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Some Teens Turning to Plastic Surgery

But not all are suitable candidates

SATURDAY, May 5 (HealthScout) -- Now that Mom's had liposuction, can teen-age Susie be far behind?

It's just a matter of time, say plastic surgeons, who've ridden a surge in cosmetic surgery in women -- up 165 percent -- during the last decade.

"There's definitely a trickle down phenomenon," says Dr. Kenneth Francis, a New York City plastic surgeon, "from the elite high society to middle-class America. Eventually, it will trickle down to the teen-age population."

In some places it already has. And that trend has doctors debating which teens are the best candidates for cosmetic surgery.

Dr. Leslie Bolton, who practices in Beverly Hills, Calif., reports a small but growing number of teens requesting liposuction, in which stubborn pockets of fat are surgically sucked from the body.

He also notes that until last May's ban by the U.S. Food and Drug Administration of saline implants for women under 18, he "performed a few augmentations on women under 18, and most of them had mothers who had augmentation."

To be sure, the number of teens having cosmetic procedures is still small, in the tens of thousands out of a population of approximately 30 million. Last year, 175,000 teens, less than 2 percent of U.S. adolescents, had cosmetic procedures, according to the American Society for Aesthetic Plastic Surgery.

The vast majority of those procedures were non-surgical ones, like mild chemical face peels as part of acne treatments, and laser hair removal, primarily dark facial hair on girls.

Dr. Debra Jaliman, a New York City dermatologist, treats many teens with chemical peels that remove dead skin and speed acne cures. She also removes hair from upper lips, chins or other parts of the body with laser surgery.

"The treatments are safe, effective and easy," she says. "If you have these minor problems that make such an impact on someone, why not take care of it? It's hard enough to grow up. Why make it any harder?"

"Teens are very sensitive to their appearance," agrees Matthew Silvan, a Columbia University psychologist who also works in the dermatology department at St. Luke's Roosevelt Hospital in New York City. "Treating acne ... and upper lip hair dramatically improves self-esteem.

"It's when you start to move along the continuum, getting into surgery, where you're taking on more significant risks. Then you have to ask, 'Do they outweigh the benefits?' " he adds.

The psychology of cosmetic surgery

The risks for teens are as much psychological as surgical, says Dr. Robert Zubowski, a New Jersey plastic surgeon.

While adults have a mature perception of how they look, teens often don't, Zubowski says. A slight bump on the nose might seem huge to a 17-year-old. But by the time he or she is 20, it's no longer a big deal.

"A teen-ager is in the process of developing a body image, and since it is not fully developed, that becomes an issue [in cosmetic surgery]," he says. "The surgeon has to say, 'It's not as bad as you think. You may look at this a little differently in a few years.' "

The key is to make sure teens, who naturally seek peer approval, aren't turning to surgical procedures as a quick fix for other problems, perhaps ones rooted in self-esteem, Silvan says.

"Kids might say, 'This is going to make me feel better, make me look like Britney Spears.' But six months later, the kid will still be having trouble," Silvan says.

That's not to say there aren't cases where cosmetic surgery is appropriate for teens.

"If you have a 17-year-old with a huge hump on her nose -- and there's no question it's an ugly nose -- you can say, 'Well, you're a very nice person,' which may be true. But she is self-conscious and she doesn't like the way she looks," Zubowski says.

Surgery is appropriate for a young woman like that, he says.

Francis, too, has performed many rhinoplasties on teens whose bone development was complete, but whose noses were out of proportion to the rest of their features.

"They are overwhelmingly happy with the results," he says.

More than just nose jobs

But with the constant advances in technology, cosmetic surgery for teens no longer just means nose jobs.

Although statistics aren't available, surgeons such as Zubowski say increasing numbers of teen-age girls are undergoing breast reductions for abnormally large breasts.

And Bolton says requests for liposuction have increased. He now performs about a dozen a year on teens. "It is growing," he says of teen liposuctions, "but it is a small part of the practice, about 10 percent."

Doctors say they carefully screen their teen patients before agreeing to such surgeries.

"I almost always have two meetings with teens, alone and with their parents," Bolton says. "Teens tend to be impulsive and deserve extra pre-operative counseling so that they won't have something done today that they will regret in a few months."

A good candidate for liposuction is a teen who is fully grown and has localized fat deposits that can't be eliminated through diet or exercise, Bolton says. He cites a recent patient who was anorexic. When her hips were reduced by liposuction, she gained a different image of her body and was no longer anorexic.

"That's different from a 17-year-old who's chubby all over and is looking for a quick fix," Bolton says. For that teen, he'd recommend dieting and exercising and would refuse to perform liposuction.

Parents can play an important role in influencing their children when it comes to plastic surgery. If a child demands a nose job by pointing to her mother and saying, 'You did it, why not me,' parents have to resist the temptation to give in, Silvan says.

"Parents need the confidence to say, 'What is all right for me isn't OK for you,' " he says.

To date, doctors say, most parents are pretty sensible about whether their children really need cosmetic surgery. But will good sense prevail over the long run?

Zubowski isn't so sure.

"It is a small part of my practice. It's a small part of anybody's practice, or should be," he says. "But awareness of cosmetic surgery is on the rise on the part of the public. Knowing this is available for teens, more will come in with concerns. It is incumbent on the surgeon to select only the best candidates for surgery."

What To Do

Cosmetic surgery, like any other surgery, is not to be undertaken lightly. The American Society of Plastic Surgeons has a site that describes the benefits and risks of most common procedures.

For year 2000 statistics on popular plastic surgery procedures, visit The American Society for Aesthetic Plastic Surgery. You'll need Adobe Acrobat Reader to view the report. If you don't have it, you can download it here.

And for recent HealthScout stories on cosmetic surgery, click here.

SOURCES: Interviews with Leslie Bolton, M.D., chairman, Public Education Committee, American Society for Aesthetic Plastic Surgery, Beverly Hills, Calif.; Debra Jaliman, M.D., clinical instructor, dermatology, Mt. Sinai School of Medicine, New York; Kenneth Francis, M.D., chief, plastic surgery, Catholic Medical Center, Queens, N.Y.; Matthew Silvan, Ph.D., assistant clinical professor, psychiatry, Columbia University, New York; Robert Zubowski, M.D., Center for Plastic & Reconstructive Surgery, Paramus, N.J.
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