Should I let my child get plastic surgery?

By Dr. Gregory A. Buford / genConnect

The issue of how young is too young for plastic surgery has been around for years. And while there are proponents on both sides, clearly there is no easy answer. Like their adult counterparts, while not every teenager is a good candidate for surgery, some are and so the challenge is in determining not only which patients are appropriate but also which procedures should be performed in this age range.

Most people would agree that surgery to fix congenital defects (such as cleft lip and palette) has its place and is appropriate. But the question remains whether it is ethical to perform other procedures that are more cosmetic in nature at such an early age. In evaluating a teenager for surgery, the American Society of Plastic Surgeons (ASPS) suggests that the following conditions be met:

• The teenager initiates the request. Like an adult, the teenager him or herself should be the one person initiating the request for surgery and the desire for surgery should not be the result of an overzealous parent or other family member.

• The teenager has realistic goals. Again, just like their adult counterparts, the teenager should be able to comprehend what can and cannot be accomplished with the procedure in question, as well as both the short and long-term ramifications. Unrealistic expectations are the bane of plastic surgery in general and definitely need to be addressed in all populations but especially in the younger patients who may not be able to decipher fact from fallacy.

• The teenager has sufficient maturity. The potential teenage patient must be mature enough to understand any associated discomfort, downtime, and short-term effects of the procedure in question. In addition, they should be as stable as possible and not be prone to mood swings, erratic behavior, or currently known to abuse drugs or alcohol.

According to ASPS statistics, nearly 219,000 cosmetic plastic surgery procedures were performed on people age 13-19 in 2010.

With that said, even with the aforementioned conditions met, it doesn't mean that a teenager will be guaranteed to be a good candidate for all procedures. One factor to keep in mind is that the teenage body is developing during these years and so some of the issues they may be looking to address may actually address themselves naturally as their bodies grow and change. As such, the more commonly performed procedures during the teenage years include the following:

• Rhinoplasty (nose reshaping). Plastic surgery for the nose can safely be performed around age 15-16 in girls and a year later in boys when the nose has come close to reaching its adult size. The surgery can address a crooked nose, a bump/hump on the nose, reshape the nasal tip, and help open nasal passages to improve breathing. According to ASPS statistics, in 2010, nearly 35,000 patients from the age of 13-19 underwent this procedure making it one of the most popular plastic surgery procedures performed in this age group.

• Otoplasty (ear reshaping/pinning). Surgical correction of protruding or misshapen ears can be safely performed after the age of five. In 2010, nearly 8,700 otoplasty procedures were performed in this age group.

• Correction of Breast Asymmetry. For young girls with significant asymmetry of one breast, correction can make an enormous difference in their ability to wear a bra but can also have a tremendously positive impact on their overall self-esteem. To address asymmetry, one or both breasts may undergo operation by either reduction (of the larger breast), augmentation (of the smaller breast), or potentially a combination of both.

• Breast Augmentation. Current FDA stipulations require that saline implants be used for women 18 years or older. However, many physicians offer both saline and silicone gel implants to their clients with the understanding that their use in this situation, while safe, is considered to be an off-label use of the implant(s). There are several concerns with breast augmentation in younger patients. First, breast development is known to occur until the early twenties, and so some of these women may actually continue to grow and, left without an operation, may eventually develop to their desired cup size. Next, there is some concern that the surgery itself may interfere with normal breast development. However, with proper counseling and careful patient selection, many women in this age group achieve results that they are very happy with for years to come.

• Breast Reduction. According to ASPS statistics, in 2010, more than 4,600 women in the age range of 13-19 underwent breast reduction. For many of these women, surgery was incredibly successful at helping them achieve relief from symptoms such as back pain, bra strap grooving, and other symptoms associated with larger breasts.

• Acne and Acne Scar Treatment. As many of you know, both acne and acne scarring can be tremendously disturbing during the teenage years. As such, control of not only active acne but also its long-term sequelae can produce very positive results in the patient population. Again, according to ASPS statistics, in 2010, teenagers underwent 19,500 laser skin resurfacing procedures, 5,500 chemical peels, and 3,000 dermabrasions.

• Male Breast Reduction (Gynecomastia). Gynecomastia, while poorly understand and most likely under-diagnosed, is a condition that is actually very easily treated. The most common procedure includes a combination of liposuction and glandular resection and is generally associated with minimal downtime and very positive results.

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In my opinion, there is no right or wrong side to the argument of teenage plastic surgery. Instead, there are different shades of grey and so all cases should be evaluated on an individual basis. To say that all potential clients mature at age 18 is simply a fallacy. Like their adult counterparts, teenagers need to be evaluated carefully and thoughtfully, and expectations need to be assessed prior to moving forward with any procedure. When plastic surgery is used for the wrong reason, at the wrong time, and for the wrong person disastrous results can ensue. However, the right procedure performed for the right reasons for the right patient can yield powerfully positive results for years to come and effectively be life-changing.

Dr. Gregory A. Buford is an internationally-renowned plastic surgeon and author of Beauty and the Business: Practice, Profits and Productivity, Performance and Profitability. His practice is based in Denver, CO. Visit Gregory A. Buford's Website.

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