For many years now, a popular high school graduation gift has been a nose job or otoplasty (ear pinning). In more recent times, that evolved into breast implants. Since the inception of Instagram in 2010, plastic surgery has seen an enormous rise in teens requesting lip fillers, Botox, and buttock augmentation.  Teens seeking to morph into someone else is fueled by studies that show that “The average millennial takes over 25,000 selfies in his or her lifetime, which is astronomical and one of the major reasons for the self-esteem issues in this age group.” More than 40% of surgeons in a recent American Academy of Facial Plastic and Reconstructive Surgery survey said looking better in selfies on Instagram, Snapchat, and Facebook was an incentive for patients of all ages undergoing surgery.  Dr. Manish Shah is a Denver board certified plastic surgeon. He wants to help teens, and parents of teens, navigate this world of teens and plastic surgery to discuss what is appropriate and at what age in a culture where it can seem as if everyone if having something done.  He understands this quandary as he is not only a plastic surgeon but a father of 3 teenagers.

Breast reduction

Some teens suffer from Juvenile Breast Hypertropy (enlargement). This often results in teasing, name calling, difficulty with exercise and clothing selection problems. It is reasonable to perform breast reduction surgery on these girls after the age of 16. This procedure is performed under general anesthesia and the breast tissue is sent off for pathological evaluation. Recovery tends to be less than two weeks with minimal overall risks. Even though breast reduction can help, these young women are at risk for significant re-enlargement in the future, especially with pregnancy.

Otoplasty (ear pinning)

Kids get teased for having “Dumbo ears” quite routinely. We become aware of the “other” in our lives after the age of 6. Otoplasty can be done at any age after 6. It is a safe surgery that can be easily performed in the office under local anesthesia. 

Rhinoplasty

There are few things a teen can do to hide a nose that they are not happy with or get teased about. Teens can have rhinoplasty surgery, but only after their faces have completed growing. For girls that can be as young as 14 years old, and for boys, it is typically around 17 years old. Often, teens have additional problems with nasal obstruction from trauma as kids. This can be fixed at the same time as the cosmetic surgery. Insurance will often cover the medical portion of the surgery, but the cosmetic portion is usually an out of pocket expense. Recovery tends to be quite easy, and the boost in self-image is often immediate.

Liposuction

Liposuction for teens is not a common procedure. For most teens, they can achieve healthy bodies via proper diet and exercise. Frankly, this is better for them. After 15 years of practice, I can say that I have never performed liposuction on anyone younger than 18 years old. In modern times, we have seen an increase in sedentary behaviors with kids and this has been key in leading to childhood obesity. Frankly getting out to play is the best medicine!

Butt Implants

Butt implants are not a procedure that teens have performed. I reserve this procedure for patients older than 22 years old who have failed exercise as a method for gluteal muscle enlargement and are not candidates for a fat transfer to the butt (Brazilian Butt Lift).

Breast Implants

The American Society of Plastic Surgeons recommends that breast implants, especially silicone implants, not be used in patients less than 22 years of age. This is primarily for reasons of patient maturity and possible early family planning. In my practice this has been the case typically; however I have placed silicone implants in patients as young as 18 years of age because they were financially independent, mature, and already had children of their own. It is important to individualize each patients’ needs to deliver appropriate care.

Botox/Dysport in the Forehead and Crow’s Feet

With today’s access to technology, everyone is squinting to look at tiny screens. Over time, this increases complaints of eyestrain, headaches, and wrinkles. I think neurotoxin can be injected for patients as early as 18 years old, and earlier if treating for migraines. I started injecting my youngest daughter when she was 16 years old because of migraines. The treatment has helped her tremendously. As many parents know, teens have it hard enough as it is, but when they have migraines, it can have fairly negative effects on their lives. The risk of neurotoxin injections is low when parents take their teens to expert injectors. In my practice I perform all injections and I have for almost 17 years!

Chin Implant

Chin implant surgery can be performed in teens after their faces have finished growing. It is a procedure that is often combined with rhinoplasty, and/or chin liposuction to create a better jawline in those whose jaws are underdeveloped. If a patient is not a candidate for jaw surgery by their dental surgeons, they often seek out plastic surgeons for this combination of procedures.

Lip Fillers

Lip fillers are not really something I perform in those younger than 18 years old. There isn’t a significant justification for lip augmentation in this population. After they turn 18 years old and are legally adults, then I have no problem injecting filler as the risks are better understood at this age. Teens have had to grow up much faster than their parents did at the same age. The pressures to conform to fairly artificial beauty standards are high and parents need to help their teens resist these pressures until they are more mature.

Lasers

Lasers for teens are common in two particular scenarios: laser resurfacing for acne scar reduction and laser hair removal. Since teenage acne is ubiquitous, scarring is the big problem afterward. Once teens get their acne under control with the help of a board-certified dermatologist, they can undergo laser treatment to soften the scars and reduce pigment. When excess facial or body hair is a source of emotional distress for a teen, laser hair removal treatments can be used to reduce the problem. Both procedures can be performed after the age of 16 years old with parental support and consent. As there are significant risks with both procedures, I always recommend they consult with experts in skin before having any procedure.

Filler in the Cheeks

I don’t recommend that teens get fillers unless it is to balance off major facial asymmetries that are congenital.

What makes some teens ready for cosmetic surgery and why would you turn away others?

For a teen to be ready for cosmetic surgery, it is necessary that they have family support, both emotionally and financially. They need to display a level of maturity that shows that they have done their research and understand the pros and cons of having a particular procedure. When I turn a teen away, it is most often because they clearly don’t exhibit a level of maturity, understanding, and rationality necessary to make a good decision for themselves. Their ability to consent to treatment is impaired. Often, there is a power struggle between the teen and the parent that clues me into the fact that they are not ready for surgery.

Are there specific procedures you just won’t do under a certain chronological age, and if so, which procedures are they?

Honestly, most of the body procedures are off limits in my practice until the patient is at least 18 years old. I will perform breast surgery on patients with congenital breast deformities before the age of 22 years old. However, routine cosmetic breast surgery can wait until the patients are more mature. Outside of rhinoplasty and chin implant surgery, most facial procedures aren’t appropriate before a patient is in their twenties.

In summary Dr. Shah feels strongly that, “Parents need to have frequent conversations with teens who seem obsessed with selfies and plastic surgery. Adolescents must understand that their idols like Gigi and Bella Hadid, the Kardashians, Cardi B, and others, make their living off their faces and bodies. They represent only a tiny fraction of the general population.  Parents need to stress that while looks do count, so too does brains, ambition, personality, good choices, and talent. In general, the bulk of cosmetic surgery should be reserved for adults who are fully actualized people and want to make tweaks with realistic expectations and motives.”