There is no question that reconstructive surgeries can benefit children and youth. Surgical procedures to correct cleft lips and palates, for example, are not controversial.
Teenage Cosmetic Surgery Debate
Plastic surgery to correct unattractive facial features that can attract ridicule from other children, such as prominent noses and ears, are generally accepted in the United States. Cultural phenomena such as surgical makeovers on numerous television programs, however, make it increasingly difficult to agree on what constitutes a "normal" appearance and when the desire to improve one's appearance is questionable or even crosses the line to psychopathology. In this commentary, I will focus on elective, cosmetic procedures on an otherwise healthy adolescent with no illness or defect.
Plastic Surgery in a Developing Teen
One of the concerns about plastic surgery on adolescents is that their bodies are still maturing. In addition to development that may occur in the late teens, growth charts indicate that the average girl gains weight between the ages of 18 and 21, and that is likely to change her desire or need for breast augmentation as well as liposuction. There are no epidemiological studies or clinical trials on the safety and long-term risks of these procedures for adolescents. Although the FDA approved saline breast implants for women ages 18 and older, it is legal for physicians to perform breast augmentation for anyone under 18 as an "off-label" use, and the number of teens 18 and younger undergoing breast augmentation tripled from 2002 to 2003. It was not until December 2004 that the American Society of Plastic Surgeons stated an official position against breast augmentation for patients under 18.
Understanding the Risks of Surgery
Will adolescents who want to improve their appearance rationally consider the risks? Studies by implant manufacturers report that most women have at least one serious complication within the first 3 years, including infection, hematomas and seromas, capsular contracture (a sometimes painful hardening of the breasts), loss of nipple sensation, and hypertrophic scarring. Since breast implants typically last 10 years, an adolescent will require repeated surgeries throughout her lifetime . Breast implants also interfere with mammography and increase the likelihood of insufficient lactation when a woman tries to breast-feed.
The economic costs of surgery are substantial, since corrective surgery is rarely covered by health insurance. With many plastic surgeons offering breast implants on the installment plan, our Center (National Research Center for Women and Families) is contacted regularly by young women who need to have a broken or painful implant removed but are still paying for the initial augmentation surgery and unable to afford corrective surgery.
Liposuction also carries potentially serious risks. Primary risks include infection, damage to skin, nerves, or vital organs, fat or blood clots (that can migrate to the lungs, leading to death), and excessive fluid loss that can lead to shock or death. In addition, the different techniques are associated with complications such as skin or deep tissue damage, lidocaine toxicity, and fluid accumulation in the lungs.
The long-term physical, emotional, and economic sequelae of many popular cosmetic surgeries, including implants and liposuction, are unknown. Despite the documented risks, the general public has an inflated sense of the benefits and a minimized sense of the risks of plastic surgery . Teenagers are often oblivious to the well-documented long-term health consequences of smoking, tanning, and other risky behaviors, and are likely to pay even less attention to the risks of cosmetic surgery, making informed consent difficult.
In addition to the influence of persuasive and pervasive advertising and television makeover programs that stimulate demand, it is difficult for a physician to neutrally present both the risks and benefits of an elective procedure that he or she is simultaneously selling . Requiring parental consent for patients under 18 does not ensure informed consent, since research is lacking on long-term risks for many cosmetic procedures.
Screening
One way to help ensure that teenagers are mature enough to make decisions about plastic surgery is to screen potential patients using psychological testing. In media interviews, plastic surgeons often describe careful interviews aimed at determining why the teen wants plastic surgery. Unrealistic expectations or having the surgery to please a boyfriend is considered inappropriate, but having surgery so that "I will feel better about myself" or "clothes will fit better" are considered reasonable responses. By the same token, teenagers who use drugs, drive while inebriated, and have unprotected sex may also make those decisions to please themselves, and not others, so that response alone is not sufficient evidence of a mature decision. Currently, there is no evidence that effective screening is widespread.
