Teen Plastic Surgery: Special Report

By Denise Mann; reviewed by Peter Fodor, MD, FACS

Is teen plastic surgery a good idea?

Recent media reports have suggested that teen plastic surgery procedures are topping many high school grads' wish lists.

Teen Plastic Surgery Statistics

Although teens make up just 2 percent of cosmetic surgery patients in the United States, these numbers have increased, according to the American Society of Plastic Surgeons (ASPS).

Is this a good thing?

It can be, depending on the circumstances.

The Rationale Behind Teen Plastic Surgery

Unlike adults who undergo plastic surgery to turn back the clock, teens sometimes crave plastic surgery to fit in. They may think a new nose will make them popular beyond their wildest imagination. Such unrealistic expectations about the surgery and its effects on their life can set teens up for major disappointment.

For these reasons, most board-certified plastic surgeons will spend a lot of time interviewing teens to make sure they are emotionally mature enough to handle the surgery, are doing it for the right reasons and have realistic expectations regarding its outcome.

The plastic surgeon may also rule out some teens who have a psychological problem known as body dysmorphic disorder (BDD). People with BDD falsely believe they are unusually ugly. They may home in on a perceived facial flaw or other perceived defect in their body. BDD is best treated by a mental health professional, not a plastic surgeon.

There are, however, some unscrupulous plastic surgeons who may capitalize on a teenaged girl who is obsessed with her appearance or whose parents are intent on having "the perfect child."

This is not to say that there are not good teen candidates for plastic surgery procedures. Some teens can gain self-esteem and confidence when certain physical problems are corrected surgically.

What Kinds of Teen Plastic Surgery Are Appropriate, and When?

Some cosmetic surgery procedures, such as rhinoplasty, may be appropriate for teens; others, such as breast enlargement, may not be. Different parts of the body mature at different ages. For example, a nose job should be considered only after the nose has finished developing. Typically this occurs by age 13 or 14 in females and 15 or 16 in males.

Otoplasty (ear pinning) may also be appropriate. Ears are fully developed when children are young, and otoplasty can be done as early as 4 or 5 years old. In contrast, the chin is not fully mature until a woman is 18 and a man is 21.

Plastic surgeries that can be appropriate for teens include the following.

  • Rhinoplasty
  • Otoplasty
  • Breast reduction. Overly large breasts can cause emotional and/or physical pain. In fact, many teens complain of shoulder, back and breathing problems due to overly large breasts. Some may even be ridiculed by their peers. This surgery may be appropriate for females as young as 15.
  • Breast asymmetry. Uneven breast size and development can be corrected with surgery. Many doctors advise waiting until the breasts are fully developed. This may be appropriate for females as young as 15.
  • Gynecomastia. Abnormally large male breasts may disappear at the end of puberty, but surgery can correct it in some cases. Surgery is usually an option if gynecomastia has been present for more than two years or if the problem is severe.
  • Another option for treating gynecomastia, breast asymmetry and bilateral breast reduction in teens may be lipoplasty-only breast reduction, which uses liposuction to reduce or even out breast size.
  • For teens with acne, microdermabrasion can remove the upper layers of the skin and improve skin irregularities. This can also help remove acne scars.
  • Chemical peels can unblock the pores, open blackheads and whiteheads and stimulate new skin growth among teens with acne.
  • Laser hair removal can also be OK in the right teenager with unwanted hair.
Only certain kinds of plastic surgery are suitable for teens; and even then only if the teen is emotionally mature.

Teen Plastic Surgery Procedures to Avoid

Plastic surgeries not generally recommended for teens include the following.

