Dr Frances Pitsilis - Teenagers and Cosmetic Surgery: A parental must read

Every parent with teenagers contemplating cosmetic surgery should read this article. Teenagers generally lack the brain maturity and insight required to make decisions about surgery or assess risk. There are increasing pressures in our society including from peers and the media. Parents should not add to that. If a teenager wants surgery, give them support and discussion which may even include a visit to an experienced plastic surgeon recommended by your family doctor. If at all possible, ask your teenager to wait…..

In the 70's it used to be that rhinoplasty (nose job) was the most popular cosmetic surgery procedure in teenagers. Now is breast surgery.

Having cosmetic surgery is a growing practice amongst teenagers. However, there is debate about the appropriateness of cosmetic surgery in this age group and whether they truly understand the risks involved.

So much so that Queensland in recent years made it illegal to have cosmetic surgery under the age of 18years.

We will now take a serious look at pros and cons of elective cosmetic surgery for teenagers.


Statistics
In the USA 205,119 teenagers had cosmetic surgery in 2007 (was 145,094 in 2000).

Global survey by Dove® in 2005 – 25% of females aged 15-64 are considering cosmetic surgery.

Plastic surgery is becoming more acceptable in general. Parents of teenagers are more accepting of it, and its role in helping confidence.

Plastic surgeons perform Plastic and reconstructive surgery. Reconstructive surgery means that the surgeon repairs a defect that impairs normal function eg cleft palate. Cosmetic Surgery has to do with improving confidence – its surgery to improve a ‘normal’ appearance.

Many would not argue with plastic surgery in teenagers for problems such as enlarged, painful breasts, male breasts (“man boobs”) causing ridicule or large ears that need pinning back.

However, it becomes more borderline when surgery is contemplated for something that is “not liked”. The argument is that is supports the young persons growth and development when it’s the right person for the right surgery. Its now about self esteem, body image, peer pressure, and peer acceptance.

And we also know that where all else is equal, the more attractive person “ get the job” etc . Parents are anxious to give their children the best start in these matters.


What types of surgery have been popular?
In the 70’s the most common procedure performed was rhinoplasty (nose job), now its breast surgery.

In younger – mid teens, rhinoplasty is most common in both sexes. Experts think that nasal surgery should not be performed until the nose is fully grown – about 14 in girls, 15 in boys.

Breast augmentation – experts suggest not before 18yrs.

A very important aspect of teenagers’ psyche is that they vary in their emotional maturity. How well does the teen really understand the risks?


Why teenagers have cosmetic surgery.
• Peer pressure – pressure to conform
• New “ normal” in society that could be related to media images – see later
• Body Dysmorphic disorder – see later
• Depression
• Excessive perfectionism / Obsessive
• Parents had plastic surgery, so why shouldn’t they?
• Parents may be encouraging the plastic surgery
• To please someone else


How to approach a teenagers desire for cosmetic surgery.
Seek the opinion of a well respected plastic surgeon, preferably one that is recommended by your family doctor. Well trained surgeons know when a person is not ready for surgery.

Below are questionable statements in my opinion…..
“The surgery is safe: there are few significant complications”.
“Our society places a high premium on physical attractiveness and rewards those who are slender, youthful and handsome”.
“We live in a culture that emphasizes competition and legitimizes self improvement as a way to gain a competitive edge”.
“Plastic surgery lives up to its expectations”.

So, If your teenager wants plastic surgery, its best if they are the one who initiates the request. Its not a good idea for a parent to suggest surgery.

Your teenager has to be mature enough to consider all the risks and other aspects that the surgery would involve. If they eventually go ahead, they need to have realistic goals about what the surgery will achieve.


Two controversial surgeries.
They are Breast Augmentation and Liposuction. They also are more expensive.

Breast Augmentation:
• Breast implants last 10 years.
• Implant complications can include – rupture, contraction (shrinkage), leakage – all needing more surgery.
• Post operative complications can include bleeding, blood clot formation, reaction to anaesthetic, loss of nipple sensation, scarring, infection.
• Medical risks increase as time goes on after surgery – reduced lactation( breast feeding), interference with mammograms
• These patients are 4 times more likely to commit suicide compared with other plastic surgery patients – this could relate to their mental health.

Liposuction:
• Post operative risks include Infection, skin damage, damage to nerves, organs, fat or blood clots. Lignocaine toxicity (anaesthetic drug used in the fat), excessive fluid loss causing shock – possibly death.


Developmental considerations and maturity that affects surgery.
Breast development can continue after age 18. This means that is the person waits, they may not need surgery.

The average girl gains weight between the ages of 18-21 and that is likely to change her desire for breast augmentation as well as liposuction.

The process of body image begins at the pre-pubertal age – this is a particularly sensitive time, when they sensitive about what others think.

Parental approval and response determines a persons self image / self esteem, so a parent has a huge responsibility here.


The area of the brain that controls risky behaviour has not developed until age 25 years.
Research has shown that body image improves amongst teenagers as they mature, whether or not they have cosmetic surgery. Should any surgery be delayed?

The desire to have Cosmetic surgery to remove body fat diminishes with time.

Girls are more vulnerable than boys to the psychological need to conform to external pressures. The age at which the person starts to feel this is around age 11-13years.


The role of the media.
Several scientific papers have discussed this. Other psychosocial influences are – TV characters, toys, magazines, book characters.

“Curvaceously thin” young women are portrayed as desirable on TV.

The general public may have an inflated idea of what cosmetic surgery can do, and how safe it its – from Makeover programmes.

Unrelenting messages are crafted to attract teenagers to buy numerous products. Success and happiness will occur if you buy / do this etc.


Body Dysmorphic Disorder (BDD).
This condition starts around the teenage years. Seven to 15 % of cosmetic patients have this condition. A concerned parent must be aware of this condition as are cosmetic doctors and plastic surgeons.

It is defined as – “ a preoccupation with an imagined or slight defect in appearance that leads to significant impairment in functioning”.

BDD will not improve as a result of surgery. It may cause more problems eg the patient is dissatisfied with the result and may want more surgery.

Typical behaviours in BDD patients:
• Excessive concern with or distress over minor or non-existent appearance flaws - 93%
• Dissatisfaction with previous cosmetic surgery – 88%
• Unusual or excessive requests for cosmetic surgery – 81%
• Specifically noticing in others an appearance flaw – 64%
• Belief that the procedure will transform the persons life or solve all their problems – 53%
• Wearing heavy clothes or heavy makeup to hid the flaw – 41%
• Difficulty in day to day functioning – 30%
• Skin picking 23%


Long term benefits?
There are actually no long term studies examining the benefits of plastic surgery on teenagers. Studies have shown that initially people report improved self esteem, and satisfaction with the body part they had altered. But the psychological results are not maintained long term.


New Law in Queensland  2006.
It is illegal for anyone under the age of 18 to have cosmetic surgery. Teenagers must have a referral from a General Practitioner and have had counselling before seeing a Plastic Surgeon.