Teen Self-Consciousness and Plastic Surgery
Teens expect that plastic surgery will improve their self-confidence, but does it? There are no empirical studies examining the long-term benefits among adolescents. One study found that body-image satisfaction improved after cosmetic surgery, but so did satisfaction among the control group, suggesting that improved body image may occur with increasing age, regardless of whether the patient undergoes plastic surgery . In fact, a longitudinal study that followed adolescents from age 11 to 18 found body image satisfaction rates were highest at age 18 in both sexes and that the satisfaction of individual participants varied as a function of their age and developmental stage . This indicates that many adolescents who are very dissatisfied with their appearance will feel more satisfied a few years later, whether or not they undergo surgery. The same study also found that the physical features with which participants were most dissatisfied reflected culturally determined stereotypes of idealized attributes emphasized in books, mass media, and advertisements.
Research indicating that breast augmentation patients are 4 times as likely to commit suicide compared to other plastic surgery patients raises questions about the mental health of the women who choose implants and the psychological benefits of the surgery. Liposuction is also of particular concern because of its association with eating disorders. The average onset of body dysmorphic disorder (BDD), defined as "a preoccupation with an imagined or slight defect in appearance that leads to significant impairment in functioning," is 16 years of age However, since the goal of cosmetic surgery is to improve and transform appearance, it may be difficult to distinguish between this desire and a pathological preoccupation .
Who decides?
Will most plastic surgeons make an accurate and objective judgment about whether a teenage girl is an appropriate candidate for plastic surgery? If plastic surgeons are performing surgeries that many physicians and psychologists would question, should medical societies and ethicists provide more guidance than is currently being provided by plastic surgery associations?
In the ideal world, informed consent would enable teens and their parents to decide carefully what is best for them. However, in the absence of longitudinal research, it is impossible for physicians to warn patients, or their parents, about the risks of performing cosmetic surgery on bodies that have not reached maturation, the operative complications and long-term physical effects of these surgeries and the psychological implications of surgery on developing body image, or the extent to which distorted body image common among adolescence may result in the pursuit of plastic surgery.
One of the most controversial topics about cosmetic surgery is if teenagers should be allowed to have cosmetic surgery done. Cosmetic surgery over the past few years have been steadily increasing in numbers and popularity due to media coverage and also due to ideals of the perfect face and body. One of the many groups which are affected by this are teenagers. During one’s teen years, people are more susceptible to what others say about their appearance. If the comments get too much then one might want to change their appearance through surgery. According to American Society of Plastic Surgeons almost 219,000 cosmetic procedures performed on people aged 13–19 years old. There are two clear sides to this topic. Some believe teenagers should be allowed to have cosmetic surgery and others believe they shouldn’t until they have more time to think about if they really wanted to change their appearance.
To an extent, the age of which one can get cosmetic surgery done is drawn legally. Parental consent is required for all surgical operations performed on patients under 18. In 2007, the FDA passed guidelines prohibiting teens under 18 into having breast augmentation. There are people who believe teenagers should be allowed to have cosmetic surgery. These people believe there is more than just getting surgery to please others it is better to do it for yourself. Jen Selter endured taunts because of her nose size. People would say she looked like a pelican and would call her butter face. Selter had rhinoplasty done at age 15. She believes that teenagers who have plastic surgery done should be about how you feel on the inside. Her getting a nose job made her feel better on the inside and outside. Many surgeons with teen patients recommend a series of at least four with a therapist before moving forward with any other precautions. This is to uncover any underlying wants of getting plastic surgery. Also to determine emotional maturity of the patient. Another argument as to why teenagers should be allowed to have plastic surgery is because it can be positive in the right circumstances. That it may not be as different as getting braces to fix crooked teeth. As long as the reason to have cosmetic surgery is responsible then it can bring confidence and happiness to a person.
The other side is some people believe cosmetic surgery in teenagers should not be practiced. One of the concerns about plastic surgery on adolescents is that their bodies are still maturing. Growth charts show most women gain weight at the ages of 18 and 21. It would likely change their desire for breast augmentation and liposuction. Another is that will teenagers ever consider the risks of cosmetic surgery. The goal of cosmetic surgery is to improve and transform appearance, it may be difficult to distinguish between this desires even with therapy sessions. These people say the general public only focuses on the benefits of cosmetic surgery and not the risks. The long term effects of plastic surgery cannot be determined. It’s natural for teens to have issues with their looks. “Their bodies are changing and they’re trying to figure out how to define themselves. Accepting how you look is part of maturing, and if d imperfections are taken care of with a knife, teens may not be learning mentally how to be comfortable with their appearance.” Should teenagers be allowed to have cosmetic surgery?
