After cosmetic surgery, patients can get pretty angry at their surgeons for results they consider less than ideal. And the angriest of all, according to a Texas psychologist, are male patients -- especially men who got their noses fixed.

Of the three patients documented in history who murdered their surgeons after what they considered to be botched operations, all were men, and two had had nose jobs.

According to a literature review by Dr. Mary Ruth Wright, assistant clinical professor of psychology at the Baylor College of Medicine in Houston, men who undergo rhinoplasty, more commonly known as a nose job, tend to be troubled even before the operation, which makes them "poor surgical risks," she says.

In a report published in last month's Archives of Otolaryngology-Head and Neck Surgery, Wright noted that a high-risk patient is likely to "decompensate," or have a breakdown, after surgery, and is even more likely to sue the surgeon -- and in rare instances, to kill the surgeon.

"A younger male rhinoplasty patient is usually safer than an older one," Wright says. "After a person has gotten accustomed to his nose, he may not really want it changed, even though he thinks he does. He might have become dependent on it."

For many people, the nose is a key part of their identity. This is certainly true of C.D. Bales, the Steve Martin character in this summer's hit movie "Roxanne." Bales' ridiculously big nose is, as Hal Hinson, film critic for The Washington Post, put it, "the perfect vehicle for {Martin's} own essential oddness and eccentricity."

For that reason, plastic surgery is out of the question for Bales -- at least dramaturgically so. Although the doctor he consults mumbles something about the excessive risks of anesthesia, the real reason the scriptwriter keeps Bales off the operating table is that the character needs his nose for his identity.

Wrote Hinson: "When he visits the plastic surgeon's office and slides picture-cards of potential noses against his own face, fantasizing himself with a 'normal' profile, . . . he seems diminished, less interesting. He becomes the one thing in the world we never wanted him to be -- ordinary."

In a way, say mental health specialists, that might be what happens to men in real life. They have come to view their oddities as a central part of their personae.

The connection may be more Freudian, too. Psychotherapists are quick to point out that the nose is a phallic symbol -- an "unpaired appendage of the mid-section," as Wright puts it. This means, says Wright, that rhinoplasty carries sexual connotations for men that it cannot carry for women.

A nose job, says Wright, is a symbolic castration.

The California husband-wife team of John and Marcia Goin -- he a plastic surgeon, she a psychiatrist -- say in their book "Changing the Body: Psychological Effects of Plastic Surgery" that the nose is indeed one of the "most psychologically loaded structures upon which the plastic surgeon is asked to operate."

According to the Goins, "It is risky to operate on patients who have not disliked their noses at least since adolescence . . . {When} an adult suddenly develops preoccupations with the appearance of his nose, he may be hoping unrealistically that the operation will resolve his personal crisis."

But while many psychiatrists and psychologists see a strong link between the nose and one's sexuality and sense of self, cosmetic surgeons don't always agree.

"I have been in this business for 25 years, and I've never seen that on a single occasion," says Dr. Eugene H. Courtiss, chief of plastic surgery at the Newton-Wellesly Hospital in Boston and author of "Male Aesthetic Surgery."

"In practice, most of the greatest fears of psychiatrists turn out to be unfounded," says Courtiss. "I would say that the vast majority of patients, men as well as women, who come to us for cosmetic surgery are as normal as the general population."

Certainly the number of men seeking plastic surgery has grown in recent years, though women still make up the large majority of patients.

Courtiss estimates that 15 percent of his cosmetic surgery patients are men. The American Academy of Facial Plastic and Reconstructive Surgery puts that proportion even higher nationwide. Of the one-half million patients who will have plastic surgery this year, they say, one third will be men.

Does that mean trouble ahead for plastic surgeons, as more and more disappointed men mount legal and perhaps pugilistic redress for surgical imperfections? Courtiss, for one, thinks not. He says men actually may be easier to please than women, because they are more specific about what they hope plastic surgery will accomplish.

"Men tend to say this fold or this jowl or these bags are bothering me," says Courtiss. "But women tend to say, 'I want to be beautiful' or 'Make me look younger.' "

What's more, the most common surgery he performs on males is not rhinoplasty but the removal of bags under the eyes, says Courtiss.

The new procedure of suction lipectomy, or fat removal, is running a close second. Men usually request lipectomy of the abdomen, where they are more likely to accumulate excess fat.

Dr. John Quincy Owsley, a San Francisco plastic surgeon, has said that eyelid surgery is the No. 1 request of his male patients. "For every man having a facelift, I do nine women," he estimated in 1984, "whereas I do three male eyelid operations for every seven women." Owsley had his own eyelids done when he was 49.

Wright of Baylor concludes that male plastic surgery patients are, in general, "more disturbed" than female patients because until very recently, plastic surgery has been forbidden territory for men.

"The healthy, coping person" will avoid "anything that is unsanctioned," she says. "But now that plastic surgery is sanctioned for the male, maybe the stable male will be more willing to undergo it."

Even today, however, it is a rare man who admits publicly -- as former auto executive John DeLorean did -- that he did indeed fix his face.

"Men tend to be more secretive" about their operations, says Courtiss. "But I don't think you can say that men are any harder to handle, either before or after surgery, as a result of that secretiveness."And while men remain hesitant about plastic surgery, it turns out that they are quite worried about wrinkles. Dr. Louise Atcheson, a psychologist with an industrial group called The Collagen Corporation, found that wrinkling is the physical change that most concerns men as they age. About one half of the 1,000 men -- ages 35 to 64 -- in her study were more worried about wrinkled faces than about sagging bodies, and 60 percent were more worried about wrinkles than about gray hair.

Given this concern about aging skin, how receptive were the men in Atcheson's study to plastic surgery? In an earlier study she had done of mid-life women, 25 percent had said they would consider cosmetic surgery. But in her poll of men, only 13 percent admitted that they would consider it.