Are teens mature enough to elect cosmetic surgery?

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Researchers who recently conducted a review of the literature on teens and cosmetic surgery found that teens are mental and physical works in progress.
Dr. Abraham says her review revealed significant mental health issues, including a slightly increased risk of body dysmorphic disorder, among young women seeking cosmetic surgery.

As more teenagers express interest in undergoing cosmetic surgery, researchers are asking critical questions about their motives, issues and whether young people are even equipped to make informed decisions regarding what are often permanent changes to their appearance.

Dr. Abraham

21 AND OVER Researchers who recently conducted a review of the literature on teens and cosmetic surgery (with a focus on breast augmentation and liposuction) found that teens are mental and physical works in progress. "There are significant physiological and psychological changes that occur during puberty," explains Anisha Abraham, M.D., M.P.H., associate professor of pediatrics, Georgetown University Hospital, Washington, DC. "Women can increase their breast size; they can gain weight. One recommendation is to certainly wait until a young woman is perhaps at least 21 before considering either liposuction or breast augmentation, simply because she is still going through pubertal changes." Dr. Abraham, coauthor of an study which appeared last Fall in Journal of Adolescent Health, says that teenagers' body images are continually developing.

These adolescents and young adults are interested in changing their bodies at a point in their development during which their beliefs and attitudes are often most nascent and confused, observes David B. Sarwer, Ph.D., associate professor of psychology in psychiatry and surgery at the University of Pennsylvania School of Medicine. Dr. Sarwer, who has long studied teens' body image, says it's usually teens and young adults who report the greatest body image dissatisfaction. "What we're doing is taking a very turbulent time in terms of their body image development and permanently changing their bodies. There is some concern that some young adults may not be prepared for that," he says.

Dr. Abraham says her review revealed significant mental health issues, including a slightly increased risk of body dysmorphic disorder, among young women seeking cosmetic surgery. "We highly suggest that cosmetic surgeons doing procedures consider screening teenagers...particularly breast augmentation and liposuction patients, for psychiatric history and concerns about body image, eating and mood disorders," she advises.

ADVISE & CONSENT The final recommendation of Dr. Abraham's study has to do with informed consent. She notes that studies have shown that the human brain does not complete development before 25 years of age. "That is why the concept of informed consent is particularly important when talking about young people," Dr. Abraham says. "We highly recommend that a true informed consent include a real discussion about risks and benefits and also about body image concerns and their expectations of surgery."

This discussion, in Dr. Sarwer's view, should not be limited to patients, but should also include parents. Particularly in the case of adolescents, cosmetic surgeons have to question whether the potential patient's interest in cosmetic surgery is truly coming from the adolescent or from some direct or indirect pressure from parents or peers.

TEEN MOTIVES Dr. Sarwer explains that two factors seem to predict especially young women's interest in future cosmetic surgery procedures: their degree of body image dissatisfaction, and their amount of exposure to mass media—including that from reality-based cosmetic surgery programs. According to Dr. Sarwer, the mass media exposure element calls into question the accuracy of the information these women may be getting. "When we think about some of the shows of the last several years...most plastic surgeons would agree those are pretty unrealistic depictions; yet, many of their patients may be viewing these shows and thinking that they are good and accurate representations," he says. "These shows could set up false and misleading expectations about what a given woman's experience will be."

In Dr. Sarwer's view, one of the key considerations with teens and young adults is not so much their chronological age as their developmental age, or maturity, in grasping how they will feel about their changed appearances decades down the road.

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