A recent study published in the Aesthetic Surgery Journal shows that not only are plastic surgery patients getting younger, but the number of teens seeking plastic surgery is increasing. Should teens be allowed to go under the knife for plastic surgery? The answer is not always so simple.
Current statistics indicate that cosmetic and plastic surgery procedures amongst teens are on the rise, but that is not something to necessarily be alarmed about. Common procedures that teens ask for include non-invasive skin procedures like microdermabrasion, chemical peels and laser skin resurfacing primarily for the treatment of acne scarring. These types of procedures can make acne scars and skin discolorations less obvious, and can improve the overall appearance of the skin. They must be done so under the care of a qualified board-certified plastic surgeon or dermatologist.
Over the past five years, dermal fillers have also made a significant impact in how faces and lips are augmented, not only in teens, but in adults. Teenagers have seen their Hollywood role models get overdone lips and cheeks, and have followed suit. Unfortunately, many of these teens have been misguided by social media surrounding these teen role models. A high majority of board-certified plastic surgeons recommend against the use of cosmetic dermal facial fillers and Botox during tremendous physical and psychological growth occurring during the teen years. The rationale that fillers and Botox can have a positive effect used as a form of “prejuvenation” to prevent aging is significantly misguided and has absolutely no scientific basis.
The Most Common Plastic Surgery Procedures Teens Request
Plastic surgery in teens needs to be put into the proper ethnic and medical perspective during these critical developmental years of psychological, social and developmental growth. Plastic surgeons are physicians first and foremost and must follow the Hippocratic Oath and do no harm.
Breast enhancements are quite popular, but cannot and should not be done under age 18 due to FDA recommended restrictions on the use of saline over silicone implants in this age group. Unless they have a significant congenital breast deformity or asymmetry after completing their final growth spurt at age 18 or later, they are not to have a breast augmentation. However, teens not infrequently are seeking breast reductions due to peer ridicule, bullying at school and back pain due to the enlarged breasts. This is a reasonable request and has significant psychological and physical advantages when done in these teenagers. The tradeoff for smaller breasts, however, is a scar around the breast itself so this must be dealt with in detail with the parents and the patient by the plastic surgeon.
In boys, male breast reduction procedures for gynecomastia are in rising in demand. Gynecomastia, or the growth of male breast tissue, is considered to be the “silent male disease” and may be caused by medication side effects, or obesity, but may occur for other reasons. As boys fully mature and slim down, the breasts may decrease in size. However, in severe cases they may benefit from surgical attention to decrease the emotional impact of excessive breast tissue. In some cases, this can be done via minimally invasive techniques using ultrasonic liposuction
Otoplasty is a procedure that is commonly performed to reshape and correct prominent ears. It can be done during the teen years, but may be done as early as age six or seven when the ears are nearly adult-sized. It most commonly is requested if a child is being ridiculed at school with names like “Dumbo ears.”
The nose is also a common subject of teasing and bullying in school-aged children and teens. Surgical nose reshaping or rhinoplasty is also commonly performed for both functional and psychological reasons. It can often result in a dramatic improvement for teens, both physically and psychologically, especially in teen girls.
Some parents are continuing to give plastic surgery as a gift for graduation, or other occasions, which, in general, is considered a bad idea.
Over the past several years, plastic surgery in teens has seen a rise in rates, which may have been driven by celebrity trends, the pressure of social media, and the need to conform. The selfie has also been credited with increasing plastic surgery rates, but the trend may be slowing. Increasing numbers of celebrities who had botched procedures, or who simply went too far, may be reducing some of the outrageous demands from teens today.
Plastic surgeons who are faced with teens wanting procedures must act as guides and help both teens and parents come to a reasonable expectation. Doctors must have a frank discussion with the teen to ensure that they are mature enough to understand both the risks and benefits of a potential change, particularly if it is a permanent, surgical procedure. In some cases, teens are encouraged to wait and see because additional maturity may give the teen what they want over time.
Most importantly, the parents or guardians of the teens must be involved. This helps prevent mistakes and misunderstandings, and helps ensure both the physical and emotional safety of the teen.
10 Guidelines for Ethical Plastic Surgery in Teens
- Engage the teen in a frank discussion about their concerns and desires with parental or guardian involvement before considering any type of elective plastic surgery
- The use of treatments to improve skin appearance from acne scarring or dermatologic problems may include chemical peels and or laser therapy
- The use of Botox and cosmetic fillers for facial enhancements are generally and broadly discouraged unless there is a medical reason for this type of treatment including a facial nerve palsy, acquired or congenital lip, or cheek deformity
- Breast augmentation is not done electively under age 18 and only saline implants are used to age 22 and must be done with proper counselling
- Breast reduction or reshaping and the use of breast implants for correction of significant congenital deformities, or significant asymmetries, is reasonable with proper patient counseling
- Male gynecomastia (male breast enlargement) can be treated if it does not subside in the later teen years with proper counseling
- Otoplasty (correction of prominent ears) can and should be done at an early age, if possible from age five to seven as the ears are almost fully grown. This is also before the intense peer-to-peer bullying behavior starts with this deformity
- Rhinoplasty is indicated for correction of functional or traumatic deformities, as well as significant cosmetic deformities due to peer ridicule (especially in girls) at age 15-17 in females vs 17-19 in males due to the growth spurt lag in males
- Liposuction, or body contouring, procedures are not indicated in most teens as this can be properly treated with diet, exercise, and nutritional counseling in most cases
- The key, and most important element to optimal outcomes, proper decision making, and safety, is to find an emphatic board-certified plastic surgeon who is certified by the American Board of Plastic Surgery. The plastic surgeon must have the proper expertise, judgement, and experience in the management of the complex issues in dealing with the mindset of the developing teenager.