  • Breast enhancement with saline-filled breast implants are indicated only in women who are at least 18 years old, as the breast may still be developing. Some exceptions to this rule include congenital errors (conditions the teen was born with), trauma or disease that may require breast reconstruction. Silicone-filled breast implants are FDA-approved for breast augmentation only for women 22 and older, but for breast reconstruction in women of all ages.
  • Liposuction is not usually recommended for teens, as they may lose baby fat with age. It may, however, have a role in spot reduction in select teens who have tried diet and exercise without success. In these cases, liposuction may remove fat pockets from localized areas of the body. It should not be used to treat general obesity among teens, nor is it ever considered a substitute for diet and exercise.
  • Certain severely obese adolescents may be candidates for weight loss surgery. Such patients may ultimately need body contouring surgeries, including liposuction, to get rid of excess skin that can result from dramatic surgical weight loss.
  • Cheek implants may not work well to enhance a teen's appearance, because facial features may still be developing.
  • Botox and other injectables are approved only for people at least 18 years old. As most of these products are designed to get rid of wrinkles that occur with advancing age, younger people are less likely to benefit. But that does not stop them. According to the American Society for Aesthetic Plastic Surgery, 8,209 people 18 and younger received Botox injections in 2007, and 2,702 received injections of another filler known as hyaluronic acid. Others may seek injections to plump up their lips.

Teen Plastic Surgery Risks

All surgeries have risks. Surgery involves anesthesia, which can be risky. In addition, wound healing can be painful and does not happen overnight.

These risks may increase if a child or teen is obese. A new study from the University of Michigan Health System found that obese children are much more likely than normal-weight children to have problems with airway obstruction and other breathing-related functions during surgery.* An estimated 15 to 17 percent of children and adolescents in the United States are considered obese.

Is Your Child or Teen a Candidate for Plastic Surgery?

There are several important questions parents must ask themselves and their children or teens before deciding on teen plastic surgery, according to ASPS. They include:

Who desires the plastic surgery? The answer should be the teenager, not the parents, peers, boyfriend or girlfriend. It is the teen who must be 100 percent committed to the change.

Is your child realistic about the benefits of the surgery? Some teens may think a nose job will change their life. They may imagine this new look will bring a new set of friends and more social options and outlets. While the correct procedure in the correct teen may bring about positive changes in self-esteem, teen plastic surgery does not guarantee a fairy-tale ending.

Can your teen handle the recovery and healing process? It can be intense and painful.

Questions that a board-certified plastic surgeon may seek to answer include:

Is your teen emotionally and cognitively mature? The surgeon needs to determine that your child understands what will and won't happen before, during and after surgery.

Is your teen physically mature? Different parts of the body mature at different ages.

Is your teen's concern consistent or fly-by-night? The surgeon needs to make sure that your teen isn't looking to correct her nose one day, then her ears the next. If what she is dissatisfied with keeps changing, it usually indicates underlying problems.

About the Reviewer of This Article

Peter Bela Fodor, MD, FACS, of Los Angeles, is an internationally recognized leader in the field of aesthetic plastic surgery and is highly respected by the profession as a surgeon, teacher and author. Dr. Fodor is associate clinical professor of plastic surgery at UCLA Medical Center. He lectures and performs live surgical demonstrations nationally and internationally.

After graduating from the University of Wisconsin Medical School, Dr. Peter Fodor completed his general surgery residency at New York's Columbia University and his plastic surgery residency at St. Luke's – Roosevelt Hospital. Dr. Fodor maintains hospital staff privileges at UCLA Medical Center, Century City Doctors Hospital and Olympia Hospital, all in Los Angeles, as well as at St. John's Hospital in Santa Monica, Calif. He is board-certified by both the American Board of Surgery and the American Board of Plastic Surgery.

*The study, reported in Anesthesiology (see below), was not conducted on children undergoing cosmetic surgery.

Sources:
Fodor PB. Pediatric Aesthetic Surgery. Pediatric Basics, 1991; 56:9-12
The American Society for Aesthetic Plastic Surgery, Cosmetic Surgery National Data Bank Statistics, 2007
The American Society of Plastic Surgeons. Briefing Papers: Plastic Surgery For Teenagers
Tait AR, et al. Incidence and risk factors for perioperative adverse respiratory events in children who are obese. Anesthesiology, March 2008, Vol. 108, Issue 3
Fodor PB. Aesthetic rhinoplasty in early adolescence. Aesthetic Plastic Surgery, 1988; 12:207-216
Matarasso A. Suction mammaplasty: The use of suction lipectomy to reduce large breasts. Plastic and Reconstructive Journal, 2000; 105:2608-2610