My Teen Wants What????

You may have read an article recently referencing recommendations made by the American College of Obstetricians and Gynecologists (ACOG) regarding "plastic and cosmetic surgery on teens".  Most of the articles make a point of patients undergoing breast augmentation or labiaplasty.

Before everyone gets excited about teens undergoing cosmetic surgery, lets look at actual data:

The plastic surgery procedures, by the numbers, include ear surgery, nose surgery, and breast surgery.  

  • Most ear surgeries are otoplasties, for prominent ears, which patients often are teased relentlessly about.  
  • Rhinoplasty certainly has a cosmetic component, but also has a functional, breathing component.
  • Breast surgery is a mixed bag.  8,000 breast augmentations were performed on 13-19 year olds in 2014 (there are no further breakdowns by age, but presumably most are 18-19 years old).  Breast reduction is tracked much less accurately, but around 5,000 reductions were performed on 13-19 year olds in 2014.
  • Labiaplasty is not tracked by the American Society of Aesthetic Plastic Surgeons, but numbers are estimated to be miniscule.

Are teens bombarded with images through media and the Internet with ideal, likely unobtainable body images?  Absolutely.  Does this lead some of them to develop unhealthy images and expectations of themselves (Body Dysmorphic Disorder)?  Sure.  

When I am faced with a teenager who is requesting a procedure, it is always a difficult issue.  Each patient is an individual with a different set of problems.  For instance, the American Society of Plastic Surgeons recommends that breast surgery be delayed until a patient is 18.  However, I have had several patients in the 15-16 year old range requesting breast reduction that are very mature, have insight and understanding of their problem, and are constantly reminded of their problem by their pain, inability to find appropriate clothing, and unwanted attention.  If they and their parents understand the risks of surgery, as well as the additional risks of that surgery in someone that young, age shouldn't be an absolute.  Likewise, the majority of teens who undergo labiaplasty (a procedure I do not perform), are patients that have functional pain from their problem.  Similar to breast reduction, these patients can have the same problems - pain, difficulty with clothing, and unwanted attention in the locker room.  

The bottom line is that much of the recent press is sensationalizing a problem that is present, but not nearly to the levels that they would have you believe.