Pediatric plastic surgeons perform both reconstructive and cosmetic surgery.
Reconstructive surgery repairs a physical defect that affects a child's ability to function normally (e.g., a cleft palate).
Cosmetic surgery aims to improve someone's physical appearance and is mainly about improving their self-image or confidence.
Age of Consent
The question of cosmetic
(aka aesthetic) surgery in teens can be a thorny subject. There are no specific laws in the United States that prevent teenagers from getting cosmetic surgery; however, parental consent is required for patients under the age of 18. Therefore, the responsibility falls to parents to help their children make the right decision.
Common Cosmetic Surgeries Performed on Teens
Cosmetic surgery can be appropriate in selected teenagers and can be safely done. In 2013, the American Society of Plastic Surgeons (ASPS) published data showing that number of cosmetic surgery done for the teens has actually come down progressively over the years, in contrast to the
media reports suggesting otherwise.
For example, in 2013 the ASPS reported that members performed 63,600 surgeries on patients between 13-19 years of age. The most common surgeries included:
(breast implants) - The Food and Drug Administration (FDA) considers aesthetic breast augmentation for patients less than 18 years of age to be an off-label use. The FDA has not approved breast augmentation in patients younger than 18. According to the ASPS, over 8,000 surgeries were performed in 2013 on 18-19 year old girls.
Rhinoplasty (nose reshaping) – This is the most requested aesthetic surgical procedure by teens. It can be performed when the nose has completed 90% of its growth, which can occur as early as age 13 or 14 in girls and 15 or 16 in boys.
Breast reduction – Frequently, this surgery is performed on girls with overly large breasts that may cause back and shoulder pain, as well as restrict physical activity. Breast reduction usually is delayed until the breasts have reached full development. In some boys, excessive breast development
(gynecomastia) can become a significant problem. In those cases, the excess tissue can be removed.
(ear pinning) – This surgery is recommended for children as they near total ear development at age five or six.
Non-surgical cosmetic procedures
The ASPS reported nearly 156,000 non-surgical cosmetic procedures including botulinum (Botox®) injections, skin resurfacing, and laser treatments of hair, skin and veins.
If Your Teenager Wants Plastic Surgery
They must voice a specific concern and have realistic goals. Teens who are able to voice a specific concern and have realistic goals for their outcome are candidates for cosmetic procedures. For example, a teen who notes a hump on the nose and requests to have it removed, has a specific complaint. If that teen's goal is to have a straight nose and blend in with peers, the outcome is likely to be achieved, so this teen may be a good candidate for cosmetic surgery. It the teenager believes that a straight nose will increase popularity, the goal is unrealistic and the teenager is not a good candidate for surgery.
They must show maturity and understand the procedure, risks, and consequences. A good candidate for cosmetic surgery is mature enough to understand the procedure, its risks, and what limitations the recovery period will require. The teenager requesting nasal reshaping who cannot rearrange their sports obligations to allow 6-8 weeks for surgery and healing is not yet ready to commit to the surgery and is not a good candidate for surgery. A mature teenager should also have an understanding of the possible things that can go wrong and be willing to accept that situation should it happen.
They must initiate the request for surgery. It is never advisable for a parent to suggest plastic surgery. The idea has to come from the child. Parents may project their own experiences and want to protect their children from emotional harm. If a teen has prominent ears, but is not bothered by them, that teen is not a good candidate even if the ears would respond well to an otoplasty. Parents who request consultation for a teen in this case may tell the doctor,
"My ears have always bothered me and I don't want my child to have the same problem." If the teen is not requesting the surgery, there is no patient consent, even if there is parental consent.
If your teen asks you about cosmetic procedures– particularly on the ears, nose or breasts – they may be candidates for cosmetic surgery. Explore what they feel they would like to change and why they would like it changed. Research what surgery might be like, what its risks are and how it would affect their activities. If as a parent-teenager team, you feel that cosmetic surgery may be appropriate, ask your pediatrician for a referral to a pediatric plastic surgeon who can explain more about it to you and your child.
State laws permit any licensed physician to call themselves a "plastic" or "cosmetic" surgeon, even if not trained as a surgeon. Look for certification by the American Board of Plastic Surgery (ABPS). If the doctor operates in an ambulatory or office-based facility, the facility should be accredited. Additionally, the surgeon should have operating privileges in an accredited hospital for the same procedure being considered.