I frequently hear the question, “How old is too old for plastic surgery?” I have covered that issue in a previous blog. The flipside to that query is the question, “How young is too young for plastic surgery?” To answer that question let’s first consider matters from a general perspective.
GENERAL CONSIDERATIONS
If the surgery is reconstructive in nature – that is to improve health or correct a severe deformity – a person is never too young to have surgery. For instance, if a child sustains a laceration, the parents may decide that the child needs stitches even if the child cries in protest. A similar situation arises for a child who has a cleft palate or a cleft lip. Surgery is appropriate. A slightly trickier situation is that of a 5 year old child with prominent ears. The parents believe that the child will be teased by their classmates when they begin to attend school and want to have the ears surgically set back. This would make it a reconstructive operation and I believe that the parents would be acting appropriately.
These cases involve decisions by parents for young children. What about a teenager who wants to have cosmetic surgery like breast augmentation? First of all, any patient in the state of California who is under the age of 18 must have their consent for surgery signed by a parent or guardian (who will hopefully exercise good judgment in the matter!) The law also states that silicone breast implants cannot be used until the person is over 21. Even if this law was not present, I think that it is important that the person be sufficiently mature to make a decision about changing a body part that may influence them to engage in inappropriate behavior. The American Society of Plastic Surgeons of which I am a member has an official position against breast augmentation for most teens under 18. I would add that cosmetic surgery at such a young age may encourage a person to develop an unhealthy preoccupation with their bodily appearance.
What about liposuction? Although there is no law governing the minimal age at which it can be done, I would again be concerned that cosmetic surgery at such a young age may encourage them to have an unhealthy preoccupation with their bodily appearance. There have been recent media reports of young girls undergoing liposuction at the request of their parents to correct areas of excess fat. I think that unless this is medically indicated, this type of thing encourages surgical body shape alteration that would be better done by life style alteration that includes more exercise and attention to proper dietary habits. Furthermore, the body of these pubescent females is changing and liposuction may be found to be unneeded if additional time is allowed for physical maturation. In these cases of young women considering cosmetic surgery, I also think it wise that their pediatrician or mental health provider also be consulted as to the wisdom of surgery.
PROCEDURE SPECIFIC CONSIDERATIONS
Let’s look at some specific procedures and age considerations.
• Breast reduction for young women and gynecomastia excision for young men are often requested. My opinion is that not only should the patient be sufficiently mature to make a decision, but several years should have elapsed since any significant growth of the breasts has occurred.
• Nasal surgery should be avoided until facial bone growth is complete, something that has usually occurred by the mid to late teens. Earlier surgery can damage the growth centers in the nose that can lead to significant nasal deformities.
• Breast reconstruction in young women who have major degrees of asymmetry between the two sides should normally be deferred until the patient’s breasts have stopped growing for two years. Otherwise the patient may find that her breasts continue to grow after surgery and the deformity returns! This surgery will usually involve a combination of augmentation and lifting. Unless the deformity is severe, I think it wise that the patient be of age 18 or older for the reasons I mentioned above.
What do you think?
Should you have any further questions, please contact my office.
George Sanders, M.D.
