Teenage women (those under 18 years old) account for about 2-3% of all patients presenting to plastic surgeons offices to discuss cosmetic surgery. Personally, I have seen an increase in both inquiries as well as consultations by teenage patients. Some of the more common reasons young women present for cosmetic surgery is for breast augmentation, liposuction, and rhinoplasty. This is controversial. The issues involved include; maturity, decision making ability, safety and legal aspects.
Maturity and Judgement
There are several good reasons that age restrictions have been placed on all sorts of things that require maturity and judgement such as purchasing a gun, driving and drinking alcohol. The frontal lobe of the brain does not fully develop until the 20?s to 30?s. This is the part of the brain that governs judgement, impulsivity, and understanding of consequences. There have been studies to suggest that 20-30% of high school students consider suicide. This is also a period with a high incidence of experimentation with illicit drugs. Clearly, adolescence is a period of time where judgement can be challenged. This is not to say that adults always make proper decisions for themselves, adolescents are simply at a distinct biologic disadvantage.
The reasons that a teenager may desire plastic surgery can be suspect. ”Fitting in”, or wanting to look like a specific air-brushed celebrity aren’t good reasons to pursue plastic surgery. This is a time of self-discovery, not self-alteration.
In general, the risks of cosmetic surgeries are similar among adults and adolescents. However, there are instances when operating before full development can effect the cosmetic outcomes. For example, breast surgery before full breast development or rhinoplasty before the nose has completely developed.
There is no specific legislation in the United States regarding teenage cosmetic surgery. As with any medical procedure, parental consent is required for patients under 18 years of age. In Australia, there have been legislature to make it difficult for teenagers to have cosmetic surgery including a “cooling off” period between consultation and surgery. There have been discussions of similar laws in the U.S.
For breast augmentation, The American Society of Plastic Surgeons and the FDA have both taken a position. Women under 18 are not approved to have saline implants and those under 22 are not approved for silicone implants. There are life-long risks associated with breast implants such as capsular contracture and deflation that become greater the longer that implants have been in place.
Reconstructive vs. Cosmetic plastic surgery
In my practice, all patients presenting for procedures that are purely cosmetic must be old enough to sign their own consent form (18 years of age) and must be suitable candidates for the planned procedure with realistic expectations. The difficulty is that some of these patients present with problems that are both cosmetic and reconstructive in nature. For example:
- children with prominent ears resulting in self-consciousness
- girls with extremely asymmetric breast development
- girls with extremely large breast development limiting physical activities
- Boys with male breast development
- Facial scarring from a previous injury
- A nose deformity causing significant breathing problems
There is clearly a continuum from purely cosmetic to purely reconstructive surgery. It takes the experience and judgement of a good plastic surgeon to make the decision of whether an operation is indicated while the patient is still a minor or should be required to wait until they are 18 in these tough cases. If you are a teenager considering cosmetic surgery visit with a reliable, board certified plastic surgeon to discuss these issues.