Teen Plastic Surgery
“Doctor, make me beautiful”, said the 15 year old.
An alarming trend in the United States is the increase in teenage plastic surgery. It has always seemed like children are in a rush to grow up. They have role models that they “grow up” with, young actors and singers featured in movies and regular television shows. Some of these young stars have best selling (or downloaded) records on the pop charts. These fast living “beautiful people” are roll models, whether they like it or not.
Keep in mind, if you ask a teenager if she is happy with the appearance of her body, 80% will say no. If you ask those same people in their college years, 80% will say yes. Age 12 through 20 is a volatile few years for attitudes and self-image. Doing too much too soon may be a mistake that lasts a lifetime. On the other hand, denying someone a surgery that can make their outsides match their insides, make them more comfortable with themselves, help them become who they were meant to be in these formative years must be considered. Guidance has to come from two main sources here: the parents and the doctor. That’s why choosing an experienced, ethical surgeon is a must.
So in consultation, I am faced with a teen-aged patient who is tormented with something he or she feels is “off” with their looks. It isn’t uncommon for tears to flow with a crescendo of emotions. The youngster’s parents are in attendance, being as supportive and non-judgmental as possible. And I become the deciding vote, which is a position of huge responsibility. So I think about it a lot before I even go in the room. There are so many variables, that I have no hard and fast rules. I try to have an open mind about the following three factors: 1) Age. 2) Family support structure. 3) Type of surgery.
Age. Is fifteen too young for breast implants? Absolutely. Is it too young for a nose job? Maybe. Is it too young to have your ears placed back or have a conspicuous birthmark removed? No.
Breast implants are a life long decision. There are just way too many body and emotional changes in the next few years to advise breast implant surgery on a teen. The few people I have seen ask for it in the teenage years were mentally and emotionally poor candidates for surgery (at any point). Often the children of plastic surgery obsessed mothers, these young ladies have no reasonable role model and are probably in for a life of dysfunction. I want no part of that. The best thing I can do for such a young woman is tell her, “No”. It may be the first time in her life she has heard it.
When faced with a teen who wants a rhinoplasty (nose job), I study the face. Some teenage faces are quite mature. Facial bone structure is set, the baby fat has gone away. Often these young girls are models or actresses and could easily be mistaken as quite a bit older. If her attitudes and expectations are as mature as her appearance, and the rest of the picture is in order (see next topic “support”), and I am comfortable with the surgical/aesthetic goals, I might do it.
Congenital defects are in an entirely different league. Ears that stick way out are prime examples. Such children are often the targets of merciless teasing. They are sometimes raised in a family in which everyone has already had the procedure (surgery) done. One of my most memorable patients was a little boy of 10. As he sat across the desk from me, I could only see his head. He calmly, eloquently and concisely described his motivation for wanting the surgery, what his expectations were. All the while, his parents sat quietly behind him, appropriately beaming with pride. He got his surgery and probably went on to great things.
Birth defects, conspicuous birth marks or trauma reconstruction fit into the same category. As early in life as the patient can have a good result, they should have the option of surgery if they want it. Yes, by that I mean that even in the pre-teen years, surgery is a reasonable option.
Support. Family support and a normal (whatever that is) support structure from the family. If there is a hint of dysfunction, like strange attitudes about plastic surgery or relationship issues, I pull back when it comes to recommending surgery. Absent parents or those who are all too present and overbearing are red flags for me. If the parents’ attitudes about plastic surgery are mainstream, I feel better about doing the surgery. When the parents appear to be plastic surgery obsessed themselves, I become way more reluctant to perform the operation on their kids.
The operation. By this, I mean the type of surgery impacts what age at which I am willing to do it. As I alluded to above, teen is too young for breast implants. I am not even in favor of doing it at 18 in some patients. But breast reduction is another story.
Unlike the desire for larger breasts (breast augmentation), women with huge breasts are being held hostage by their own bodies. They cover up, avoid athletics, and often shun relationships. They feel conspicuous and embarrassed most of the time. The surgery frees them. It allows them to be the outgoing fun people they are inside. As long as my patient is in the later teen years and the breast growth seems to have stabilized, I will offer the surgery if the support system is there.
Liposuction is another story. Body sculpting such as liposuction isn’t for teens. Fat distribution can be altered by exercise and diet. Someone so young hasn’t had time to explore all the possibilities. This is one of those times that surgery is a last result and should only be done on someone in their 20’s.
So when the fifteen year old says “Doctor, make me beautiful!”, I sit back, keep an open mind and listen. Sometimes I say “Let’s let nature take it’s course.” Other times it’s “Lets give nature a little help”.