See also The American Society of Plastic Surgeons’ statistics on “Cosmetic Procedures and Teens.”
Alexis totally hated her nose. At 15, she’d had it with all the teasing she endured at Harriton High School. Taunts of “flat as a board” followed 17-year old Emily through her years at Lower Merion High School. She wanted the “problem” fixed before she went to college.
Jessica had the opposite issue: She wore a DD bra. Finding clothes and playing sports were difficult, but it was nothing compared to what she put up with from fellow students at Lower Merion. “It’s like, yes, you want boys to pay attention to you, but not for something that’s embarrassing,” says the 15-year-old. “Actually, girls were worse than boys. They’d call me fat and things like that. When I told my mom that I was going on a diet, she was like, ‘Oh, no. We’re not going to start with that.’”
Jessica opted for a breast reduction; Alexis underwent rhinoplasty; and Emily got breast implants. Their stories are hardly unusual. In fact, they represent a growing trend. Almost 219,000 cosmetic surgery procedures were performed on teens ages 13-19 in 2010, based on the most recent statistics from the American Society of Plastic Surgeons. And those numbers are almost certainly on the rise.
But is cosmetic surgery really a medically necessary response to teens’ wobbly self-esteem and body-image problems? Surely there are other options. And where should parents and doctors draw the line?
To an extent, the line is drawn legally. Parental consent is required for all surgical procedures performed on patients under 18. There are ethical considerations. In 2007, the FDA passed guidelines prohibiting teens under 18 from undergoing breast augmentation.
Most of the local surgeons we spoke to have performed breast augmentations on 18-year-olds, and only skew younger in cases of severe asymmetry. Some do liposuction on 18-year olds, but most have an age minimum of 21 for that procedure. Rhinoplasties and breast reductions are routinely performed at 14.
Why can’t a 12-year-old have a nose job and a 16-year-old get breast implants? Doctors have two answers: biology and psychology. Doctors don’t want to alter body parts until they’ve fully developed, and different areas reach maturity at different ages. “Rhinoplasty has to wait until the mid-face skeleton has matured, because we don’t want to do the surgery knowing that those bones can still grow and change the effect, or cause even bigger problems,” says Dr. Larry Jonas, systems chief of plastic surgery for Main Line Health. “In girls, that’s usually between the ages of 14 and 15. In boys, it’s between 16 and 17.”
Breast tissue can continue to grow after the age of 16. “It’s possible that a girl could develop breasts that are a size she’s comfortable with, which would eliminate the need for implants,” says Dr. Kirk Brandow, whose offices are in Bala Cynwyd and Somers Point, N.J. “I also consider the long-term effects of having implants in a body. I only use saline, not silicone.”
With silicone, there are big problems. “It leaks by 20-30 percent over a lifetime,” says Brandow. “That’s a lot of silicone entering the body of a woman, and we don’t know the effects of that. But it can’t be good.”
Then there’s what’s going on between the ears. “I want my patients to have the maturity to handle the surgery and recovery, and to have realistic expectations about the results,” says Dr. Paul Glat, who also practices in Bala Cynwyd. “I had a string of the Sweet 16 requests for breast augmentations, but I squashed them. The girls were too young, emotionally and physically. That’s why I have the girls wait until 18.”
But is even 18 too young? At least one body-image specialist thinks so.
“I’d argue that cosmetic surgery shouldn’t be considered until boys—and especially girls—are well into their 20s,” says Dena Solomon, clinical director of Main Line Psychological Services. “There’s a misunderstanding about the psychological development of teens’ body images. Awareness doesn’t begin in adolescence—it begins soon after toddlerhood. That’s particularly true for girls. It starts at a very early age, when parents start expressing praise or criticism. We tell young girls that they’re pretty or cute and comment on their appearances, and they internalize it.”
Kids’ body images are “lowest at age 9,” Solomon says. “All kinds of biological changes are happening that they have to figure out. The truth is that, with both boys and girls, body-image satisfaction keeps going up and up until 18, and it continues to rise.”
Dr. Stephen Mechanick agrees. “In most cases, cosmetic surgery can wait,” says Bryn Mawr Hospital’s chief of psychiatry. “There is value in letting the child grow up and make the decision as an adult. Even at 18 and 19, teens are still not fully mature, and parents should be part of surgical consultations.”
Then again, parents are sometimes part of the problem. “Some push their kids to look a certain way as a way of living out their own goals,” says Mechanick. “Moms can put pressure on girls to be thin or dress a certain way because that’s how they want them to look. Those who put a lot of emphasis on their own appearances have difficulty with daughters who don’t put the same emphasis on theirs.”
And a mother may unwittingly pass down her body-image insecurities. “If you see it in a girl, you’ll often see it in her mother,” says Solomon. “The other reality is that—especially with Main Line glamour moms—some daughters are just more plain-looking than their mothers. Maybe the parent has had work done, or didn’t blossom until she was in her late teens or 20s. The daughter might not know that. She may compare herself to her mother and find herself wanting.”
Solomon delves deeper with her patients. “When I have a girl who wants to alter herself, what I do is to look at where the pain is coming from psychologically,” she says. “She’ll say that her life sucks because of her nose, but when we really delve into it, the nose is only her focus because she can literally see it. Once we address the other issues in her life, she usually feels more body satisfaction and less urgency to go under the knife.”
But it’s not just the knife—it’s also the needle. “BOTOX is what I’m getting requests for from teenagers and girls in their early 20s,” Brandow says. “They say, ‘I have a wrinkle right here,’ and you’d have to squint to see it. They also want bigger lips. I’ll use Restylane or Juvéderm on a woman in her 20s, but not in her teens. But the kids will go elsewhere to get it. You can buy coupons for BOTOX and Juvéderm on Groupon, and go to a nurse or medi-spa and get it done for $20.”
And teens don’t consider the dangers. “They want immediate results and immediate gratification,” says Brandow. “It’s up to parents to put limits on them, for their own health and safety.”
As long as the parents are on board, Bala Cynwyd’s Dr. Paul Glat sees some upside to the trend. “There are real benefits to self-esteem from having some of these cosmetic surgeries done when the patient is a teenager,” he says. “If it’s safe and can improve the patient’s life, why not do it?”
Alexis, for one, is glad she did. “Life is hard enough as a teenager,” she says. “Why make it harder with a big nose?”
219,000 procedures were performed on patients ages 13-19
35,000 teens ages 13-19 received nose jobs
13,500 boys ages 13-19 underwent breast-reduction operations.
19,500 patients ages 13-19 underwent laser skin resurfacing.
8,500 girls ages 18-19 had breast augmentations.