Expert advice on aesthetic procedures for adolescents

What’s right and wrong in terms of cosmetic procedures for teens is not black and white, experts say. There don’t seem to be formal guidelines to determine whether a teen should or shouldn’t have a cosmetic procedure. So, often, it’s left up to the discretion of the physician consulting with the patient.

Gia Washington, Ph.D.“Most would agree that any aesthetic procedure with a negative or unexpected outcome could potentially be damaging to an adolescent’s self-esteem or body image,” says Gia Washington, Ph.D., a clinical psychologist at Texas Children’s Hospital and assistant professor at Baylor College of Medicine, Houston. “Certainly a reconstructive surgery (breast, facial, removal of excess skin after excessive weight loss) would be considered acceptable and safe for an adolescent’s emotional development.”

While Michelle Welch, M.D., a dermatologist practicing in Lexington, SC, says it is her personal opinion that Botox, facial fillers and lip augmentation are among the cosmetic procedures that are inappropriate for teens, it may be important to address physical scars from a major trauma. And some skin conditions need to be cosmetically addressed. For example, Dr. Welch says, she strives to help patients with acne feel better about themselves.

Michelle Welch, M.D.“… you can imagine, if people make fun of [kids with acne], or they feel like people are going to make fun of them. I’ve had kids come in and say so-and-so didn’t want to be their boyfriend because they had pimples all over their face,” Dr. Welch says.

Among the procedures she uses to smooth skin damaged from acne: microdermabrasion and light chemical peels.

“Microdermabrasion is a wonderful treatment to help slough off those surface layers and help open their pores. Products can get in the skin better,” Dr. Welch says. “There are some chemical peels that are very light and very mild that may help them if they have a lot of redness. And if they already have scarring and you’re trying to improve their skin, there are some [light chemical peels] that would be beneficial for teenagers, but not the deep, invasive chemical peels that older people might get.”

Some procedures seem perfectly reasonable for some kids, but not for others.

John M. Hilinski, M.D., a facial plastic surgeon in San Diego, Calif., says that while rhinoplasty is a reasonable request for a teen who has a large or misshapen nose, it’s not for the teen that wants to hide his or her ethnicity, or for someone who wants to change the way they look, drastically.

“I’m not that kind of guy to take somebody’s nose and make it mismatched on their face,” he says.

And some teens need to wait to have surgery, simply because they’re still growing, Dr. Hilinski says.

“You shouldn’t operate on a male nose at around 14 or 15 [years]. Usually, with males you should wait until they’re at least 17, or when the last shoe size change was a good year ago. Females, we’ll operate as young as 16 years,” Dr. Hilinski says.

Vivian Diller, Ph.D.Even age, itself, isn’t always a good indicator whether a cosmetic procedure is appropriate for a teen, according to Vivian Diller, Ph.D., a New York City-based psychologist.

“You have to look at the maturity of the patient that you’re talking to,” Diller says. “You can find a 16-year-old who is extremely mature, who has been thinking about a particular feature they want to change; has done their research; is thinking for themselves. Then, you find a 50-year-old who is being highly influenced by someone other than themselves (it could be a mate, a parent, a movie star…). Really, I tell physicians to think less about chronological age and more about maturity.”
 

3 Tips for evaluating teens for aesthetic procedures

The trick for physicians and surgeons consulting with these patients is to be objective; not judgmental, says Diller.

“…when an adolescent approaches you about wanting surgery, they’re suffering a great deal. I’ve had the experience of talking to an adolescent who has been bullied or who has required reconstructive surgery as a result of an accident or injury. And to judge that young person that they’re too young for that surgery, I think is unfair to them,” Diller says. “I’d rather talk to them in great depth about how they’re thinking about it.”

For example, Diller says, a teenager who wants Botox for wrinkles isn’t appropriate in most cases-unless that teen is under the spotlight, in the media, or whose income may depend upon maintaining a certain look, perhaps. Breast surgery is another example. Adolescents’ bodies are changing and they’re still evolving mentally and socially. Breast augmentation during the teen years is a clear red flag. Breast surgery to correct uneven breasts, however, might be a different story.
 

Teens and cosmetic procedures: How to say ‘no’

“To provide that kind of normalization can sometimes truly help a child going into adulthood feel much more confident about themselves,” Diller says.

Often the desire for plastic surgery reflects a desire for improvements in quality of life, and it is the adolescent’s quality of life that parents and physicians should consider, Washington says.

'Yes' answers to these questions would likely be reasons to consider cosmetic surgery in adolescence, according to Washington: 

• Is the adolescent’s physical appearance of cleft lip, asymmetrical breasts, protruding chin and nose, or severe acne making it difficult for them to enjoy an expected quality of life?

• Are they unable to meet the expected developmental milestones of adolescence such as making and establishing friends, obtaining independence from family, attending social activities, etc. because of damage to their confidence and self-esteem related to the esthetic concern?

• Are they being teased mercilessly by peers or even adults about these conditions?   

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