Take the commercialization of aesthetic surgery: print media, reality television, the Internet, advertisements. Add to it the increasing number of medical specialties entering the realm of aesthetics: facial plastic surgeons, oculo-plastic surgeons, dermatologic plastic surgeons, dental plastic surgeons, and plastic surgeons who have shifted away from reconstruction. Stir in a societal obsession with beauty defining success and the desire for quick fixes, and you have a perfect storm for the expansion of plastic surgery into Generation X and younger people.
As a plastic surgeon dedicated to the care of teens and adolescents, I have seen the benefits that plastic surgery can have when it is performed on the right patient at the right time and for the right reason. I know from my years of involvement with this patient population that what I do can truly advance a person’s quality of life.
I am an advocate for what I do and for the patients I treat. However, I worry that plastic surgery on teens and adolescents may become an abused marketplace.
Teens today are exposed to much more uncensored information than those in preceding generations. If they see something on television or in a magazine, they are only a mouse click away from finding as much detail about it as they desire.
An advertisement for an aesthetic surgeon in a magazine can soon become a Q&A session on that surgeon’s Web site. It may result in a consultation, unbeknownst to the teens’ parents—until the fee appears on their credit card.
Generation X is especially overexposed to aesthetic surgery. A reality show may imply that aesthetic surgery is just another aspect of good grooming and pay little attention to the risks of such procedures. In addition to the media, there is the sheer number of peers and family members—siblings, parents, and grandparents—who have had plastic surgery.
“Aesthetic surgery” has, unfortunately, become a generic industry that crosses specialties, cultures, and generations. It can play upon an individual’s insecurity and the promise of an instantly better life.
This has placed many responsible plastic surgeons on the defense, causing them to spend considerable time explaining why a person does not need surgery or is not a good candidate for a desired procedure. As aesthetic surgery shifts from a “service” profession, where the goal is problem solving, to a “product” industry, where the goal is to buy perceived perfection, the job of the responsible surgeon becomes harder.
The task of the surgeon who cares for teens and preteens is easier or harder, depending on one’s frame of reference. Television programs like I Want a Famous Face, The Swan, Extreme Makeover, Miami Slice, and Dr. 90210 glamorize and trivialize the significance of the responsibility in patient selection and make surgery sound too easy. Magazines like Teen People, Teen Cosmo, and Teen Vogue display airbrushed photos of celebrities, creating images that are barely attainable by the celebrities themselves—much less by the average teen wannabe.
For surgeons with a conscience who are concerned about improving the self-esteem of children with psychologically damaging physical flaws, patient selection becomes a greater challenge. Conversely, for those surgeons looking for an expanding market, the media provides it for them. All they need to do is hyperlink their Web sites to purchasable domain names and sell their wares.
Unfortunately, there is no easy solution, only steps in the right direction. First and foremost is education at all levels.
Physicians who care for this patient population must be on guard with a strict moral conscience. We need to determine which patients will benefit from plastic surgery and which will not. This is a tall order with many levels of communication: physician-patient, physician-parent, physician-referring physician, physician-consultant.
Plastic surgeons also must follow the American Society of Plastic Surgeons (ASPS) guidelines for teenage and adolescent surgery—particularly if this is not part of their everyday practice. Occasionally, treatment outside the guidelines will be mandated—but only for a good reason.
Plastic surgeons must protect their integrity by supporting those patients in need and yet not allowing the marketplace to drive their surgical decisions.
The media must be educated on the risks, benefits, and outcomes of plastic surgery, and the depth and breadth of the specialty. If the media paid more attention to plastic surgery’s reconstructive aspects, then perhaps a board-certified plastic surgeon would receive more respect and his opinions would be more valued.
The ASPS must constantly remind the media about the seriousness of plastic surgery on teens and not allow our profession to be trivialized. I would even suggest airing public service announcements to that effect—especially before, during, and after the sensationalized plastic surgery-themed reality television programs.
Families must become aware of the benefits and risks of plastic surgery. Children in need should not be dismissed out of hand. Conversely, teens must be taught that plastic surgery is not a panacea for the everyday angst of adolescence.
Frederick N. Lukash, MD, FACS, is in private practice in New York City and Manhasset, NY. He can be reached at (516) 365-1040 or .