Teen Plastic Surgery

A major news outlet recently reported a rise in plastic surgery for teenagers with the top three procedures being: breast augmentation, rhinoplasty, and ear surgery. The teen years represent a time of major change in “body image” and teens are very aware of their peers’ opinions and “fitting in”, which is greatly impacted by social media. I have medically evaluated teens who want to alter a body feature to emulate a “celebrity” or a peer, but given a few more years their judgment might change or their body feature that they find objectionable may no longer be an issue. For example, a young teenage girl (e.g. 13 or 14 years old) may wish to have her breasts enhanced but they are still changing. The American Society of Plastic Surgeons has mentioned 18 as a minimum age to consider this procedure; and even at 18, it would be ideal if parents were involved with this decision. There is a lot to think about with breast augmentation; it can alter breast anatomy, and implants do not last “forever”, and it is most likely that the young woman having a breast augmentation will need an “implant exchange” later in life. There are some exceptions to this line of thought, for instance, in the case of maldevelopment or no development of one breast, which could be addressed at an earlier age. On the other end of the spectrum, when a breast is too large; I had a female patient who was around 13 years old and truly had “ macromastia”- about a DD or DDD. She was seeing a psychologist related to her body image problems, especially because her male peer group was making her life miserable; (our culture seems to put an emphasis on large female breasts; but many of these women have problems with back, neck, and shoulder pain, exercise intolerance, fitting in their clothing, etc.) In this particular case, despite her young age and with her parents’ and behavioral specialist’s blessings, I went ahead and performed a breast reduction which ultimately, according to the patient’s mother radically changed her daughter’s self-esteem and even got her thinking about “going to a prom” which had been totally out of the question previously. The nose is one of the more difficult areas that plastic surgeons address because it is “right in the middle of the face” and always receives close scrutiny. I counsel my teenage patients, particularly if they are in sports, that it might be best to postpone a “nose job” until after their playing days are over. It isn’t just the boys at this point as there are a lot of girls involved in sports now compared to a few years ago. Obviously if there is nasal trauma that affects the nasal airway or fractures that affect the bone, these can be dealt with emergently; later on if there is residual deformity present, this can be dealt with via a rhinoplasty. Again, as with the breast situation, each patient has a unique “nose” and the plastic surgeon should have an honest and thorough discussion with his/her patient as to “what” features they want to alter (and why) and if this is indeed realistic given the patient’s particular anatomy. Sometimes, a very minor adjustment can make a big difference: e.g. a large “hump” on an otherwise nice looking nose can be removed, and produce a very pleasing result. Ear surgery usually relates to their shape: e.g. too big (“Prince Charles”), too protruding, too big a lobe, torn earlobes, etc. An otoplasty is an operation that addresses the so-called “lop ear” problem: big and protruding; and is often performed at an early age, e.g. age five or six as the ear has attained most of its growth and children this age can be very “pointed” in their teasing of those with these problems. However, it is not just children: I had a 20-something male who had long hair covering his “lop ears” and he had come to a point that he just wanted to wear his hair short and not have to deal with concealing the problem. A very common problem I see is “torn ear lobes”, typically from a forceful pulling out of the earring: this can lead to a “cleft earlobe deformity” or “V’ shaped defect, or sometimes the earring hole becomes enlarged so much that the earring will not fit or falls through (particularly a problem with diamond studs). These can be repaired in the office at any age, including teenagers. Overall, despite some of the cautions noted above, it is very gratifying to operate on young people, especially when a “bad” body image can change that person’s outlook on life.

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