Cosmetic surgery can be seen as a quintessential example of medicalization (Conrad, 2007; Dull & West, 1991; Sullivan, 2000), a process in which human conditions that were once merely considered problems with living are treated as medical conditions (Szasz, 2007), from baldness (Conrad, 2007) to the transformation of childbirth (Ehrenreich & English, 1978; Riessman, 1983; Wertz & Wertz, 1977). However, little has been studied on how doctors and patients take lifeworld issues such as cosmetic appearance and transform them into conditions worthy of surgical intervention.With the exception of Julien Mirivel (2002, 2005, 2007, 2008, 2010), there has been little work done using face-to-face, real time interactions between cosmetic surgeons and patients, as opposed to post hoc perceptions (Dull & West, 1991; Davis, 1994, Gimlin, 2007; Brooks, 2004). In doctor-patient interactions, most identity work and presentations of self occur early in the problem-presentations phase when patients disclose their concerns (Heritage & Robinson, 2006).Videos of initial cosmetic consultations between 19 patients and one cosmetic surgeon in a Beverly Hills practice were examined through conversation analysis and ethnomethodological principles. Of particular focus were patients’ language practices in performing the role of cosmetic surgery patient. Findings were supported with ethnographic observations. The process of becoming a cosmetic patient, what Harvey Sacks calls “doing being a patient” (1984), is performative and involves an identity that is mutually co-constructed in the course of interaction. Interactional norms of medicine are actively being enacted and expanded to fit the commercial contingencies of cosmetic medicine. In this study, patients received medically relevant responses only when their concerns invited medical evaluation, delineating a clear boundary between patient and consumer. Through interaction with the surgeon, patients legitimized seeking intervention by transforming aesthetic desires into medical concerns. Patients were also socialized into the role of cosmetic surgery patient by acquiring the ability to discuss their appearance in a medically appropriate fashion through interaction with the surgeon. In order to be seen as viable surgical candidates, patients managed tensions between conflicting sets of interactive norms to perform “being a patient” in an environment in which issues of health were virtually absent.