Teenage Cosmetic Surgery

Plastic surgeons perform surgery on virtually all age groups.   In fact, there is a sub-specialty of plastic surgery for pediatrics.   Pediatric plastic surgeons care for the most difficult of birth defects  and childhood injuries.   Teenagers may present in the plastic surgeon’s office with a wide variety of concerns including scars, birth defects, trauma, acne, tumors, and perceived physical cosmetic defects.   Perceived defects include all parts of the body but are usually related to breasts, nose and localized fat collections.

This teenage quest for perfection often presents an ethical dilemma for plastic surgeons, deciding if and when it is appropriate to operate.   Operate too early and you risk doing surgery in an emotionally vulnerable or immature developmental stage.   Operate too late and you might leave your patient with permanent psychological scars related to their deformity.   Clearly, some plastic surgery involves real functional or physical concerns.   For instance, consider the teenage girl with breasts so large that she is unable to be physically active, due to actual physical pain.   I recently completed a breast reduction on a 16 year old girl who had superficial open sores on her shoulders where her bra straps rubbed.   Forcing this patient to wait to an arbitrary age, I felt was wrong and may have left her with permanent shoulder scarring.  It is a more complicated situation than it might first appear.

On the other hand, a teenage girl with diminutive breast size suffers no such physical or real functional problems.   Her concern is purely emotional.   She is just not comfortable with her own physical appearance and postponing an option for surgery does not present medical difficulties.  Besides, time often corrects feelings of physical inadequacy.  So to surgically treat a perceived physical deformity, during this time of critical emotional and physical development, is risky at best.   I have to applaud the FDA for their recommendations regarding age of breast enlargement.   The compromise allowing saline breast implants to be considered in patients 18 years of age and older, while limiting silicone  gel implants to 22 years and older is reasonable.   Yet, plastic surgeons still have the discretion to do breast enlargement   at younger ages by simply labeling the surgery a reconstructive procedure.  I evaluate young patients with considerable caution and  I have chosen to follow the FDA’s recommendations regarding breast enlargement.

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