Teenagers & Plastic Surgery: What a Plastic Surgeon Thinks About 11 Plastic Surgery Procedures Often Gifted to Teens by Dr. George Bitar

For many years now, a popular high school graduation gift has been a nose job or otoplasty (ear pinning). In more recent times, that evolved into breast implants. Since the inception of Instagram in 2010, plastic surgery has seen an enormous rise in teens requesting lip fillers, Botox and buttock augmentation. Teens seeking to morph into someone else is fueled by studies that show that the average millennial takes over 25,000 selfies in his or her lifetime, which is astronomical and one of the major reasons for the self-esteem issues in this age group.

More than 40 percent of surgeons in a recent American Academy of Facial Plastic and Reconstructive Surgery survey said looking better in selfies on Instagram, TikTok, Snapchat and Facebook was an incentive for patients of all ages undergoing surgery. 

I want to help teens and parents of teens navigate this world of teens and plastic surgery to discuss what is appropriate and at what age in a culture where it can seem as if everyone if having something done. I understand this quandary as I'm not only a plastic surgeon, but a father of a teenager.

1. Breast Reduction

Some teens suffer from Juvenile Breast Hypertrophy. This often results in teasing, name calling, difficulty with exercise and clothing selection. It is reasonable to perform breast reduction surgery on these girls as early as 13 because it is a medically necessary surgery in terms of relieving back pain, neck pain and psychological trauma associated with heavy breasts. This procedure is performed under general anesthesia and the breast tissue is sent off for pathological evaluation. Recovery tends to be less than two weeks with minimal overall risks and very happy and grateful patients.

2. Otoplasty (Ear Pinning)

Kids get teased for having "Dumbo ears" quite routinely. We become aware of the "other" in our lives after the age of 6. Otoplasty can be done at any age after 6. It is a safe surgery that can be easily performed in the office under local anesthesia, or if the patient or parents should choose, general anesthesia is available. This procedure should only be performed if it bothers the patient and not the parents. If a patient is OK with their ears, then this surgery should not be performed.

3. Rhinoplasty

There are few things a teen can do to hide a nose they are not happy with or get teased about. Teens can have rhinoplasty surgery, but only after their faces have completed growing. For girls that can be as young as 15 years old, and for boys, it is typically around 16 years old. Often, teens have additional problems with nasal obstruction from trauma as kids. This can be fixed at the same time as the cosmetic surgery. Insurance will often cover the medical portion of the surgery, but the cosmetic portion is usually an out-of-pocket expense.

I am one of the pioneers of the non- surgical rhinoplasty, which is a five-minute procedure in which a filler is injected to shape the nose. It can improve the appearance of a bump or bulbous tip, or even a deviated septum, to a limited extent, and thus avoiding or delaying surgery. This procedure is very popular among teenagers because it is much less expensive than a surgical rhinoplasty, it is reversible, and will last about a year or so, so it is not as huge a commitment as a surgical rhinoplasty.

The apps available to modify noses on smartphones has created anxiety among teens, and the perception that their idols' noses on social media are perfect is thanks to apps and digital alterations. Therefore, it is very important to discuss with a teenager and their parents what are the realistic goals that a rhinoplasty, surgical or non-surgical, is expected to achieve.

4. Liposuction

Liposuction for teens is not a common procedure. For most teens, they can achieve healthy bodies via proper diet and exercise. Frankly, this is better for them. I can say that I have never performed liposuction on anyone younger than 18 years old and rarely under 25.

5. Butt Implants

Butt implants are not a procedure that teens should have performed. I personally do not like nor perform this operation because of its high rate of complications. I believe this procedure should not be undertaken in patients less than 21 years old. Other better alternatives are exercise as a method for gluteal muscle enlargement and fat transfer to the butt (Brazilian Butt Lift), which is popular among women 30s to 50s .

6. Breast Implants

The American Society of Plastic Surgeons recommends that breast implants, especially silicone implants, not be used in patients less than 22 years of age. This is primarily for reasons of patient maturity and possible early family planning. I have performed saline breast implants on women 18 and older, and because I do it from the armpit, there is no visible scar. It is a popular procedure in my practice with the demand for teenagers on the rise! These patients are incredibly happy with their breast augmentations. A big misperception is that women who have breast implants early in life cannot breast feed and will lose nipple sensation. Those two complications are incredibly rare in my practice.

