INTRODUCTION Recent graduates of plastic surgery training programs seem to have abandoned the traditional model of mixed reconstructive and cosmetic practices in favor of seeking only cosmetic patients. In this article we describe the demographics, referral sources, and payment methods of the first 100 surgical patients from a new, private, single surgeon, cosmetic practice in a major metropolitan city. METHODS The first 100 patients operated on in this setting were included in this study. Date of surgery, patient age, gender, type of surgery, type of payment, and source of referral were studied. RESULTS Fifty-two reconstructive and 48 cosmetic cases were performed. The most common payment types were insurance (42%), cash (33%), and credit card (20%). The most common referral source was the ER (36%) followed by patients (23%), physicians (23%), and friends (14%). One hundred percent of ER referrals were reconstructive and 100% of patient referrals were cosmetic. Eighty-six percent of friend referrals and 39% of physician referrals were cosmetic. DISCUSSION Although this surgeon had set out to establish a purely cosmetic practice, in reality, his practice followed a more traditional model. In fact, it appears that the volume of reconstructive cases positively contributed to the success of the practice.