Volume 16 • Issue 44 | April 2 - 8, 2004

Choosing a new look

When teens consider plastic surgery

By Dr. Amy Glaser

We all want to fix our imperfections. But is it healthy for a teen to have plastic surgery? Adolescents are typically self-consciousness and they may be tempted to fix what they see as the imperfections staring back at them from the mirror.

According to Dr. Shirley Madere, a Soho plastic surgeon, some physical disfigurements do seem to stand as barriers to the healthy psycho-social development of certain teens.

Problems such as significant breasts in males or asymmetric or unusually large breasts in females can cause both significant embarrassment and, in some cases, physical pain. Surgery may be more than a cosmetic fix for an annoying imperfection, but a cure for a significant clinical problem as well as an important first step in helping the teenager form a positive body image.

Adolescents are patients in transition both emotionally and physically, and proper pre-surgical screening is critical. They are more vunerable than adults to forming opinions based on how others see them. It is critical that decisions be their own, not their peers or parents.

These teenagers live in a society of anorexia and bullemia. And surgery is obviously not the solution there. Those who have psychiatric issues need a different type of help.

But if the proposed surgery is cosmetic or due to health concerns, a certain physical maturity must be reached before surgery is done. Skeletal growth and hormonal change may modify the surgical outcome. On the other hand, it can fix the problem rendering surgery unnecessary.

More emotionally mature adolescents are apt to see themselves differently and reevaluate their decision with time. Dr. Madere requires a waiting period and sometimes a psychological or endocrinological evaluation. Teens, like adults, must be in agreement with the goals, expectations, risks and temporary disfigurement that plastic surgery entails. They must understand what they want done and why they want to do it.

The most popular plastic surgical intervention under age 18 in males and females, both for Dr. Madere and nationwide, is rhinoplasty, or the old-fashioned nose job. It can be a difficult procedure with risks including: bleeding, perforation scarring and a need for further surgery. Patient satisfaction varies as well. As body image is changing with age, the youngest patient Dr. Madere has performed this type of surgery on was 15.

Dr. Madere’s second most common procedure in female teens is liposuction. But what about dieting? The ideal candidate for liposuction is not overweight, said Dr. Madere. At near ideal weight, certain areas of the body can be recalcitrant to diet and exercise. So it is only after dieting, exercise and routine psychological clearance that she will consider these candidates. It is a relatively permanent modality of treatment, whose success depends on both the age, location and skin elasticity of the patient.

In adolescent boys, the second most common procedure is correction of gynecomastia, or enlarged breasts. Often, gynecomastia is the product of an endocrinological problem, or a secondary problem from drug abuse, which must be addressed before surgery is performed. Diet and exercise may also be important to maintain the benefits of surgery.

For adolescent girls a common procedure is breast reduction. There are often good medical indications for surgery above and beyond cosmetic considerations. These include back pain or impairment of sports activities or other activities of daily life.

But as a pediatrician who often encounters the thirty-something mom who is having trouble with breast feeding because of a breast reduction procedure, I asked Dr. Madere if she felt adolescents could understand all the possible repercussions, particularly those that may not have an impact for many years.

We both agreed that changing sexuality and self-image may modify a girl’s preferences in regard to breast size over the course of her life, making it essential that such decisions be made with great care.

Decisions to pursue plastic surgery are different in adolescence than in adulthood. Although adults also should be carefully screened to ensure that their expectations are realistic, adolescents are still exploring their self- image. Surgery can make permanent alterations in their appearance that they may regret later.

Teens who believe that their life will be forever changed and infinitely improved by correcting a single perceived imperfection will likely be disappointed. There may be better answers for a period of life affected by awkward self-consciousness.

But for those who have a significant physical problem standing as an obstacle to a healthy self-image, surgery may be an option. But teens need to be carefully screened by a caring professional and make the decision after being fully advised of the risks and benefits.

Amy Glaser, MD, has a private adolescent practice at 430 West Broadway, 212-941-1520 or aglasermd@aol.com


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