Tips for Parents & Teens Considering Facial Aesthetic Surgery
Article by Donn R. Chatham, MD
Louisville Facial Plastic Surgeon
Teenagers have body self-esteem and functional issues just like adults, with a desire to look their best. However, the pressures to look good, feel attractive, and not be “too different” are usually more intense since peer pressure is strong, bodies are maturing but ego strength is not yet strong in many young people.
The following information is designed for parents of teens as well as teens to help with pre-consultation understanding of some of the issues that will determine success versus a not-so-positive experience for a teen considering an aesthetic surgical procedure.
A. Examples of cosmetic facial procedures
1. Traumatic nose/disproportion nose: this may involve both cosmetic and functional (breathing) issues, and surgery to improve these problems seems to be greatly appreciated, allowing the teen to both look normal and function better.
2. Acne scarred skin: the bane of many teens, acne can cause intense stress, which in turn worsens acne, and then often is worsened by scarring. Efforts to reduce acne and soften scars can make a major psychological improvement in self- esteem. Microdermabrasion can sometimes help with active acne (as can a number of medical therapies). An actual “dermabrasion” is sometimes used to smooth acne-scarred skin.
3. Receding chin: sometimes a weak chin suggests a weak personality, and when coupled with a large nose the profile seems out of harmony. Improving a teen’s profile with an implant can improve self -esteem.
4. Hyperhidrosis (excessive sweating): profuse perspiration, especially during social situations where this is not expected, creates great embarrassment and stress. When not controlled by traditional means (antiperspirants) it can be reduced by Botox injections which act to reduce sweat gland activity for several months.
5. Traumatic scars: few people desire an unattractive scar including teens. Whether from a fall, burn, automobile accident or dog bite, it is important to do everything possible to reduce the size and severity of the wound and scar.
6. Protruding ears: when ears stick out more than the ears of most of one’s peers, some kids are ridiculed, and then try to hide the ears under their hair. Otoplasty is the procedure designed to reposition ears to a less conspicuous position. This has the widest age range, from age 5 to older.
There are other body image issues that may relate to excess weight or breast size, but these areas are not in the realm of facial plastic surgery.
B. Development issues
7. Physical maturation: most boys continue to grow until about age 18-19 and most girls until age 16-17. Operating on a still-growing and developing teen risks having physical changes affect the outcome even some time after surgery. Some studies have shown that body image improves as the teen matures, and is higher among 18 year olds than it is with younger teens. So sometimes body image self- corrects with or without surgery.
8. Psychological maturation: teens mature emotionally at varying rates, and those who seem able to grasp some of the psychological aspects of cosmetic surgery will do much better with surgery and the ultimate physical changes the surgery produces. Surgery creates not only physical discomfort but also emotional distress. All patients, including teens, need to possess the emotional reserves and have parental support to cope with this temporary increased stress. So those who are already struggling with life and emotional issues may not be ready to take on additional stresses.
9. Age: while the chronological age of the teen is important, just as vital is the “emotional age” and “perceptive age.” This separates those who understand what is happening from those who do not.
10. Impulsivity: some teens make impulsive decisions, sometimes based more on emotions than reason. Usually there is no real rush to surgery, and a careful methodical approach usually is beneficial. A teen who has a history of making impulsive decisions (illegal drug use, body alterations with tattoos and piercings, unprotected sex, inappropriate alcohol use, for example) may be more at risk of making a spurious surgical request.
C. External influences
11. Peer pressure: while there are many reasons that a teen might request cosmetic surgery, and most of us just want to look average (although an “attractive average” is even better), it is important for them to understand that neither happiness nor social acceptance can really be produced from cosmetic surgery. There can be no denial that society rewards those who are pretty, handsome and young. In my opinion, one understandable but sometimes misguided malady is the pressure for girls to be sexy enough to attract the “coolest” guys. While surgery can help boost self esteem, it is equally important that teen girls hear the message that they possess great value apart from their physical beauty.
12. Parental support: it is important for a teen patient to be able to openly discuss the pros and cons of a procedure not only with the surgeon but also with their parents. Ideally parents are supportive and insightful. But sometimes parents can act as barriers or even create more stress and problems for their children if not in tune with how they feel. Another side to the coin is the parent who wants their child to undergo an elective surgical procedure but the teen has no desire to do so: here the doctor generally should discourage surgery.
13. “Star power”: Fame, Hollywood, and sex all are powerful forces that can influence and even seduce vulnerable teens who may want to emulate the appearance and behavior of their show-business idols. Not all of these famous people are healthy role models and parents play a pivotal role in healthy decision- making.
14. The “retail experience”: in today’s world, medicine sometimes is presented as something easily purchased at a mall, shopping center or spa. Cosmetic services are sometimes trivialized and it is not uncommon for non-medical people to offer medical procedures (lasers, Botox, Fillers, skin care), creating a very casual atmosphere. Teens need to be reminded that surgery involves more than a trip to a glitzy spa-like facility, on a level with manicures, tanning beds and waxing. There are serious complications that can occur, even when performed by well-trained surgeons. And if a teen does not really like their new look, it is not like the purple hair they find remorseful: surgical results do not fade away.
D. The physician
Physician suitability: One of the most important factors in successful surgery with a teen patient is the discernment and judgment of the surgeon. In addition to necessary surgical skills, the wise surgeon knows when to refuse surgery as well as to take on requests from teen and non-teen patients alike. An experienced board certified facial plastic surgeon with good people skills is key during the first consultation.
It seems wise for a parent to trust their child’s face and health only to those with whom there is complete confidence. By a commitment to understanding the goals and needs of the teenage patient, and by keeping the health and well being of that patient at the forefront, the wise surgeon will usually make the right decision.