Parent the crucial link
The dilemma for surgeons and patients (and their parents) is summed up by ASAPS’ fellow lobby group the American Society of Plastic Surgeons (ASPS). In a statement, it says that while it has no formal position on plastic surgery for teenagers, it does not fundamentally dissuade potential patients. Under 18-year-olds require parental consent, but ASPS advises parents to evaluate the teenager’s physical and emotional maturity as a pre-condition.
Certain cases call for guidance by an American Board of Plastic Surgery‑certified plastic surgeon. And certain milestones in growth and physical maturity must be achieved before undergoing plastic surgery.
The parent is the crucial link, as a public survey run in Seattle this summer showed. RealSelf.com, an online cosmetic surgeries and treatments community, asked the public’s opinions about teen plastic surgery. It found that 68% of people were in favour of plastic surgery for teens when it comes to bullying; 24% identified rhinoplasty and otoplasty as appropriate, if it averted possible bullying.
RealSelf values the medical–beauty industry (elective cosmetic surgery, obesity management and cosmetic dentistry) at $30 billion.
The US market for teen surgery
ASPS says that the most common surgery procedures for teens are:
- Rhinoplasty: ordinarily not performed until the nose reaches its adult size (age 15–16 years in girls; 16–17 years in boys). ASPS says that 35000 rhinoplasty procedures were performed on patients aged 13–19 years in 2010. This was almost 50% of all cosmetic surgical procedures performed on this age group
- Otoplasty made up 11% of cosmetic surgical procedures performed on this age group in 2010 (8700 procedures), but also 42% of this surgery (all ages) across the US
- Breast asymmetry surgery
- Breast reduction to overcome both physical (e.g. back pain) and psychological burdens in teenage girls. In 2010, well over 4600 breast reductions were performed on patients aged 13–19 years in 2010
- Acne treatment and smoothing or ‘refinishing’ the skin with a laser or via microdermabrasion. In 2010, almost 9100 microdermabrasion procedures were performed on US patients aged 13–19 years. Other treatments for acne-related skin problems include laser skin resurfacing, dermabrasion and chemical peels. In 2010, 19500 laser skin resurfacing procedures, 5500 chemical peels and 3000 dermabrasions were performed on patients aged 13–19 years
- Gynaecomastia, in which teenage boys with large breasts undergo plastic surgery. The procedure accounted for 17% of cosmetic surgeries in patients aged 13–19 years in 2010 (13500 procedures)
- Breast augmentation, where saline‑filled implants can be used for breast augmentation in women 18 years or older, and for breast reconstruction. Silicone implants for breast augmentation are approved for use in women aged over 22 years. More than 8500 breast augmentations were performed on US 18–19-year-olds in 2010, up 3% on 2009 (and accounting for 3% of the US total).
Growing awareness of otoplasty in the UK
In the UK, data revealed by the British Association of Aesthetic Plastic Surgery (BAAPS) show that otoplasty (also called pinnaplasty) — the surgery brought into the headlines by the plight of the 14-year-old US girl mentioned above — is considered by 1–2% of the UK population. This might be seen as the number of people who believe their ears to be too prominent.
BAAPS spells out the reasoning behind young people seeking to access otoplasty; prominent ears often lack a normal fold, and sometimes one ear is more prominent than the other.
Corrective surgery can in fact be undertaken within the first few weeks of life, when it is possible to reshape the ears by applying a small splint to the rim — the cartilage of a new-born’s ear is easily remoulded. After a few weeks, a permanent correction can be achieved. By the age of 6 months, the cartilage is too hard to be remoulded and a surgical solution is required.
However, it is best to operate when the patient is 5 years or older, as, until then, the cartilage is very floppy and does not hold the stitches well. It is recommended that although parents may feel that their child’s ears should be corrected to avoid teasing and stigmatisation, it is best to wait until the child recognises the problem and wants the ears corrected.
