Date: Fri, 11 Aug 2000 11:34:54 -0700

Good morning Ilena:

I just read some disturbing news about Implant Surgery on teenagers under 18 and wanted to share those two sites with you and your extended family.

Plastic Surgery Briefing: Plastic Surgery for Teenagers

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Teenagers who express a desire for plastic surgery are usually similar to adults in their motivations and goals. Often seeking to improve physical characteristics about which they feel awkward or flawed, teens may achieve the same gains as adults in self-esteem and confidence when their problems are corrected. In fact, successful plastic surgery may result in reversal of the social withdrawal that so often accompanies teens who feel "different."

Not every teenager seeking plastic surgery is well suited for an operation. Without a measure of emotional maturity and an understanding of the limitations of plastic surgery, an unstable teen may not be able to take full advantage of the opportunities offered by a surgical procedure. In addition, certain milestones in growth and physical maturity must be achieved before undergoing plastic surgery.

Although health insurance does not pay for purely cosmetic surgery, coverage is usually provided when a procedure alleviates physical symptoms or improves a bodily function. Such is usually the case, for instance, when breast reduction eliminates the rashes, shoulder grooves, and back and neck pain that have prompted the request for surgery.

The American Society of Plastic Surgeons (ASPS) has no formal position on cosmetic plastic surgery for teenagers. However, ASPS advises parents to appraise the teen's physical and emotional maturity and believes that individual cases merit careful evaluation under the guidance of a board-certified plastic surgeon. The most rewarding outcomes are expected when the following exist:

1. The teenager initiates the request. While parental support is essential, the teen's own desire for plastic surgical improvement must be clearly expressed and repeated over a period of time.

2. The teenager has realistic goals. The young person must appreciate both the benefits and limitations of plastic surgery, avoiding unrealistic expectations about life changes that will occur as a result of the procedure.

3. The teenager has sufficient maturity. Symptoms of emotional distress must be reduced to a level that will permit the teen to tolerate the discomfort and temporary disfigurement of a surgical procedure. Plastic surgery is not recommended for teens who are prone to mood swings or erratic behavior, who are abusing drugs and/or alcohol, or who are being treated for clinical depression or other mental illness.

* Rhinoplasty: Plastic surgery may be performed on the nose to straighten the bridge, remove an unsightly hump, reshape the tip, or open breathing passages. Ordinarily this is not performed until the nose reaches its adult size, about age 15 or 16 in girls and a year later in boys. In the event of a prior injury or obstruction to breathing, insurance may cover a portion of the procedure.

* Breast Reduction: Surgical reduction of very large breasts can overcome both physical and psychological burdens for a teenage girl. Although waiting may prolong the awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. Insurance reimbursement is often possible with this procedure.

* Otoplasty: Surgical correction of protruding ears, in which the ears are "pinned back," may be performed any time after the age of five.

* Acne and Acne Scar Treatment: Acne eruptions may be brought under good control by the proper use of modern prescription drugs, such as Retin-A. In addition to supervising the use of these medications, plastic surgeons may be able to improve acne scars by smoothing or "refinishing" the skin with a laser or with a sanding technique called dermabrasion.

* Correction of Enlarged Breasts in Boys: Teenage boys with large, breasts (gynecomastia) are often eager to undergo plastic surgery. Surgical correction, accomplished in a variety of ways, is frequently covered by insurance.

* Breast Augmentation: Effective May 10, 2000, the Food and Drug Administration (FDA) ruled that saline-filled breast implants were approved for breast augmentation in women 18-years or older and for breast reconstruction.

* Correction of Breast Asymmetry: When one breast grows to a much larger size than the other, an operation may correct the discrepancy by reducing the larger breast, augmenting the smaller, or both. Insurance reimbursement is often possible with this procedure.

* Liposuction: Localized deposits of unwanted fat in such areas as the hips or thighs may be improved by the use of liposuction. The procedure is not a treatment for obesity, however, and provides the best results in patients who are closest to their ideal weight.

Additional information on these procedures can be found on the ASPS website at www.plasticsurgery.org .

Because there are no federal or state laws governing the scope or quality of specialty education a physician must attain to designate him/herself a specialist, parents should exercise care in selecting a plastic surgeon for a teenager. In particular, ASPS recommends that parents inquire whether plastic surgery privileges have been granted to a particular surgeon at an accredited hospital, because hospitals must examine credentials carefully before granting specialty privileges to staff physicians.

If any procedure is to be performed outside a hospital, parents may want to inquire whether the surgical facility meets one or more of the following criteria:

* The faculty is accredited by a national or state recognized accrediting agency/organization, such as the American Association of Ambulatory Healthcare.

* It is Medicare certified, and/or it is state licensed.

The American Society of Plastic Surgeons represents 97 percent of all physicians certified by the American Board of Plastic Surgery (ABPS). By choosing an ASPS member plastic surgeon who is certified by the ABPS, one can be assured that the physician has graduated from an accredited medical school and completed at least five years of additional residency training, usually three years in general surgery and two years of plastic surgery. Additionally a physician must also practice plastic surgery for two years and pass comprehensive written and oral examinations.

Consumers may call the Plastic Surgery Information Service at 1-888-4-PLASTIC (475-2784) or visit the ASPS website at www.plasticsurgery.org for informational brochures and the names of qualified plastic surgeons in their area.

This document is designed to provide accurate and authoritative information on the topic covered as of the date of publication and is subject to change as scientific knowledge and technology advances and as practice patterns evolve. The views expressed represent the collective, but not necessarily the individual, views of members of the American Society of Plastic Surgeons.

Too Young for Breast Implants?

I've been hearing that more and more teenagers are getting breast implants. Is it safe to have plastic surgery at such a young age? What is the best age to get breast implants? -- Anonymous

(Published 8/10/00) I'm afraid you're right about a disturbing trend among teenage girls -- more are getting breast implants than ever before. According to the American Society of Plastic Surgeons (ASPS), in 1998 (the last year for which complete figures are available), more than 1,800 girls younger than eighteen had breast implants. That number is up 47 percent from 1996, and up 89 percent from 1992. And those numbers don't include implants provided by surgeons who aren't members of the ASPS. Incidentally, most of the surgeries were performed in three states -- California, Texas, and Florida.

I find this trend distressing because I believe this kind of surgery reflects a nonacceptance of the body. I'm also afraid that many young women don't fully appreciate the risks involved. Plastic surgery isn't benign. It poses the same types of risk of infection and bleeding as other types of surgery. And there are risks unique to breast implants:

* Capsular contracture, which can occur if the scar around the implant tightens, makes the breast feel hard. The implant or the scar tissue may have to be removed with more surgery.

* Nipple numbness or oversensitivity can develop among some women. This is usually temporary but can become permanent.

* Implant breakage or rupture can occur as a result of injury, normal compression, or even ordinary movement of the breast. If a saline-filled implant breaks, the fluid will leak out and the implant will deflate.

* Implants don't last forever, so you have to be prepared to undergo surgery again down the road. Reputable plastic surgeons will try to make sure that any woman seeking breast implants does not have unreasonable expectations about how the surgery will affect her life. From a medical point of view, I don't know that there are any age limits on breast augmentation, but certainly anyone seeking the procedure should be mature enough to deal with the significant change they are making to their body -- as well as the discomfort that follows any type of surgery. Even so, I would try to discourage teenage girls from undergoing cosmetic surgery, in general -- a few extra years can add up to a very different and much healthier body image.

Dr. Andrew Weil