Skyllar Kuppinger, Class of 2023
In a world where filters and facetune are the norm, it is not surprising that plastic surgery rates have increased, especially in teenagers. According to the American Society of Plastic Surgeons in 2018, the number of adolescents undergoing cosmetic surgery (a.k.a. plastic surgery) has risen, with approximately 229,551 cosmetic procedures performed on teens during that year (“Plastic Surgery Statistics”, 2018). The most common operations performed on teens were rhinoplasty (“nose job”), breast augmentation, and breast reduction, respectively (“Plastic Surgery Statistics”, 2018). This brings up an ethical dilemma: should adolescents be allowed to undergo plastic surgery? If so, under what circumstances?
A key factor in this debate is the mental/emotional state of adolescents compared to adults. Body dysmorphic disorder (BDD) is much more prevalent in teens than in adults. Studies have shown that patients who wish to undergo liposuction and breast augmentation are especially likely to have BDD (Koot, 2001). In these cases, it is difficult to distinguish between a realistic desire to improve one’s appearance and a BDD-induced preoccupation with a certain physical feature. In the latter situation, the patient is likely to have a negative body image even after the procedure. Adolescence is also a formative period in which one may feel pressured by their peers to fit in. Other changes in a teenager’s life may include family divorce or change in financial situation (Singh, 2015). These factors can all negatively affect self esteem and body image. There have been no longitudinal studies done to show whether or not teenagers’ self esteem improves after cosmetic surgery, but studies do show that body image improves naturally with age (Sarwer, Wadden, & Whitaker, 2002).
There are also physical risks that come with operating on someone whose body is still changing. For example, most girls gain weight between ages 18-21, which would disrupt the effects of surgeries such as liposuction or breast augmentation (Afrooz, Mendez, & Rohrich, 2018). Additionally, breast implants have to be surgically replaced every 10-15 years (Afrooz et al., 2018). One can see how this cost would build up for someone who initially gets implants at age 18. There is also a concern that teenagers are less likely to understand the risks of plastic surgery in general, because they are more likely than adults to engage in risky behavior (Zuckerman, 2005).
Dr. Gabrielle Caswell, president of The Cosmetic Physicians Society of Australasia, believes that physicians should defer cosmetic surgery in patients under age 20 unless there are compelling medical or psychological reasons (Singh, 2015 ). However, the question is what defines a “compelling reason”? Where is the line between a severe disfigurement that necessitates surgery and a normal physical feature? Surgical procedures such as cleft lip repair are cosmetic in nature, but it is considered acceptable for children or teens to undergo these procedures. Surgeries to correct other features, such as a large nose or prominent ears, are less widely accepted because the aforementioned features are not considered as severe.
It is becoming increasingly evident that teenagers with significant cosmetic nasal deformities often undergo bullying, which can be psychologically traumatic (Dale et al., 2017). The topic of bullying raises another question about the motives for plastic surgery: Although bullying is traumatic, is it a justified reason for undergoing surgery? How would a surgeon be able to tell if the teenager is truly unhappy with a certain feature versus if he/she only wants to change that feature due to pressure from peers? Should parents approve of their children’s desire to change their appearance, or should they teach their children that confidence comes from within?
It should be standard practice for plastic surgeons to “screen” their patients to ensure that their motives for undergoing surgery are valid. For example, wanting to change your appearance to impress a significant other would be considered a flawed motive, whereas wanting to change one feature in order to feel more confident about oneself is more justified. Unfortunately, there is no evidence to suggest that screening is widespread (Zuckerman, 2005).
Overall, there is much research left to be done regarding the subject, such as the long-term effects of certain procedures, the impact that surgery has on body image, and the prevalence of screening. Even after abundant research is conducted, however, there still will not be a black-and-white answer. Nonetheless, adolescent plastic surgery and its implications toward our society must be given great consideration by teenagers, their families, and physicians alike.
Works Cited
Afrooz P, Mendez B, Rohrich R. 2018 Apr. An Update on the Safety and Efficacy of Outpatient Plastic... : Plastic and Reconstructive Surgery. LWW. [accessed 2020 Feb 27]. https://journals.lww.com/plasreconsurg/fulltext/2018/04000/
An_Update_on_the_Safety_and_Efficacy_of_Outpatient.14.aspx
Dale, Jeremy, Guy, Alexa, Lee, Kirsty, Wolke, Dieter. 2017 May. Adolescent Desire for Cosmetic Surgery: Associations with... : Plastic and Reconstructive Surgery. LWW. [accessed 2020 Feb 27]. https://journals.lww.com/plasreconsurg/Fulltext/2017/05000/Adolescent_Desire_for_Cosmetic_Surgery__.19.aspx
Koot H. 2001. Body Image, Psychosocial Functioning, and Personality: How Different Are Adolescents and Young Adults Applying for Plastic Surgery? Journal of Child Psychology and Psychiatry. [accessed 2020 Feb 27]. https://www.academia.edu/19089187/Body_Image_Psychosocial_Functioning_and_Personality_How_Different_Are_Adolescents_and_Young_Adults_Applying_for_Plastic_Surgery
Plastic Surgery Statistics. 2018. American Society of Plastic Surgeons. [accessed 2020 Feb 27]. https://www.plasticsurgery.org/news/plastic-surgery-statistics
Sarwer D.B., Wadden T.A., Whitaker L.A.. 2002 Jan. An investigation of changes in body image following cosmetic surgery. Plastic and reconstructive surgery. [accessed 2020 Feb 27]. https://www.ncbi.nlm.nih.gov/pubmed/11786842
Singh K. 2015. Cosmetic surgery in teenagers: to do or not to do. Journal of cutaneous and aesthetic surgery. [accessed 2020 Feb 27]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411597/
Zuckerman D. 2005 Mar 1. Teenagers and Cosmetic Surgery. Journal of Ethics | American Medical Association. [accessed 2020 Feb 27]. https://journalofethics.ama-assn.org/article/teenagers-and-cosmetic-surgery/2005-03
A key factor in this debate is the mental/emotional state of adolescents compared to adults. Body dysmorphic disorder (BDD) is much more prevalent in teens than in adults. Studies have shown that patients who wish to undergo liposuction and breast augmentation are especially likely to have BDD (Koot, 2001). In these cases, it is difficult to distinguish between a realistic desire to improve one’s appearance and a BDD-induced preoccupation with a certain physical feature. In the latter situation, the patient is likely to have a negative body image even after the procedure. Adolescence is also a formative period in which one may feel pressured by their peers to fit in. Other changes in a teenager’s life may include family divorce or change in financial situation (Singh, 2015). These factors can all negatively affect self esteem and body image. There have been no longitudinal studies done to show whether or not teenagers’ self esteem improves after cosmetic surgery, but studies do show that body image improves naturally with age (Sarwer, Wadden, & Whitaker, 2002).
