Dr. Bosshardt's Blog

Plastic Surgery in Adolescents

(This appeared as one my columns in the Orlando Sentinel in January 2001)

Q: A recent article in the paper was about a 15 year old girl who was seeking breast enlargement surgery with her motherÂ’s blessing. There seemed to be a lot of concern about this, presumably because of her young age. Is there a minimum age for plastic surgery?

A: The answer to this question depends on whether you are speaking of cosmetic or reconstructive surgery and must take into consideration both physiologic and  psychological concerns. Reconstructive surgery is done routinely on children and even infants. Timing in such cases, however, is crucial. An excellent example is the repair of cleft palate. In this deformity, the two halves of the roof of the mouth fail to fuse leaving a gap which typically affects the muscles of the soft palate. Because there is no separation between the mouth and nose, food and liquid can go up into the nose when the infant eats. In addition to this, speech cannot develop normally since an intact palate is essential for normal speech.

Repair of the cleft palate is a significant surgical procedure which cannot be done until the baby has reached a sufficient weight to withstand the surgery and , equally  important, the anesthesia. If repair is done too soon it can affect the growth of the upper jaw. If done too late, after speech has begun to develop, then the results of the repair will not be as good. Most cleft palate surgery is done around 18 months of age for these reasons.

Otoplasty, or correction of prominent ears presents a different problem. Prominent ears do not cause any difficulties with hearing.  The concern here is more of a psychological and/or social one. Children are not overly concerned with their appearance until around 5 or 6 years of age. This coincides with the time kids start kindergarten and become more socialized. Around this time clothing and appearance become more an issue. This is when teasing usually begins in earnest and, unfortunately,  children with prominent ears often bear the brunt of teasing from their peers. Corrective surgery is fairly simple but can stunt growth of the ear. Full growth of the ear is not achieved until adolescence but the ears reach about 80% or so of their adult size by the age of 6 or 7. In this case, to prevent unnecessary  emotional distress, we fix the prominent ears at this time since any affect on future growth will be minor.

Unlike reconstructive surgery, cosmetic plastic surgery is done to try to improve the appearance of an otherwise normal structure. Medical necessity and functional problems do not apply. By definition, cosmetic surgery involves a change in appearance, sometimes a fairly dramatic change, and therefore the body image of the patient must always be taken into consideration. The adolescent, i.e. the teenage years, are a time of tremendous changes in appearance and establishment of a healthy body image is one of the desired results of this period of passage into adulthood. That this is a difficult transition is clearly evident from the prevalence of eating disorders among teenage girls.

A lack of sufficient conclusive studies on the effect of cosmetic plastic surgery performed on teenagers has made it impossible to establish any consistent guidelines regarding how to approach this issue. It would , however, seem obvious that such surgery should be approached with great caution. Age alone, should not be the only consideration and emotional maturity and basic physiological facts should be taken into account.

In the case of breast augmentation, breast development varies greatly among women, both in age of onset  and in ultimate size of the breasts. In my opinion, a 15 year old girl with small but otherwise normal breasts is young to be considering breast augmentation. Significant breast development may occur in the years that follow. I would hesitate to recommend this procedure for women under 18 years of age. By then, breast size should be fairly stable.

The situation is different if one breast is normal and the other is visibly smaller, a cup size or more. This situation does not correct itself spontaneously and can be emotionally very distressing. Augmentation of the underdeveloped breast, sometimes with an adjustable implant to allow for future growth, can provide great psychological relief.

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