Orthognathic surgery is largely a cosmetic procedure from the patient’s perspective. This creates several unique issues including subjective expectations of patients based on notions that maybe non-realistic in practice. The Informed Consent Document (ICD) is meant to provide details of outcomes including risks of negative outcomes based on which a patient gives consent. While it may be possible to outline expected outcomes and risks based on objective data, it is often difficult to meet expectations based issues of ‘vanity’. The paper reviews published data of litigations in cosmetic surgery where between 30% and 40% of cases are disappointed for want of explanation of potential benefits in the ICD. The paper also provides ICD templates for addressing these issues and precautions to be taken for patients with Body Dysmorphic Disorder (obsession about mild or imaginary imperfections) and other obsessive conditions as they are unlikely to be satisfied with outcomes. The surgeon’s responsibility to high light limitations and realistic expectations in elective cosmetic surgery in addition to mention about complications in standard ICDs is stressed.