Determining whether to do a procedure requires good communication between doctor, patient and parent, and plenty of parental support. Impetus to go forward must belong to the teen, warned Dr. Catherine Begovic, a plastic surgeon in Beverly Hills. "The responsibility of the doctor is to be sure the teenager is the one initiating it. I usually meet with them and their parents on multiple occasions before proceeding to get a good understanding of motivations and expectations," she said.
Teens tend to ask for plastic surgery to fit in. Adults seek it more to stand out, Begovic said.
Dr. Jeffrey Spiegel said cosmetic need resulting from trauma or birth defect is likely reasonable. Gray areas appear when a child is a teen and doesn't like the way his ears look or the bump on her nose. "Are they emotionally able to make those decisions?" said Spiegel, chief of the Division of Facial Plastic & Reconstructive Surgery at Boston University Medical Center. "I talk to the patient, talk to the family and then must use my judgment as to whether the deformity is substantial or not."
Some people feel strongly that appearance is not a reason for surgery, especially given risk. On the other hand, Spiegel acknowledged, "a beautiful teen with a very large nose" will have a different high school and college experience than she would if the nose was smaller. Fixing a substantial issue may be life-enhancing. Seeking help for a small deformity may signal emotional immaturity.
"A bad candidate is someone who has what most people would classify as a relatively small issue, but they find earth-shatteringly significant," Spiegel said. They won't go to a dance or be seen because of the hated feature. "These people are not ready for surgery and might need counseling for what is really going on."
He recently reviewed a case in the news of a girl who had surgery because her oversized ears resulted in bullying. "Though there may have been an indication for surgery, there are better ways to end bullying. You are going to have negative feedback for something your whole life," Spiegel said. "I don't consider that to be appropriate."
"It's important to understand the motivation behind the desire to have a cosmetic procedure, as you are often your own worst critic," said Dr. Daniel Bober, psychiatrist and assistant clinical professor at Yale. "The magnitude of the visible cosmetic concern and the expressed emotional distress associated with it can sometimes rise to the level of a mental illness if it affects your daily functioning."
Teens obsessed with body image concerns may suffer from body dysmorphic disorder, a type of mental illness, he said. They obsess about differences between their actual and their ideal selves. Mental, physical or emotional neglect can contribute to development of the disorder. When it occurs alongside depression or anxiety, if can significantly impair a young person.
Begovic cautions against teenagers who expect plastic surgery to fix personal issues, not just physical attributes. "Patients who seek surgery to be more popular, get a boyfriend, or just are not emotionally mature enough to handle the changes that come are not good surgical candidates," and Begovic declines the job. She may ask for assessments by psychiatrists and other specialists to help determine whether a patient should have surgery.
Those concerns are also all expressed by the American Society of Plastic Surgeons on the topic of teens seeking plastic surgery.
"Most of what I'm seeing is not bullying that I would think should result in plastic surgery," said Mary Pritchard, a psychology professor at Boise State University. "The latest hot graduation gift" is breast enlargement surgery. "I'm sorry, but that is not a graduation gift. What I am getting frustrated with are kids who want liposuction or breast augmentation for vanity reasons."
Bober knows of parents who gift plastic surgery for graduation and Christmas, too.
Pritchard said research shows when people get plastic surgery for appearance, improved self-esteem lasts a year or less. "Then they're back to where they were at the beginning — or worse."
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