The latest American Society of Plastic Surgeons (ASPS) statistics suggest that cosmetic surgery, in general, is increasing in the 13- to 19-year-old age category. But as a cosmetic surgeon, when do you say “yes” to these young patients and when do you say “no”? Two experts offer their advice.
Dr. FagienBoca Raton, Fla., oculoplastic surgeon Steven Fagien, M.D., says he understands the dilemma that surgeons have when it comes to performing cosmetic procedures on teens.
“It depends what you mean by cosmetic surgery. For, a teenage girl or boy interested in a rhinoplasty because they haven’t liked their nose since they were old enough to figure out their body image, that’s ok,” Dr. Fagien says. “The question is when you’re extending beyond congenital or familial traits that are undesirable, do you really need cosmetic surgery when you’re not old enough to sign your own consent?”
Teen Cosmetic Trends
The 2014 ASPS statistics show that procedures among teens on the rise include breast reduction in men, dermabrasion, liposuction, botulinum toxin type A, chemical peels, laser skin resurfacing and hyaluronic acid fillers. Some procedures that appear to be on the decline in this age group are breast augmentation, mentoplasty, otoplasty, blepharoplasty, rhinoplasty, microdermabrasion and collagen fillers, which dropped 63% from 2013 to 2014.
Dr. DavisSteven L. Davis, D.O., a plastic and reconstructive surgeon in Cherry Hill, N.J., says he isn’t surprised by the 2% drop in breast augmentations among teens.
“What we’re seeing is a trend for a lot of young girls who have matured too quickly or have asymmetrical breasts to get breasts lifts or breast reductions. I think it’s a movement toward becoming more lean, tight, athletic and perky; less big chested,” Dr. Davis says.
The demise of collagen as a filler is no surprise either because it’s not easily reversible, says Dr. Davis, an assistant clinical professor of surgery at Rowan University School of Medicine, Glassboro, N.J.
“Hyaluronic acid fillers are definitely going to be the winner in that category, especially for kids. They’re reversible, as opposed to calcium hydroxyl appetite, fat and polylactic acid — all of those are difficult to make go away,” Dr. Davis says.
Even the number of surgical rhinoplasties might be affected by a surge in hyaluronic filler use among teens. With hyaluronic acid fillers, physicians can perform nonsurgical rhinoplasties, according to Dr. Davis.
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When to Say ‘Yes’
In cases where a surgical or more permanent procedure is involved, Dr. Davis uses a risk-benefit ratio to determine with the patient and parents if it’s worth having the surgery, knowing, for example, in the case of breast surgery, that the patient will be left with scarring and her breasts might very well change again if she becomes pregnant and breastfeeds.
The frank discussion needs to be with the patient, parents and anyone else who is a person of influence in that child’s life.
“You don’t want to get involved in a potential problem where someone in the family is really very upset about it,” Dr. Davis says.
The most important thing for plastic surgeons to keep in mind with teen patients, according to Dr. Davis, is to make sure the patients are mature enough to have the procedures they want. The surgeon also should analyze whether a patient might grow into the changes they want. For example, boys who want breast reductions might have fat that will naturally diminish in a few years, according to Dr. Davis.
“Often these men in their teenage years are so young that we really do want to give it time… because some of that fat will burn off, and, if it does, you’ve saved them from having to have surgery. But if they appear to have matured, and their chest still looks feminine, that’s where we want to intervene, before they have too many social issues,” Dr. Davis says.
According to Dr. Davis, typical comments from girls who may be good candidates for breast reductions include they:
- Don’t want to be viewed in college as the girl with big breasts.
- Don’t want to have to wear clothes to downplay their breasts.
- Want their breasts to better match their bodies.
Dr. Davis says he also often encounters young patients whose breasts are genetically so droopy that they look like they’ve already been through multiple pregnancies and decades of life.
“I have to tell you, the majority of those patients along with their parents can’t wait to have that operation,” Dr. Davis says. “Knowing that all we’re going to be doing is cutting away skin to make things look tighter and perkier is a home run for those girls. It’s a whole new world for them.”
Dr. Fagien also believes that it makes sense to operate on children severely affected by body image concerns because of their noses, chins or ears, for example. Because of their looks, they might be ashamed, become introverted or constantly embarrassed. Dermabrasion or other procedures to address acne scarring or blepharoplasty to treat inherited eye puffiness are other good reasons for cosmetic surgery during the teen years, according to Dr. Fagien.
“I’ve had situations where I’ve operated on very young girls who always had puffy lower lids. I have done blepharoplasty for a few of those patients, and it changes them, because they were insecure, embarrassed. People asked them if they were tired,” Dr. Fagien says. “The good news is that young men and women usually don’t need very much because their skin is perfect; so, you take out a little fat transconjunctivally and they look dramatically transformed.”
NEXT: A Difference of Opinion
A Difference of Opinion
Still, Dr. Fagien says he encourages all teen patients to wait until they’re 18 and can make the decisions about cosmetic surgery on their own, without their parents’ consent.
If they insist and Dr. Fagien agrees to do the surgery, he says he makes sure the teen is aware of the reality of what’s about to happen.
“Usually parents want to protect their children. Let’s say a child needs a necessary surgical procedure for [an illness]. It’s understood that the parents would give consent, and the child is somewhat kept out of it in order to alleviate fears. The game changes for cosmetic surgery. Because this is something obviously that the child wants, I think the child should be involved even though they may have to have a co-signature or a signature with consenting adults.”
Dr. Davis says he is not as concerned with the risk-benefit ratio for non-invasive, reversible procedures. Even in the case of Botox for teen patients, he says, the teens might have valid reasons for wanting the procedure.
“Most of the older teenage girls that come in for something like Botox are coming in because they’re trying to prevent the look that they see that’s coming down the pike — the look they see in their parents,” Dr. Davis says. “That’s when we talk about using a little Botox in that area over the course of many years, so they won’t be able to put that crease in their skin, which will also make it so they don’t have that look.”
Dr. Fagien, however, says he has a policy against doing injectables in teens for purely cosmetic reasons.
“I have patients who bring their kids (the mother has had cosmetic surgery for years) and the 15-year-old wants her lips injected,” Dr. Fagien says. “I don’t do it. My philosophy is if the patients can’t sign their own consent for something like that, they should wait until they’re 18.”
