Doctors Approach Teenage Cosmetic Surgery with Kid Gloves

Today's teenager is an assemblage of current fashion and the newest technology: stylish fitted jeans, tight polo shirt, coach purse hanging from the left shoulder with color coordinated cell phone and iPod inside.  So when fashionable appearance meets technology in the medical world is it really that surprising to see a teenage presence?

A Look at the Numbers

Plastic surgery for teenagers is certainly not a new thing.  For years, 17 and 18 year olds have been getting nose jobs as graduation gifts.  But as the trend continues and media coverage heightens, the focus on teenagers seeking plastic surgery has increased, but saying that Americans are seeking cosmetic surgery at a younger and younger age isn't exactly right.  Sure, the amount of nose jobs performed on teenagers has risen from 4,311 in 1994 to 42,513 in 2003 according to American Society of Plastic Surgeons (ASPS) statistics, but compared with procedural totals, that is about 12% for each year.  In fact, the percentage of teenage patients compared to the total has stayed about the same throughout that time period: about 3 to 4%.

The total number of cosmetic procedures performed on teenagers and children (18 and younger) in 2003 was 331,886.  Leading the way were chemical peels with just over 126,000, and one procedure, otoplasty (ear surgery), was more prevalent in this age group than in all of the others combined.  Of course, ten years ago the number for this age group was just a fraction of what it is, but across the board numbers have risen dramatically.  The 2003 total for all age groups was 8,793,943, dwarfing the 1994 total of 364,398.

Accepting Teens

As a society we have become more accepting of cosmetic enhancements.  Just turn on the television almost any night during primetime and you can find a makeover show or see a feature on plastic surgery on the local nightly news.  In addition, technology has changed, there are more available options, and procedures are safer.  This does not mean that plastic surgery is for everybody, and it is certainly not for many teens, especially those that are still growing.

Most surgical organizations, like the ASPS and the American Society for Aesthetic Plastic Surgery (ASAPS), place an age minimum of 18 on breast augmentations unless it is for strictly reconstructive purposes.  For all other procedures, however, there is no such mandate, which means patients should be informed of possible complications, and it is up to the surgeon to choose which hopeful patients will make good candidates for surgery.  For most surgeons, 16 or 17 is not an unreasonable age for many procedures, but each decision must be approached on a patient-by-patient basis. Physical maturity plays an important role in this decision, which is why girls can typically have surgery at a younger age than boys; their bodies develop faster.

Pushy Parents, The Uninformed Patient and Other Factors

Aside from physical restrictions, doctors have to weigh a lot of different factors when choosing patients for surgery.  Chicago plastic surgeon Dr. Sam Speron says that he can't think of a scenario in which he would perform cosmetic surgery on anyone under the age of 16.  In addition, any teenage prospective patient that comes in to his office will receive more attention and a longer consultation time in order to ensure surgical success.  Of course many hopeful clients he has to turn away.  Some just don't have realistic expectations, he says, while others are obviously being pressured in to surgery.  No, not pressured by schoolmates judging popularity by physical appearance: by their parents.  "As high as a third of patients" fall in to this category according to Dr. Speron.  He says that in many instances, parents will find a flaw with a particular aspect of their child's appearance, while the young man or woman is not bothered by it at all.  In many cases he has to tell the parents to quit interrupting and answering questions directed toward their child, and eventually finds out that the child has no interest in the surgery at all.  These types of cases don't make good patients. 

Patient Selection

So how do you ensure a patient that is pursuing surgery with understanding and realistic intentions?  Dr. Speron uses a few different methods.  First, he schedules an hour-long consultation with all teenage patients, and will often have a secondary or follow up consultation just before surgery.  He shows the patients pictures and discusses their options and what they expect to get out of the surgery.  After that they have an eight-page permission form to read through.

Teens can often be more physically and emotionally fragile than older patients, and sometimes don't look into the future with any sort of realism.  "Not now" is oftentimes a good response to youngsters that don't quite know what they are getting in to, and with the backing of the ASPS and the ASAPS, who has actually developed an initiative on how to handle teenage patients, it is something most all surgeons are comfortable doing.  However, with the right sort of patient selection and preparation, Dr. Speron says that teens are as happy and comfortable with their surgery post-operatively as any other age group.  "Success depends on the doctor and how much time they spend with the patient."