7. Botox in the Forehead and Crow’s Feet, As Well As for Gummy Smile Correction

With today's access to technology, everyone is squinting to look at tiny screens. Over time, this increases complaints of eyestrain, headaches and wrinkles. I think neurotoxins can be injected for patients as early as 25 years old for cosmetic reasons, and earlier if treating for migraines. I have not treated teenagers with Botox to reduce wrinkles or as age prevention tool. I have injected Botox in teenagers to improve a gummy smile. Botox is injected in the muscles that elevate the upper lip and make them less active to fix a gummy smile. This is a simple procedure that makes teens with gummy smiles smile a lot more!

8. Chin Implant

Chin implant surgery can be performed in teens after their faces have finished growing. It is a procedure that is often combined with rhinoplasty, and/or chin liposuction to create a better jawline in those whose jaws are underdeveloped. If a patient is not a candidate for jaw surgery by their dental surgeons, they often seek out plastic surgeons for this combination of procedures.

9. Chin and Cheek Fillers

Nonsurgical chin and cheek augmentation, with fillers to shape the chin and cheeks, is a very common procedure in my practice. Similar to non-surgical Rhinoplasty, nonsurgical chin and cheek augmentation give a nice contour of the chin with a fillers, as opposed to a silicone implant. The advantages are that it is less expensive than a chin/cheek implant, it is a procedure that takes a few minutes without any downtime, and it is temporary. If a patient likes the shape of the chin or cheeks and wants to continue doing fillers, they can. If they want more volume, they can have more fillers. Ultimately if they want a more permanent solution then there are chin and cheek implants as an option.

Fillers to noses, chins and cheeks have given teenagers a lot more flexibility at a lower price point than surgery. The nonsurgical facial chiseling trend for teenagers is here to stay.

10. Lip Fillers

Lip fillers are not really something I perform in those younger than 18 years old. There isn't a significant justification for lip augmentation in this population. After they turn 18 years old and are legally adults, then I have no problem injecting filler if the volume request is reasonable and the young patient has realistic expectations and a healthy body image. Creating attractive lips in teenagers is an art and can have a very high rate of satisfaction. Since the material injected is hyaluronic acid, then it can easily be dissolved if the patient does not like it. I feel the injector, whether a physician, a PA or a nurse, has a moral obligation to create attractive, normal looking lips for teenagers and not overfill the lips and create an unnatural and unhealthy look.

11. Lasers

Lasers for teens are common in two particular scenarios: laser resurfacing for acne scar reduction and laser hair removal. Since teenage acne is ubiquitous, scarring is the big problem afterward. Once teens get their acne under control with the help of a dermatologist, they can undergo laser treatment to soften the scars and reduce pigment. When excess facial or body hair is a source of emotional distress for a teen, laser hair removal treatments can be used to reduce the problem. Both procedures can be performed after the age of 16 years old with parental support and consent. For hirsute teens, laser hair removal of the face is God-send and can improve tremendously their self image!

When Are They Ready?

What makes some teens ready for cosmetic surgery and why would you turn away others? For a teen to be ready for cosmetic surgery, it is necessary that they have family support, both emotionally and financially. They need to display a level of maturity that shows that they have done their research and understand the pros and cons of having a particular procedure. When I turn a teen away, it is most often because they clearly don't exhibit a level of maturity, understanding, and rationality necessary to make a good decision for themselves. Their ability to consent to treatment is impaired. Often, there is a power struggle between the teen and the parent that clues me in to the fact that they are not ready for surgery.

My ultimate litmus test in deciding whether to operate on a teen or not is the question: "If this patient develops a complication are they able to handle it maturely and in a safe way?" If the answer in my mind is "no" then I will not offer them surgery.

Specific Procedures and Chronological Age

Honestly, most of the body procedures are off limits in my practice until the patient is at least 18 years old. I will perform breast surgery on patients with congenital breast deformities before the age of 22 years old, such as Poland's syndrome, where a muscle is missing in the chest causing a chest deformity. However, routine cosmetic breast surgery can wait until the patients are more mature. Outside of rhinoplasty and chin implant surgery, most facial procedures aren't appropriate before a patient is in their twenties.

I feel strongly that parents need to have frequent conversations with teens who seem obsessed with selfies and plastic surgery. Adolescents must understand that their idols like Gigi and Bella Hadid, the Kardashians, Cardi B and others make their living off their face and bodies. They represent less than only 1 percent of the population. Parents need to stress that while looks do count, so too do brains, ambition, personality, good choices and talent. In general, the bulk of cosmetic surgery should be reserved for adults who are fully actualized people and want to make tweaks with realistic expectations and motives.

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