The retail industry puts a heavy emphasis on teenagers looking good, wearing the right clothing, listening to the right music, and both fitting into their peer groups as well as standing out as individuals. Adolescence is a tough time in its own right. Children’s body image concerns may be further influenced by sociocultural influences such as dolls, television characters, and characters in children’s books and movies. In many parts of our country, especially in the Sun Belt area, this also means looking into cosmetic surgery.
The American Society of Plastic Surgeons (ASPS) estimates that more than 333,000 cosmetic procedures were performed on patients 18 years of age or younger in the United States in 2005, compared to approximately 14,000 in 1996 . In 2005, one in four of these were surgical procedures such as nose reshaping, ear surgery, breast augmentation, liposuction, chin augmentation, and abdominoplasty.
Teenagers as well as adults may be concerned about the appearance of their noses and may have functional problems. The nose grows until about age 16, so I usually reserve cosmetic and reconstructive nasal surgery on patients until that age, unless they had a nasal injury such as during sports that need to be corrected sooner.
Protruding ears are a problem that is usually treated before children start school at age 5 but my second “spike” in patients is teenage girls who are just starting to date. It’s interesting that if boys don’t have the surgery done before age 5, they don’t seem to seek treatment much at an older age.
Teenage girls who develop significant breast enlargement during puberty not only have psychological problems because everyone focuses on their breasts, possibly making fun of them, but they also experience functional problems, particularly if they are engaged in sports. Since breast development continues until age 18, and their breasts will also enlarge during pregnancy, it’s very important to assess the maturity of the patient and discuss with the patient and her family the significant outcome of a breast reduction. I have done breast reductions on girls as young as 17, only to have them come back at age 25 after having had a child and developing breast hypertrophy.
I’ve seen teenage girls who have had congenital breast deformities where one breast may be an A cup and the other breast is a C or D cup. These patients certainly should be considered for surgery. On the other hand, a teenage girl with normal breast development who wants to increase her B cup size to a D cup, because she feels this will make her more popular, needs to be looked at differently. The physician has to look at her reasons more critically.
When a teenager comes in for a cosmetic surgery consultation, the plastic surgeon needs to evaluate the patient as they would an adult seeking surgery, but with certain other considerations.
Dr. Michael Bermant recently wrote an article in which he made interesting points regarding the consultation. Every analysis for potential surgery must weigh the following:
- The purpose for surgery: Is the proposed surgery realistic? Does the patient seem competent to make the decision to have surgery?
- Degree of deformity: Is the deformity noticeable? Are the patient’s expectations for correction appropriate?
- Level of physical maturity: Will the patient grow out of the deformity?
- Social costs: Does the patient suffer socially because of the problem?
- The patient-parent decision: Are the parents supportive of the surgery? Are the parents pushing for the surgery against the patient’s desires?
- Post-surgery patient attitude: Will the patient be able to adhere to a post-operative regimen?
Dr. Phil recently had the topic of teenage cosmetic surgery on his show. The patient who was on the show wanted a breast augmentation and it was evident from watching the show that this patient had significant psychological issues. It reinforced in my mind that dealing with cosmetic surgery issues with adolescents is as difficult a problem as dealing with many of the issues with adolescents, take it from a father of four.