Plastic Surgery as a graduation gift

There's an article on MSN.com today "Way to go, grad! Here's a check for a new nose - Is cosmetic surgery an appropriate commencement gift for teens?" that's kind of interesting. It's a brief synopsis over the increasing trickle-down of Plastic Surgery procedures to teens which ballooned to 244,000+ procedures in 2006 (data form the Amer. Society of Plastic Surgeons (ASPS)), including about 47,000 nose jobs and 9,000 breast augmentations. The discussion mostly centers around teenage girls and breast surgery. The few teenage boys you see in a Plastic Surgeon's office usually have gynecomastia (excess male breast tissue).

The story of one of the the teens featured caught my eye,

When Courtney Powers graduated from high school last year, she didn’t receive a new computer or a trip to Europe. The North Carolina teen got a pair of D-cup breast implants.

“My breasts hadn’t grown since I was 16,” says Powers, who underwent cosmetic surgery two days after her 18th birthday. “I was a 36AA and my mom and dad knew I was very self-conscious.”

Not to beat a dead horse, but in general, I'd consider the implant size (425-500+ cc) required to go from an A-cup to a D-cup to be a very,very poor choice for long term results in most women. Larger implants are both heavier and wider which dramatically accelerate "aging" of the breast tissue and skin. Ms. Powers' native horizontal and vertical boundaries and tissue attachments likely had to be violated to accommodate her implants, which is something best avoided when you can help it. Avoiding over-sized implants (particularly saline, as they're heavier) is the single most-effective thing you can do in breast surgery to minimize reoperation rates. Last year the perceived problem breast augmentation in teens by a prudish politician caused a mild political controversy in Australia, which I touched upon here.

Issues about the propriety of doing surgery on adolescents or young adults come up a good deal in our field as almost all these procedures are elective rather then absolutely necessary. It's a little patronizing to make blanket statements about older teens like Ms. Powers, as many of them are old enough to vote, marry, or serve in the military. With younger teens it becomes something to consider on an individual basis and becomes invested with a lot of gray area.

Is it appropriate to do teen surgery for breast reductions or reconstruction of congenital breast deformities (which often require implants)? Many feminists who decry cosmetic surgery in teens (or adults) would probably make exceptions for those patients despite the fact that those operations are often cosmetic (rather then functional). The ASPS position paper on elective breast surgery and other procedures recommends using 18 years old as a relative (but not absolute) guide for practice guidelines.

There's a little of the PC sentiment about inner beauty proffered in the article on MSN by Courtney Macavinta, author of “Respect: A Girl’s Guide to Getting Respect and Dealing When Your Line Is Crossed.”

"By giving teen girls, in particular, surgery we’re just sending this message to them that they can be anything they want to be — they can go to any school or do anything in life — as long as they look a certain way on the outside.

I’m all for taking a shower, combing your hair and getting a cute outfit, but there is only a tiny percentage of people whose profession and success rely on appearance,” says Macavinta. “The girls who thrive and prosper in life very quickly invest their energy other places — like their brains, compassion and humor."

This is quickly squashed with a cold,hard dose of reality by Dr. David Sarwer, Associate Professor of Psychiatry at the Hospital of the University of Pennsylvania, and probably the world's authority on issues of body image and psychological outcomes in Plastic Surgery

“From a societal perspective, the reality is that whether we like it or not, our appearance does seem to matter.Studies show that attractive people are treated more favorably and that a positive body image can account for up to one-third of self-esteem....Body image improves after surgery. Self-esteem and quality of life can improve as well. However, more studies are needed before we can say that kids benefit the same way adults do.” "

Rob Oliver Jr. MD