There are also physical risks that come with operating on someone whose body is still changing. For example, most girls gain weight between ages 18-21, which would disrupt the effects of surgeries such as liposuction or breast augmentation (Afrooz, Mendez, & Rohrich, 2018). Additionally, breast implants have to be surgically replaced every 10-15 years (Afrooz et al., 2018). One can see how this cost would build up for someone who initially gets implants at age 18. There is also a concern that teenagers are less likely to understand the risks of plastic surgery in general, because they are more likely than adults to engage in risky behavior (Zuckerman, 2005).
Dr. Gabrielle Caswell, president of The Cosmetic Physicians Society of Australasia, believes that physicians should defer cosmetic surgery in patients under age 20 unless there are compelling medical or psychological reasons (Singh, 2015 ). However, the question is what defines a “compelling reason”? Where is the line between a severe disfigurement that necessitates surgery and a normal physical feature? Surgical procedures such as cleft lip repair are cosmetic in nature, but it is considered acceptable for children or teens to undergo these procedures. Surgeries to correct other features, such as a large nose or prominent ears, are less widely accepted because the aforementioned features are not considered as severe.
It is becoming increasingly evident that teenagers with significant cosmetic nasal deformities often undergo bullying, which can be psychologically traumatic (Dale et al., 2017). The topic of bullying raises another question about the motives for plastic surgery: Although bullying is traumatic, is it a justified reason for undergoing surgery? How would a surgeon be able to tell if the teenager is truly unhappy with a certain feature versus if he/she only wants to change that feature due to pressure from peers? Should parents approve of their children’s desire to change their appearance, or should they teach their children that confidence comes from within?
It should be standard practice for plastic surgeons to “screen” their patients to ensure that their motives for undergoing surgery are valid. For example, wanting to change your appearance to impress a significant other would be considered a flawed motive, whereas wanting to change one feature in order to feel more confident about oneself is more justified. Unfortunately, there is no evidence to suggest that screening is widespread (Zuckerman, 2005).
Overall, there is much research left to be done regarding the subject, such as the long-term effects of certain procedures, the impact that surgery has on body image, and the prevalence of screening. Even after abundant research is conducted, however, there still will not be a black-and-white answer. Nonetheless, adolescent plastic surgery and its implications toward our society must be given great consideration by teenagers, their families, and physicians alike.
Works Cited
Afrooz P, Mendez B, Rohrich R. 2018 Apr. An Update on the Safety and Efficacy of Outpatient Plastic... : Plastic and Reconstructive Surgery. LWW. [accessed 2020 Feb 27]. https://journals.lww.com/plasreconsurg/fulltext/2018/04000/
An_Update_on_the_Safety_and_Efficacy_of_Outpatient.14.aspx
Dale, Jeremy, Guy, Alexa, Lee, Kirsty, Wolke, Dieter. 2017 May. Adolescent Desire for Cosmetic Surgery: Associations with... : Plastic and Reconstructive Surgery. LWW. [accessed 2020 Feb 27]. https://journals.lww.com/plasreconsurg/Fulltext/2017/05000/Adolescent_Desire_for_Cosmetic_Surgery__.19.aspx
Koot H. 2001. Body Image, Psychosocial Functioning, and Personality: How Different Are Adolescents and Young Adults Applying for Plastic Surgery? Journal of Child Psychology and Psychiatry. [accessed 2020 Feb 27]. https://www.academia.edu/19089187/Body_Image_Psychosocial_Functioning_and_Personality_How_Different_Are_Adolescents_and_Young_Adults_Applying_for_Plastic_Surgery
Plastic Surgery Statistics. 2018. American Society of Plastic Surgeons. [accessed 2020 Feb 27]. https://www.plasticsurgery.org/news/plastic-surgery-statistics
Sarwer D.B., Wadden T.A., Whitaker L.A.. 2002 Jan. An investigation of changes in body image following cosmetic surgery. Plastic and reconstructive surgery. [accessed 2020 Feb 27]. https://www.ncbi.nlm.nih.gov/pubmed/11786842
Singh K. 2015. Cosmetic surgery in teenagers: to do or not to do. Journal of cutaneous and aesthetic surgery. [accessed 2020 Feb 27]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411597/
Zuckerman D. 2005 Mar 1. Teenagers and Cosmetic Surgery. Journal of Ethics | American Medical Association. [accessed 2020 Feb 27]. https://journalofethics.ama-assn.org/article/teenagers-and-cosmetic-surgery/2005-03
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