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Dr. Ellenbogen is leading an effort to create guidelines
for Plastic Surgeons with regards to elective surgery for teenagers.
Below is a copy of the speech he gave at the LA Society of Plastic
Surgeons on August 17, 2005. To join the effort or find out more
about D.A.T.E.S., please email alia@crierpr.com.
D.A.T.E.S.
Recently and on going, the media has insinuated that Plastic Surgeons
operate on teenagers below the age of consent without proper evaluation.
ASAPS and ASPS have no formal policy. They recommend, of course,
proper parental consent and evaluation by the parent for maturity
supervised by a board certified plastic surgeon. The best outcomes
are of course when the teenager initiates the request and is firm
about it for a long time. The goals from the outcome must be realistic
as well as understanding the actual procedure and recovery. Life
changes will occur as a result. ASAPS does recommend that teens
with mood swings, drug abuse, alcohol abuse, or treatment of depression
should be excluded.
Teens tend to have plastic surgery to fit in with their peers.
Teens frequently gain confidence and self-esteem when the physical
problems are corrected. In other words, just like all plastic
surgical patients, the proper candidate with the proper operation
is a good idea. ASAPS agrees that with appropriately selected
teenage patients, cosmetic plastic surgery can have a positive
impact on the emotional and physical development.
Interestingly, the number of teens having cosmetic surgical operations
has been of the same percentage of all plastic surgical operations
fluctuating from 2.5 to 4% for the last six years. Although the
percentages have remained pretty much the same during that time,
the media would like to believe it has
drastically dropped. In 2005, 346,000 teenagers below the age
of eighteen had cosmetic plastic surgery. This is not counting
peels, dermabrasions, scar removal, and laser hair removal which
together constitute more patients under eighteen than all the
surgical procedures. Rhinoplasty has remained at 50%, otoplasty
20%, breast reduction 15%, including 4% for gynecomastia, asymmetrical
breasts 2%, acne scars 2%, breast augs 5%, and chin implants 2%.
With emotional maturity, certain teen operations if the teen is
realistic about the advantages and downsides do not need much
evaluation on the part of the surgeon. Otoplasty is pretty obvious.
The ears are overly large. The teen does not have to convince
the doctor that he is being made fun of in school and has a strong
motivation. Asymmetrical breasts, overly large breasts with back
pain, gynecomastia, acne, chin implants, and bariatric surgery
also need very little convincing of the doctor that the teen is
a good candidate. It is not to say that each case should not be
decided upon its own merit, however.
This leaves rhinoplasty, breast augmentation, and liposuction
as the operations which need proper evaluation. Rhinoplasty if
operated on before physical maturity will require revision because
of growth of certain parts that are out of proportion with others.
Liposuction has to be evaluated on individual cases. The question
here of course are the liposuctions on waists, abdomens, and thighs
that young almost perfect girls desire. The major problem is augmentation
mammoplasty in girls below the age of consent and the age of majority.
It rankles many groups that we are sexually enhancing minors.
Thus, the name dates. These are the patients that we wish to evaluate
very carefully, the young girls trying to become more popular
by breast surgery. Of course each case has to be determined on
its own merit and does not exclude every party.
D.A.T.E.S. RECOMMENDED GUIDELINES FOR TEEN
BREAST AUGMENTATION:
1. A desire of this surgery for at least a year with approval
of both parents.
2. A realistic and mature understanding of the procedure and the
downsides and complications of surgery.
3. Doctors physical assessment that growth is complete so that
further breast growth will not jeopardize results.
4. Patient should be well-adapted in school with grades, social
acceptance, and friends without a history of antisocial behavior
or acting out.
5. No concurrent treatment for depression, eating, or body image
disorders.
6. (We feel this is the most important) A waiting period of three
months or longer and reevaluation.
D.A.T.E.S. RECOMMENDED GUIDELINES FOR TEEN LIPOSUCTION:
1. Proof that diet and exercise have been tried and have been
unsuccessful.
2. A waiting period for patients with contestable small amounts
of waist, abdomen, and thigh liposuction eliminating the perfectionist
syndrome.
D.A.T.E.S. RECOMMENDED GUIDELINES FOR TEEN RHINOPLASTY:
1. The same as breasts stressing that surgery before growth completion
may be a result in deformity and obligatory revisional surgeries.
Each case is evaluated of course on its merit. Each patient is
different just as in our regular plastic surgery practice. However,
the TV shows may stimulate teens to want plastic surgery for the
wrong reasons. We also as plastic surgeons feel it wrong for allowing
young girls to get breast augmentation as a birthday present or
graduation present.
I will submit these guidelines to my peers and the media so that
it can be seen that our only desire as board certified plastic
surgeons is to fit the proper operation to the proper patient.
To join the effort or find out more about D.A.T.E.S.,
please email susan@crierpr.com.
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