Teenagers and Cosmetic Surgery: What every parent must know

If your teenager is thinking about getting cosmetic surgery, you must read this. Few teenagers have the physical brain maturity and insight needed to evaluate the risks or make sound decisions about surgery.

Teenagers today are under tremendous pressure from the appearance standards advocated by the media and from pressure by their peers. The last thing they need is added pressure from their parents. If your teenager is thinking about plastic surgery, support them, discuss the matter and even go see a plastic surgeon recommended by your family doctor. If it  is possible at all, ask your teenager to wait with the surgery.

More and more teenagers have plastic surgery. In America, for instance, 205,000 teenagers had elective plastic surgery in 2007, up 40% from 2000.

Society has become much more used to and accepting of plastic surgery. Parents recognise the role plastic surgery can potentially play in improving their teenager’s confidence.

However, one can ask if plastic surgery is appropriate for teenagers and whether one can expect them to really understand the risks and consequences of such surgery.

It is telling that Queensland adopted a law in 2006 that makes it illegal for people under 18 to have cosmetic surgery. Anyone in that age group that wants cosmetic surgery must be referred by a general practitioner and must have had counselling on the matter before seeing a plastic surgeon.

For the rest of this article, we will consider particular factors for and against elective plastic surgery for teenagers.

What plastic surgeons do

Plastic surgeons perform both reconstructive and plastic surgery. Reconstructive surgery refers to operations where the surgeon repairs a physical defect that affects the patient’s ability to function normally, for instance if they have a cleft palate. By contrast, cosmetic surgery aims to improve someone’s normal appearance and is mainly about improving their self image or confidence.

Few people will argue against cosmetic surgery for teenagers with problems that cause ridicule, for instance pinning back large ears or fixing “man boobs”, or reducing  painful, large breasts for girls.
 It is widely acknowledged that, all else being equal, people who are more attractive have a better chance of getting the job they want. People may want to look better in order to have the best chance in life, and parents cannot be blamed for wanting changes that can help secure a better life for their children.

Where it becomes contentious is when the purpose of the surgery is to change something that the person simply doesn’t like about their appearance. Here the main drivers are likely to be peer pressure, self esteem and body image issues.

Reasons for cosmetic surgery in teenagers

Individuals differ, of course, but a number of reasons have been identified as common among teenagers seeking plastic surgery.

• To please someone else (even sometimes their parents)
• Peer pressure
• Media stereotypes (more about this below)
• Emulating parents who have had cosmetic surgery
• Obsessive perfectionism
• Body Dysmorphic Disorder (more about this below)
• Depression

Popular types of cosmetic surgery

Back in the 1970s, the most popular type of cosmetic surgery for teenagers was rhinoplasty, the famous “nose job”. These days, breast surgery is the cosmetic operation most teenagers want.
However, for people in their early to mid-teens, nasal surgery is still the major type of plastic surgery, for girls as well as boys. Expert opinion is that rhinoplasty should not be performed before the nose is fully grown. This usually happens at around the age of 14 for girls and a year later for boys.

Breast reduction is popular, even for boys who have problems with “man boobs” (gynaecomastia). Breast augmentation is not suggested before girls are at least 18 years old.
Liposuction to literally suck out unwanted fat is also popular.

What to do if your teenager wants plastic surgery

It is never advisable that you as parent suggest plastic surgery. The idea has to come from your child.

Remember that teenagers are not all equally emotionally mature. They have to be able to evaluate the risks and understand the consequences of the surgery.

Once matters get serious, it is crucial to consult a well-respected plastic surgeon, preferably one that has been recommended by your family doctor. Experienced, responsible surgeons will be able to tell if someone isn’t emotionally ready for the operation.

Statements such as the following need to be treated circumspectly:

• “Modern culture emphasizes competition. Self improvement is a legitimate way to gain a competitive edge.”
• “Society values physical attractiveness. People who are handsome, youthful and slender get rewarded.”
• “The operation is safe, with few or no complications.”
• “Cosmetic surgery lives up to its expectations.”

If you decide to go through with the operation, your teenager has to have realistic expectations of what this will achieve.

Facts about liposuction and breast augmentation

These are two of the most popular operations. Both are expensive and carry risks worth thinking about.

Post-operative risks of liposuction include damage to the skin, nerve or organs, blood clots and infection. The anaesthetic drug used in the fat, lignocaine, may be toxic to the body. Excessive fluid loss may cause shock and, in extreme cases, even death.

The post-operative risks of breast augmentation include reaction to the anaesthetic, bleeding, blood clots forming, scarring, infection and loss of sensation in the nipples.

Breast implants only last about 10 years. Before that, there is the risk that they can leak, rupture or shrink – all of which requires another operation to fix.

Other medical risks that can manifest over time include reduced lactation (milk production for breast feeding) and rendering mammograms problematic.

Patients who have had breast augmentation surgery have been found to be four times more likely to commit suicide than other plastic surgery patients. The reasons for this may be complex and not causally related to the surgery.

Developmental aspects that affect surgery

Body image becomes important to children in pre-puberty, usually at the age of around 11 to 13 years. Girls, especially, feel a great psychological need to fit in and conform to peer group pressure. This is a very sensitive time, when children are very concerned about what others think of them. The approval of a parent can do a great deal to improve their self-image and self-esteem in these years.

As teenagers grow up, their body image tends to improve – whether they have plastic surgery or not. The desire to have body fat removed surgically also diminishes over the years. This suggests that surgery is best delayed.

There are also purely physical aspects that can make it worthwhile to delay cosmetic surgery. One is that breasts continue to develop even after girls turned 18. If they wait, breast surgery may not be what they want at all. Also, girls usually gain weight between 18 and 21, which can affect their desire for either breast augmentation or liposuction.

Media stereotypes

Media stereotypes have been discussed in many scientific papers. Children and teenagers are especially susceptible to the influences of toys, magazines and characters in films, TV and books.

They are bombarded with advertisements that tell them that products will give them the kind of appearance that will guarantee success and happiness. Everywhere, they are presented with images of “curvaceously thin” young women who are held up as the desirable ideal.

On top of this, makeover programmes give people an exaggerated idea of what plastic surgery can achieve and not what the risks really are.

Body Dysmorphic Disorder (BDD)

This condition that affects 7-15% of people who opt for cosmetic surgery usually starts in the teenage years. As a parent, you should be aware of its existence, which is already well-recognised by plastic surgeons and other health professionals.

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

Being of largely psychological origin, surgery will not improve BDD. In fact, it may cause more problems, with the person being dissatisfied with the outcome of the operation and wanting more work done on them.

People with BDD display a range of typical behaviours:

Typical behaviours in BDD patients:-

• Excessive concern over minor or non-existent flaws in appearance - 93%
• Dissatisfaction with previous plastic surgery – 88%
• Unusual requests for cosmetic surgery – 81%
• Consistently noticing a specific appearance flaw in others – 64%
• Belief that the procedure will transform their life and solve their problems – 53%
• Wearing heavy clothes or heavy makeup to hide the supposed flaw – 41%
• Difficulty to function from day to day – 30%
• Picking at their skin 23%

Long-term effects of cosmetic surgery

As far as can be established, there are no long-term studies about the effects of cosmetic surgery on teenagers. Patients usually report improved self-esteem and satisfaction with the relevant body part in the early stages. However, it is unlikely that these psychological results are maintained as the years pass.

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