New Guidelines Seek to Rein in Inappropriate Teen Plastic Surgeries

New teen plastic surgery guidelines call for age consideration, parental consent and other measures to improve upon the safety of these procedures.

The guidelines are published in the September issue of Plastic and Reconstructive Surgery®.

About 229,000 cosmetic procedures were performed on patients aged 13 to 19 in 2017. Currently, teenagers account for about four percent of all cosmetic surgery procedures, with the most common procedures among teens being nose reshaping, male breast reduction and ear surgery, according to statistics from the American Society of Plastic Surgeons (ASPS). Adolescents also account for a small percentage of total nonsurgical cosmetic procedures, such as laser hair removal, skin resurfacing and Botox injections.

Most notable of the guidelines are age considerations, which vary based on each procedure and the growth and development of the area of the body being operated on. Additionally, the doctors reinforce the important steps that should be taken when assessing underage patients, including obtaining parental consent, determining the physical and emotional maturity of the patient and discussing their desires, goals, risks, expected postoperative course, limitations and complications of the procedure.

Guidelines for the most popular plastic surgery procedures, include:

•           Rhinoplasty: In children and teens with significant nasal deformities, nose reshaping may be recommended. It is recommended that surgery not be performed until nasal growth is completed – typically age 15 to 16 in females and age 16 to 18 in males. In some situations, such as a child with a cleft lip, a rhinoplasty may be performed at a younger age.

•           Breast reduction: To alleviate back and neck pain, a breast reduction is commonly performed on teen girls; however, it's important to ensure that surgery is performed after the patient has completed breast development, which typically occurs between 12 and 19 years of age. Additionally, breast enlargement can be a temporary problem in adolescent boys, but is sometimes treated by male breast reduction if it has not resolved in the early teen years.

•           Otoplasty: Surgery to correct ear deformities can be performed as young as age five, as this is when the ear is almost fully grown.

•           Liposuction: Unless performed as part of a breast reduction surgery, it is not recommended that a teenager undergo liposuction.

•           Breast augmentation: Candidates with uncommon chest deformities or congenital breast asymmetry are generally the only cases in which a board-certified plastic surgeon should deem breast augmentation appropriate for a teenager. It's important to note the Food and Drug Administration approved saline-filled breast implants for breast augmentation in women age 18 or older and for breast reconstruction in women of any age. The FDA approved silicone-filled implants for women age 22 or older.

"While a rhinoplasty or ear surgery can be performed safely by a board-certified surgeon and are, in many cases, appropriate for an adolescent, other cosmetic procedures such as breast augmentation, liposuction or injectables are typically not recommended for minors for several reasons, including lack of research," says plastic surgeon Rod J. Rohrich, M.D of the Dallas Plastic Surgery Institute. "It's concerning that there has been a surge in the use of injectables in young patients to achieve augmented cheeks and lips when there is no evidence that these procedures are safe for adolescents." 

The American Society of Plastic Surgeons emphasizes the importance of understanding a teen's motive for surgery and ensuring that every potential teenage patient undergoes a careful and extensive preoperative evaluation to ensure they are an appropriate candidate for their desired procedure.

"Despite its growing popularity, guidelines and outcome studies for teenage plastic surgery have previously not existed," explains study co-author Min-Jeong Cho, M.D, a plastic surgeon at the Dallas Plastic Surgery Institute. "Our research exposed a need for stringent guidelines, particularly when it comes to determining when a procedure is appropriate to perform and the recommended age for each procedure, so that's what we set out to deliver."

PHOTO CAPTION: Dr. Rohrich consults with a teen patient