Plastic surgery in children and adolescents.

Abstract

A n increasing number of children and adolescents now undergo plastic surgery to alter their physical appearance. The American Society of Plastic Surgeons (ASPS, 1999), which represents 97% of all physicians certified by the American Board of Plastic Surgery, reported that 24,623 persons under the age of 18 underwent cosmetic procedures in 1998 (see Table 14-1). This represents an 80% increase in the number of procedures from 1996 and a 138% increase since 1994. These figures are an underestimation of the actual number of cosmetic surgeries performed annually, because many nonelastic surgeon physicians now perform cosmetic procedures. For example, the American Society for Aesthetic Plastic Surgery (ASAPS, ZOOO), which includes procedures performed by dermatologists, otolaryngologists, and plastic surgeons, reported that more than 175,000 adolescents underwent cosmetic procedures in 1999. (The difference in the numbers is largely accounted for by chemical peels used to treat acne and laser hair removal.) If other more or less permanent methods to alter one's appearance (i.e., tattoos, body piercing, branding, and orthodontia) are considered also, it is likely that more children and adolescents are modifying their appearance than at any other time in history.Cosmetic surgery is designed to improve the appearance of an individual with a "normal" appearance, and includes procedures such as liposuction (fat removal), rhinoplasty (nose surgery), and breast augmentation. Each year, thousands of adolescents also undergo reconstructive surgical procedures such as cleft lip and palate, that are used to treat a person with an "abnormal" appearance in an attempt to return them to a "normal" appearance. Because of the lack of agreement as to what constitutes a "normal" appearance, the line between cosmetic and reconstructive procedures is often unclear.

Body Dysmorphic Disorder in Cosmetic Surgery Patients

“…60 Given the evidence that the vast majority of persons with BDD do not benefit from cosmetic procedures, coupled with potential for BDD sufferers to become violent toward themselves and possibly their surgeon, BDD is often considered a contraindication for cosmetic surgery. [61][62][63] In most cases, these patients should be referred for further psychiatric evaluation and treatment.…”

Psychological Issues in Patient Outcomes

“…First, cosmetic surgery patients exhibit a wide range of psychological symptoms and it appears that all psychiatric disorders likely appear among them. 19,30,43 Nevertheless, with the exception of body dysmorphic disorder (BDD; discussed later) the relationship between preoperative psychopathology and postoperative outcome is unknown. Second, in the absence of conclusive results, it may be premature to confidently conclude that cosmetic surgery leads to psychological benefits in the majority of patients.…”

“…Very little is known about the psychological characteristics of adolescents who seek these procedures and the effects of these procedures on their psychological development. 43 One concern is that adolescents do not appreciate the relatively permanent effects of these procedures on their bodies. Adolescents also may be less likely to fully understand the risks and potential side effects of a procedure, although some adults also see cosmetic surgery as a medical treatment with minimal risks and few side effects that produce "Cinderella-like" transformations in appearance.…”

“…As noted previously, it is likely that all of the major psychiatric disorders exist among the increasing number of individuals who seek cosmetic surgery. 19,30,43 With the exception of BDD, however, the prevalence of specific disorders among the population of cosmetic surgery patients is unknown. Similarly, the relationship between preoperative psychopathology and postoperative outcome is unknown.…”

“…71 Given the evidence that the vast majority of persons with BDD do not benefit from cosmetic procedures, coupled with potential for BDD sufferers to become violent toward themselves and possibly their surgeon, BDD is typically considered a contraindication for cosmetic surgery. 19,30,43 In most cases, these patients should be referred for further psychiatric evaluation and treatment.…”