Ethics of Cosmetic Plastic Surgery in Adolescents
Appearance and deformities are important to anyone who engages in social interaction. Teens as well as adults have valid cosmetic conditions that benefit from plastic surgery. Adolescent cosmetic surgery is not new, but the topic has come to the forefront as a result of recent media attention. The most common sources of information for teens about plastic surgery are magazines and television [1]. The quick fixes on television "reality" shows can establish unrealistic expectations and distort the facts about actual plastic surgery.
Teens are often uncomfortable with their evolving bodies. Distortions in body appearance can lower self-confidence and disrupt social acceptance. This can result in difficulty with school, aggression, or withdrawal. The cosmetic procedures teens desire most to alter their appearance in ways that improve their self-confidence are liposuction, rhinoplasty, and breast augmentation [1].
A major factor when considering an adolescent patient for plastic surgery is that the patient is still growing. The body itself is maturing, decision-making skills are evolving, and social skills are forming. Every analysis for potential surgery must weigh the following:
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?
To illustrate the application of these guidelines, I will discuss several common surgeries requested by adolescents and the factors important in each.
Rhinoplasty
Rhinoplasty (nose reshaping) [2] is among the most requested surgical procedures for teenagers and, if done early, can prevent years of emotional distress. For a teenager concerned with appearance, a large or deformed nose in the center of the face gathers much attention. Rhinoplasty can be performed when the nose has completed most of its growth, which happens as early as 13 to 14 years in girls and about a year later in boys. When an unsightly nose is refined with cosmetic surgery, there can be a transformation in confidence, attitude, and demeanor.
For teenage nasal sculpture, one must evaluate the patient's purpose for surgery and ensure that the patient has realistic expectations. Enhancing the positives and subtracting the negative features are acceptable goals; trying to imitate a famous person's nose is not.
Gynecomastia: Male Chest Contouring Plastic Surgery
Gynecomastia, or female-sized breasts, is particularly distressing to males [3]. Protruding breasts can result in mockery, social avoidance, and maladaptive behavior. Although gynecomastia can occur at any age, adolescents are particularly susceptible during their hormone changes [4]. While most teenage gynecomastia resolves, that which has not resolved after 2 years typically will not. Many adolescents have stable gynecomastia problems; some have breasts that continue to grow. The problem affects each individual differently; a significant deformity can be subtle or massive in the patient's eyes. It takes very little breast tissue to make "puffy nipples" stick through a shirt or disturb a male chest contour.
Forcing a 13-year-old boy with C cup breasts to go to gym and play basketball shirtless can be cruel. The surgeon must weigh whether to perform surgery early and risk further growth or delay surgery and deal with the emotional problems due to large breasts. One must also balance the possible need for secondary surgery after further growth. I have treated many men, now independent and able to make their own decisions, who were angry that pediatricians kept saying their breasts would go away. In some of those cases, parents totally ignored the emotional stress of gynecomastia.
Female Breast Reduction
Some adolescent women suffer from massive breast size . Macromastia can result in pain from weight, awkward momentum, shoulder grooving, and social distress . An appropriate teenage breast reduction can result in an amazing transformation.
Making a teenager wait until her body further matures can be brutal. Early surgery, however, carries the risks both of further breast growth and a patient's decision about breast size that she regrets as an adult.
Otoplasty: Ear Cosmetic Plastic Surgery
Protruding or deformed ears can cause concerns for children and adolescents . Some do not want to, or cannot, wear their hair long for camouflage. Otoplasty is an option to bring projecting ears closer to the head, balance elements of the ear, or rebuild deformed components .
The ear reaches almost adult size by the age of 5. Young children's cartilage is softer, resulting in an advantage for earlier plastic surgery. Firmer adult ear cartilage may need to be weakened during surgery, a potential distortion risk that can often be avoided in younger children. Projecting ears are a typical deformity often subject to much ridicule. External ear deformities are best treated before children start social interactions.
