Editor's noteOur recurring column, called First Person Surgical, reflects seminal case studies told in the surgeon's own voice. If you have a case study to share that broke new ground in your surgical approach or understanding, please e-mail us at [email protected]icsurgerytimes.com
Cosmetic surgery for teenagers may be the fastest growing segment of cosmetic surgery, but it is not without tremendous controversy. I recently had a 12-year-old patient from whom I removed 33 pounds of fat (total aspirate) by liposuction and on whom, a few months later, I performed an abdominoplasty. A local newspaper ran a Sunday front-page story on the little girl, which resulted in People magazine and a host of other media outlets carrying it.
Figure 1 One year before surgery. According to her mother, patient weighed 225 pounds.
PROFESSIONAL BLOW-BACK Much to my surprise, I received a great deal of criticism and hostility from many quarters. The circumstances around this case are quite unusual, but the bottom line is that I had been called upon to justify my position of performing liposuction and an abdominoplasty on a youngster. Some thought the physical makeup was just too immature to consider something so life changing as cosmetic surgery. Others thought that the risks of any surgery were just too great to be considered for a teenager. One nationally recognized plastic surgeon flatly stated that teenagers should not run to their plastic surgeon — they should just run.
PSYCHOLOGIC MATURITY I am not certain at what point in the chronological passing of time psychological maturity occurs. Certainly some children who live in a very protected environment with little social interaction remain immature into their 20s or perhaps their whole life. Others seem to be quite gregarious and quite sensible at a very early age. As such, every case should be taken individually. I do not think there can be a specific rule of exactly what age is "reasonable." I have delivered babies for a few girls at age 11 and plenty at 12 or 13. Psychological maturity is certainly a sliding scale.
Figure 2 Patient, aged 12, weighing 219 pounds.
PHYSIOLOGIC MATURITY Some of the criticism has been based on the simple fact that surgery is risky and even riskier in a young person. I am unaware of any studies showing that younger people heal more slowly than older people or that younger people are less resistant to complications of surgery than older people.
Figure 3 Six months after liposuction which removed 33 pounds and an abdominoplasty which removed an additional 10 pounds. Patient weighs 155 pounds.
In fact, recent studies have been performed with surgery in utero because the very youngest seem to heal the very best. When earthquakes and other disasters have occurred, often the survivors that last the longest in the most traumatic situations are the youngest.
A SPECIAL CASE In this particular case, there were extenuating circumstances. The patient was 12 years old when we first met. Her father called and asked if I would consider liposuction for his 12-year-old daughter. Initially, I said, "No. She should consider diet and exercise." Well, her dad had been a patient of mine for about 25 years. He said, "This girl weighs 225 pounds and is at her wit's end." To which I responded, "At age 12, people can grow out of things and she should get on a serious diet and exercise regimen."
He told me that she had been dieting and exercising since age three and that her life was miserable.