Two characteristics of teen cosmetic surgery stand out – One, as per an expert, teenagers go through the surgeries more easily and the other, the proportion of male- female teenage patients is not as skewed in favor of women as in the case of adult patients.
As per Dr Mary H. McGrath, Professor of surgery in the division of plastic and reconstructive surgery at the University of California, San Francisco, cosmetic surgeries in teenagers are remarkably conflict free when compared to other teen surgeries or adult cosmetic surgeries. The reasons are not clear – since not much research has been done in this respect except rhinoplasty – she said “it could be because surgery comes during a time of great overall change for teenagers”.
18 year old or younger patients took up 1.4% of total surgical & nonsurgical cases of 9.2 millions in America as per the 2011 statistics of the American Society for Aesthetic Plastic surgery (ASAPS) and had 34,663 surgical and 97,214 nonsurgical procedures.
For them, the leading surgical cosmetic procedure was otoplasties (ear cosmetic surgery) in which the males took up 34% of estimated 11,000 cases. Next was Rhinoplasty (nose cosmetic surgery) of which, 20% of the 9,500 procedures were taken up by the males. Breast augmentation, liposuction and breast reduction (for cosmetic reasons) were the next in numbers done. The next common procedure was gynecomastia (male breast reduction) which of course was 100% for males.
The above male teen age proportions are quite higher than the 10% overall male participation figure for all age groups.
Dr. McGrath has some recommendations to deal with teenagers whenever one approaches for cosmetic procedure:
- Assessing physical and mental health as the first step.
- Knowing that the teenager has necessary emotional and physical maturity and has reached growth milestone for the particular surgery, for example breast augmentation for a 16 year old or any procedure for people with psychiatric contra-indication such as Body Dysmorphic Disorder (BDD) are to be ruled out.
- Speaking with the patient alone and also in presence of family member/s to assess degree of support; allowing the patient to articulate the need for the surgery and his or her expectations.
- Plastic surgeon’s own appraisal of the deficiencies, outlining achievable improvements and the potential risks to the patient.
- Asking the teenager to explain how he or she would handle a complication and also to repeat back all the important points of discussion to ensure they truly understand what they are going into.
Dr McGrath also provided some insight on some of the procedures:
Otoplasty – The ears grow 85% by 3 years age. The goal of surgery sometimes is to approximate symmetry. The top of the ear is usually closer to the head than the middle and the bottom end lobule sticks out the most.
” Otoplasty is usually an outpatient procedure. Patients can expect a bulky head dressing postoperatively, suture removal after 7-10 days, and to sleep with an elastic band around their head for 2-3 weeks. Hematoma and infection are potential early complications and residual deformity or asymmetry can emerge later. An estimated 8%-10% of patients undergo reoperations, almost always for asymmetry.”
Rhinoplasty – The noses grow till 17 or 18 years and may outgrow any surgical cosmetic change if done earlier. Rhinoplasty should therefore be avoided till then, even though younger kids may have genuine issues with over sized or unattractive noses.
“Prepare teenage patients for the postoperative course by showing them photos of typical patients. Tell them to expect splinting for 7 days, ecchymosis for 10-14 days, and residual swelling for 2-3 months. Postoperative changes become quickly obvious after a bony ridge removal. In contrast, a nasal tip rhinoplasty, because it involves soft tissue and more edema, can take months to see the final result.”
“This is the hardest surgery we do,” Dr. McGrath said. “It is complicated to understand all the pieces of the puzzle and get it right. It requires the greatest amount of art.” The most common complication is bleeding in about 4% of patients.
Breast Augmentation – Another popular procedure requested by female teens after age 18 is breast augmentation. This not only enhances their body beauty, but also boosts their self confidence and self esteem.
Breast augmentationis not encouraged for early teenagers and only 1.5% of the total breast augmentation procedures was done for 18 year olds and younger in 2011. The purpose is almost always to improve the shape and not necessarily the size. But in 25% cases, operations need to be repeated within 10 years and it is an important issue to know whether this point is acceptable to the patients.
Silicone breast implant is not allowed by FDA before the age of 22 and only saline implant is an option for 18 year olds or younger. The saline implant may be inserted with a small incision and then filled with saline – an advantage over silicone implant.
“Pain, hematoma, seroma, wound infection, and decreased skin sensation are potential complications. These potential complications can become rate when tumescent fluid is utilized; plus it enables the procedure to be performed while the patient is awake; i.e. Awake Breast Augmentation.
However “the problems due to the implantable device are the real issues,” Dr. McGrath said. Scarring can occur around 15% of implants; 8% or 9% can become mal-positioned and about 7% will deflate over 5 years. In addition, patients with a family history of breast cancer may choose not to have implants.”
“Consultation with a qualified cosmetic surgeon who can focus on long-term implications is warranted.“
Breast Reduction – This procedureis to be taken after full breast maturation and growth is achieved, with breast size remaining stable without any growth for 9-12 months. The contra-indications are smoking, obesity, medical conditions that impair wound healing, bleeding disorders or a body mass index greater than 30kg/m2, as in any major procedure.
The patients need informing that lactation is not always possible after such procedures and it has been found that this deters many young women.
Liposuction – Liposuction ad tummy-tucks are not appropriate for teenagers for weight loss, cautions the American Society of Plastic surgeons(ASPS) and obese teenagers are to be advised so. However, lipoplasty, liposculture or liposuction to treat localised fat may be indicated for some teenagers, ideally for those who are at or near ideal body weight with elastic body skin that retracts.
“Submental liposuction of the fat pad creating a double chin in older teenagers can be fantastic. It can be done in an office setting. Bruising, seroma, and bumpy appearance are potential complications. Instruct patients that they will have to wear a compression garment around their head at night for about 3 weeks.“
Gynecomastia – “About 8% of all gynecomastia corrections involved patients 18 years and younger. Approximately 50% are unilateral and 50% bilateral procedures.
Gynecomastia can have a hormonal etiology and be associated with obesity. Surgical results, however, are poorer in the obese patient. The distinction between what is gynecomastia and fat tissue gets murky in overweight patients.
However, an upcoming procedure for male teens is breast liposuction as many teen boys are embarassed by large breasts which can easily be reduced. SmartLipo and tumescent liposuction techniques can now do this while the patient is awake with minimal downtime.
Gynecomastia can be self limited with an average duration of 1-2 years. For those in whom it persists, some seek surgery because it is a source of embarrassment. Like our young women, it’s not so much the size it’s the odd look of a protuberant breast on a male.”
Dr McGrath believes that the central issue for cosmetic surgery is the effect that the perceived problem has on the patient and how much it affects his or her quality of life and if the plastic surgeon thinks he or she has a role to play in improving the quality of life.
[Source: This write up is sourced from the article “Tips and Trends in Teen Elective Plastic Surgery” dated April 06, 2012 By: Damian McNamara, Skin & Allergy News Digital Network]