Inverted Nipples Cosmetic Surgery
Inverted nipples can be unattractive, causing distress for some adolescents. A major factor in the decision to pursue this surgery is the patient's gender. Although duct-sparing procedures can help lesser deformities, some nipple inversion requires that the ducts be surgically divided for correction. Duct division can result in a woman's inability to breast-feed. Hence, for some women, this surgery may be better postponed until adulthood. On the other hand, for a male teenager with nipple inversion from adherent gynecomastia tissue, gland and ducts have no function. Release of this adherent tissue and the subsequent change in the patient's chest sculpture can have a major positive emotional impact for him.
Losing Weight and Plastic Surgery
Liposuction can be valuable for sculpting tissue ; it is not very useful for reducing weight. Removed fat cells are gone, but remaining fat cells can accumulate more fat. Teens therefore may better manage their weight loss by a change in habits, dieting, and exercise. Plastic surgery is better employed as a refinement tool.
In the maturing female teenager, body fat distribution is evolving. Many teens' body shape and habitus will change during the teenage years. A chubby teenager may grow in height and become a slim young adult. The degree of deformity must be balanced against advantages of waiting until the contour better defines itself.
Plastic Surgery after Massive Weight Loss
After a patient loses a large amount of weight, connective tissue fibers in the skin and fascia may be so stretched that folds of flesh remain . Although younger skin tends to shrink better than older skin, redundant folds can remain around the stomach circling around the back, the chest and breast region, thighs, arms, and neck. Plastic surgeries such as a tummy tuck, body lift, thigh lift, arm lift, or facelift are options.
For an adolescent patient, the surgeon must balance the degree of deformity against further body growth filling in the loose skin. The patient's level of emotional distress and the concern for regaining of the weight must also be addressed directly and honestly.
Navel Cosmetic Surgery
The present popularity of the bare midriff style of dress exposes the belly button, a focal point of the abdomen . For a teenager, peer pressure and clothing choice can lead to stress over the appearance of the navel. The "outie" shape of the navel bothers many patients; it is difficult to adorn an "outie" with navel jewelry. Belly button umbilicoplasty can easily convert an "outie" to "innie" navel. Unlike nasal, ear, or breast problems, camouflage by clothing is an option for this condition.
The Parents
Although parents have the legal responsibility for their adolescents, the impetus for surgery needs to come from the patient. In elective cosmetic surgery, it should be the patient who is bothered by the problem and is looking for a solution, not the parents.
Conclusion
The deformity, physical and emotional maturity, and desired outcome for each adolescent patient must be carefully evaluated before any decisions are made. Additional consultations and long discussions before plastic surgery are often merited. Sometimes, however, the real question is: is it ethical not to operate on an adolescent patient?
Most important questions and answer ask by users
Should teenagers plastic surgery?
Most teens seek plastic surgery to improve their appearance or to increase self-esteem. Teens often report that their self-image and self-confidence improves when their perceived physical shortcomings are corrected.
What are the disadvantages of cosmetic surgery?
Chance of Addiction
A grave disadvantage of cosmetic surgery is that some individuals get addicted to it. This has extreme effects on patients' state of mind as they may increase the severity of or develop Body Dysmorphic Disorder, or BDD, (whereby they continuously find faults and flaws with their appearance.)
Why is cosmetic surgery bad?
Possible complications for any surgical procedure include: Complications related to anesthesia, including pneumonia, blood clots and, rarely, death. Infection at the incision site, which may worsen scarring and require additional surgery.
How does cosmetic surgery affect society?
Studies have shown that people report increased satisfaction with the body part they had surgery on, but results are mixed on whether plastic surgery boosts their self-esteem, quality of life, self-confidence and interpersonal relationships in the long term.
Does plastic surgery last forever?
Plastic Surgery Leaves No Scars and Lasts Forever
And while many plastic surgery procedures are long lasting and can give you years, if not decades of personal satisfaction, many factors determine how long the results will last. Plastic surgery can turn back the hands of time - but the clock keeps on ticking.
What is the safest cosmetic surgery?
Minimally invasive cosmetic procedures, including fillers, neurotoxins and laser and energy device procedures are exceedingly safe and have essentially no risk of serious adverse events, reports a new study that analyzed more than 20,000 procedures around the country.
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