a matter of health concerns. The conditions that put would-be patients of plastic surgery at risk are : heavy smoking or drinking, diabetes , high blood pressure, bleeding disorders, heart or lung diseases, obesity , severe allergies, high cholesterol and arthritis.

No surgery is risk free observes D'Amico. But as cosmetic surgery in most cases is elective and not medically necessary, “we need to make sure we minimize the risks," he says.

Another factor that worries surgeons is psychological concerns. D'Amico puts them in the category of "management of expectations." This also means making sure the patient knows the limitations and risks of any cosmetic procedure.