Should You Let Your Teen Undergo Plastic Surgery?
At 41 years-old, I have learned that beauty is truly skin deep, and yet just when I think I've finally allowed that statement to fully integrate into my overall consciousness, an off-hand comment hurled my way can revert me back to that 16 year-old insecure teen who desperately wanted a nose job.
To provide you with a bit of background, I come from an extended family of chronic rhinoplasty patients. Both the men and women in my family have gone under the knife to have their ‘ethnic’ looking noses transformed into the more coveted Roman, white Anglo Saxon Protestant ones. And really, what choice did I have to veer from our family tradition when the matriarch of my family, my grandmother, offered me, as she had my cousins, the money to pay for the procedure? In fact, I will NEVER forget sitting at my dining room table with her as she peered into my eyes and said in the sweetest voice, "Oh Melissa, you are so pretty... except for that nose." Thanks grandma!
While it was intended to be a lovely gesture on her part, I declined the offer. Even at the tender age of 16, I felt that concealing my true ethnicity would almost be a betrayal to the men and women upon whose backs I stood - those who bore the torment of Anti-Semitism, those who were murdered for it and those who didn't have the means or access to refine their facial features so they could pass as gentiles. So I've lived with my big ethnic nose for 41 years, and like it or not, one of my kids has inherited it as well. However, if one of my kids were bullied and made to feel less than because of their nose, would I consider allowing them to get nose surgery?
I chatted with ABPS board-certified plastic surgeon and Adjunct Associate Professor of Plastic Surgery at Columbia University, Arthur W. Perry, MD, FACS about the trend of teens under 18 undergoing plastic surgery to combat bullying and he had some very insightful opinions to share.
Melissa Chapman: Have you operated on teens who have felt insecure and were being bullied?
Dr. Perry: I have not operated on teens who openly admit to being bullied, but I frequently operate on teens who feel insecure about their appearance. This includes girls with large noses, small breasts, or protruding ears, and boys with large noses, female type breasts, and protruding ears.
MC: How young is too young to consider surgery to avoid bullying?
Dr. Perry: Different procedures can be performed at different ages. Protruding ears can be operated on in kids as young as six years. Rhinoplasty surgery can be performed on girls at age 14 and boys at age 16. The FDA requires girls to be 18 before they can have a breast augmentation, although this age is quite arbitrary and sometimes punitive. Boys with breast growth can be operated on as young as 16 years. These ages are for anatomical issues and bullying is much more complicated than that. Bullying is a psychosocial problem and I am not sure it can be solved by simply altering someone’s appearance. Kids can get picked on ruthlessly with even minor differences.
MC: Do you think the bully wins when a person resorts to surgery to change his or her looks because of bullying?
Dr. Perry: Maybe, but that doesn't preclude surgery.
MC: When would you refer a child to counseling rather than plastic surgery?
Dr. Perry: If a child has a significant deformity, then surgery is reasonable. I have two hours of preoperative discussions with kids, adolescents and their parents and I need to feel comfortable that they understand the risks and benefits of the surgery and still want to move forward with the surgical procedure. If there is a question about the psychological status of a child, I will request clearance from a psychiatrist. Even if the child is cleared by a psychiatrist, I need to feel comfortable that he or she has a good grasp of the ramifications of the surgery and I will not operate if I can't connect with the child.
MC: Would you perform cosmetic surgery on a teen who has no deformity but thinks they need to look better and wants cosmetic surgery? For example breast surgery, lip injections or liposuction?
Dr. Perry: To justify surgery on a teen especially an underage teen, there must be an anatomical abnormality that is correctable with surgery. Cosmetic surgery is designed to make abnormal appearances normal. I often refuse to operate on people who have unrealistic goals.
MC: There have been reports of young children having plastic surgery for protruding ears, large noses and weak chins to avoid bullying. What other surgeries have you done to avoid bullying? What are the most common surgeries- if any- performed on teens to combat bullying, etc.?
Dr. Perry: Male breast growth is a source of much unhappiness and ruthless bullying among teenage boys. Boys with large breasts do not take off their shirts at the beach and often opt out of gym class. Male breast growth is readily fixed with an outpatient procedure. It is probably the biggest source of embarrassment in boys, although most kids "outgrow" this condition and don't require surgery.
MC: What changes, if any, do you need to make during surgery on a younger patient who is still growing?
Dr. Perry: As a rule, we don't operate for cosmetic reasons until growth is largely complete. The ear is 90% of adult size by age six, and the nose is 95% of adult size by age 14 in girls and 16 in boys. Breast growth in girls is complete by age 18 in virtually everyone.
Ultimately I think this is a decision a parent, their child and their physician need to contemplate and agree on as a team. As for me and how I would deal with this, should my own daughter or son feel compelled to alter their nose or another facial feature? I believe it is not so black and white. While I hope my kids would be able to love their features for their rich genetic history and accept them as an intrinsic part of who they are, I also know that being bullied for the way they look and having to endure social pressures and taunts could have long-lasting impact on their self-esteem and the choices they make. Therefore undergoing surgery would need to be a decision we'd make in conjunction with the guidance of a therapist and a board-certified plastic surgeon like Dr. Arthur Perry who has an extensive understanding of the teen psyche. Bottom line- it would NOT be off the table.
What are your thoughts on teens and cosmetic surgery???