| 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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