Wed Sep 29, 2004 5:31 pm by Indy11
How Young Is Too Young to Have a Nose Job and Breast Implants?
By MARY DUENWALD
Published: September 28, 2004
Thanks in part to television shows like "I Want a Famous Face" on MTV, "The Swan" on Fox and "Extreme Makeover" on ABC, cosmetic surgery is more popular than ever. And children and teenagers are not immune to the trend.
The number of cosmetic surgeries performed on people 18 and under reached 74,233 in 2003, a 14 percent increase from 2000, according to the American Society of Plastic Surgeons. Girls and boys as young as 6 get plastic surgery to flatten protruding ears. Adolescents of 13 or 14 have nose jobs. And nearly 3,700 breast augmentation surgeries were performed on teenage girls last year, according to the society. Almost as many teenage boys - 3,300 - had overly developed breasts reduced.
But experts say that in young people, surgically altering the body for cosmetic reasons should only be undertaken for clear and justifiable reasons.
"In extreme situations where the size or shape of the nose or ears is really affecting a child's self-image, I believe surgery may be an appropriate thing to do," said Dr. Steven Shelov, chairman of pediatrics at Maimonides Medical Center in Brooklyn. "But in teenagers, in my mind, breast implants have no place whatsoever."
Diet and exercise, not liposuction, he said, are the proper ways to treat excess weight in children.
The need for surgery must be evaluated on a case-by-case basis, plastic surgeons say, because children mature physically and emotionally at varying rates. The first step is for the doctor to find out why a child or teenager wants surgery.
Wanting to look like a celebrity is not a healthy motivation. Nor is a desire to relieve some deep-rooted psychological problem,
"If it's 'My boyfriend is sure looking at all these other girls who have bigger breasts so I guess I should get bigger breasts,' that is not a person you should do surgery on," said Dr. Walter Erhardt, a plastic surgeon in Albany, Ga., who is a past president of the plastic surgeons' society.
If a teenager is brought in by a parent who says, "My daughter needs a nose job," another kind of red flag goes up.
"Sometimes you really need to talk to the patient alone, to make sure that surgery is her idea and not just her parents'," Dr. Steven J. Pearlman, a facial plastic surgeon in New York and president of the American Academy of Facial Plastic and Reconstructive Surgery, said.
But surgeons also say that many teenagers make level-headed decisions to have cosmetic surgery. That perception is backed up by a series of recent studies from Erasmus University Rotterdam in the Netherlands, where patients 12 to 22 were interviewed about their body image, their reasons for wanting plastic surgery and their experiences after getting breast implants, nose jobs or ear reconstruction.
The teenagers were notably realistic in their assessments of the body part they wanted to have changed, said Dr. Hans M. Koot, a developmental psychologist who is now at Free University Amsterdam. Rather than overestimating their physical problem, they typically rated their deformity as less severe than the surgeons did.
The study subjects were found to be as satisfied with their overall appearance as the average teenager. After undergoing cosmetic surgery, they reported that they were no longer concerned about their appearance, and that they felt more self-confident. In contrast, a control group of young people who were dissatisfied with their appearance but who did not have surgery did not develop a better self-image or gain self-confidence.
Even when surgery is clearly justifiable, there are issues of physical readiness. Physically, a girl is not old enough for breast enlargement or breast reduction until her breasts have stopped growing. That happens as early as age 17 in many girls, and in rare cases as early as 16, said Dr. Peter B. Fodor, a Los Angeles plastic surgeon who is president of the American Society for Aesthetic Plastic Surgery.
"If I saw a girl with no breast tissue at all who had been menstruating for two or three years, then I would put a small implant into that person," he said.
Boys mature more slowly than girls, so breast surgery cannot be done until age 17 or 18. Surgeons used to wait until patients reached age 17 or 18 before reshaping a nose for fear that if they did it any younger, the child's nose would keep growing and end up in an odd shape. But they have found that nose growth ends earlier, and now do nose jobs, known as rhinoplasty, on girls at age 13 and boys at 14. A child would be unlikely to want surgery much earlier than that, Dr. Fodor said, because nose abnormalities do not show up until age 10 or 11.
Ears that stick out are another story. They are obvious even in the toddler years and by the age of 5 or 6, they can provoke teasing and name calling. ("Dumbo" is a common taunt.) By age 6 or 7, a child's ears are nearly full grown. If teasing is causing intense emotional strain, corrective surgery, called otoplasty, to reshape the ear cartilage and allow it to fold back against the head can be performed.
"By the age of 6, kids can participate in the decision to have surgery and understand why it is being done," Dr. Pearlman said.
Surgery for younger patients, of course, does not cost any less than it does for adults. Cosmetic procedures, according to the plastic surgeons' society, can run from $2,500 for otoplasty to $3,375 for breast implants.
And patients of all ages tend to underestimate the pain, recovery time and risks involved in cosmetic surgery, according to a survey published in the current Archives of Facial Plastic Surgery.
"The word cosmetic makes it sound less invasive than regular plastic surgery," said Dr. Grant S. Hamilton III, a fellow in facial plastic surgery at the University of Illinois at Chicago, who conducted the study. "People even think you can undo cosmetic surgery if you don't like it, but it's important to realize that surgery is surgery."