Cosmetic Surgery in Adolescents a Booming, Yet Controversial Medical Niche

Peggy Peck

October 13, 2004

Oct. 13, 2004 (San Francisco) — According to data compiled by the American Society of Plastic Surgeons, a total of 335,924 cosmetic procedures were performed on adolescents in 2003, which represents 4% of all cosmetic procedures done in the U.S. and is a significant increase over 2002, when adolescents accounted for just 2% of procedures.

Julia Corcoran, MD, an assistant professor of plastic surgery at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois, discussed the indications for cosmetic procedures at the American Academy of Pediatrics (AAP) 2204 National Conference & Exhibition.

In an interview with Medscape Dr. Corcoran said that while some cosmetic procedures are medically indicated, it can be difficult to determine if adolescents are good candidates for surgery. "They often have unrealistic expectations or, in some cases, it is the parents that want the procedure done, rather than the child," she said. For this reason, she asks adolescents to write down their expectations for surgery.

"If a teen comes in and says that she wants to look like Britney Spears, she is not a good candidate," Dr. Corcoran pointed out.

Age is also a factor in selecting candidates for surgery, Dr. Corcoran said. For example, while a "bump" on the nose can be surgically repaired even in young teens, surgery to make a big nose smaller or otherwise reshape the nose has to wait until the face is fully grown, usually about age 14 to 16 years in girls and 15 to 17 years in boys. "We can't determine if a nose is really big until the jaw has fully grown in," she explained.

And while teens are a growing market for cosmetic procedures, she noted that currently most procedures are nonsurgical. Last year, 257,653 of the cosmetic procedures done on teens were nonsurgical such as chemical peels, microdermabrasion, and collagen injections. "These are all procedures that are often used to treat acne scarring," Dr. Corcoran said.

The most common surgical procedure in teens was rhinoplasty and 42,513 of those were done in 2003. The next most common procedure among teens was otoplasty, a procedure that reshapes ears so that they lie flat against the head. "I was surprised by the otoplasty data because I consider this an operation for little boys. In girls their hair usually covers the ears, but as they reach their teens they may want to try different styles and the ears become a problem," she said.

Otoplasty is easily justified because many children are ridiculed for their "funny ears," Dr. Corcoran said. "That can lead to aggression on the part of the child, which interferes with school work and with the ability to make friends." Often psychologists will refer boys to her for this surgery, she said.

During an AAP press conference, she related the story of one boy who was referred because he was having a great deal of difficulty in school. In his case the problem was so severe that "Medicaid agreed to pay for the procedure." She said that six months after surgery, the boy's mother reported that the boy "was much happier in school and at home." The fighting, she said, was no longer a problem.

Yet, not all pediatricians are comfortable with the concept of plastic surgery for teens. Dr. Corcoran said that often pediatricians will call her and say, "You really can't do anything about this, can you?"

Michael Wasserman, MD, a staff pediatrician at Ochsner Clinic Foundation in New Orleans, Louisiana, told Medscape that many pediatricians are wary of cosmetic surgery for children and adolescents. Pediatricians are well aware of the risks associated with any surgery, he said, but often teens and their parents minimize this risk. "There is always a risk associated with surgery, and I think this needs to be clearly communicated," he said in a telephone interview.

Moreover, Dr. Wasserman said while he sympathizes with children who are ridiculed "because their ears stick out, otoplasty is not without risk. I had a patient who lost part of his ear because he developed an infection in the wound." Because the ear cartilage has poor blood supply, risk of infection is significant, he said.

On the other hand, Dr. Wasserman said that many teenage girls may benefit from breast reduction surgery, while boys often need surgery to reduce gynecomastia (in many boys, gynecomastia resolves when they go through puberty, but some teens may need surgical help). Girls, on the other hand, may experience back pain when their breasts are disproportionately large.

Dr. Corcoran agreed that breast reduction surgery is often warranted during the teenage years, but she said that in her practice she will not do breast augmenting surgery until the "girl is at least 19 and is living on her own, away from the parent's house. I feel this helps to confirm that the girl is making this life-changing decision on her own."

AAP 2004 National Conference & Exhibition: Presentation F293. Presented Oct. 10, 2004.

Reviewed by Gary D. Vogin, MD


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