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Teen plastic surgery guidelines

Article-Teen plastic surgery guidelines

plastic surgeon marking skin

More teens are having cosmetic surgery — a trend experts say is fueled by selfies, social media and teens’ increasing self-awareness and desire to fit in. Not only are adolescents having rhinoplasty, otoplasty and reduction mammaplasty, but also the more adult procedures including liposuction, nonsurgical laser resurfacing, fillers, botulinum toxin type A injections to prevent aging and more. This is despite scant data on whether it’s safe to perform many of these cosmetic procedures on patients younger than 19, according to a systematic review and recommendations for teen plastic surgery published in September in Plastic and Reconstructive Surgery.

“As the saying goes, ‘Just because you can doesn’t mean you should,’” according to review authors and plastic surgeons Rod J. Rohrich, M.D., and Min-Jeong Cho, M.D., of the Dallas Plastic Surgery Institute.

American Society of Plastic Surgeons (ASPS) member plastic surgeons performed about 229,000 cosmetic procedures on patients ages 13 to 19 in 2017, according to ASPS statistics. Teens account for about 4% of cosmetic surgery procedures, led by rhinoplasty, male breast reduction and otoplasty. Adolescents also make up about 1% of nonsurgical procedures performed in the U.S., including laser hair removal, laser skin resurfacing and botulinum toxin type A injections, according to the paper.

There are plastic surgery procedures that are indicated for teens and have been well studied, including rhinoplasty for cleft lip, breast reduction for symptomatic macromastia, otoplasty for prominent ears and breast augmentation to address congenital breast absence or severe asymmetry, the authors report.

Plastic surgeons and teen patients, however, have few studies looking at the safety of nonsurgical procedures for teens and have no access to established guidelines recommending when these procedures are best performed. Dr. Rohrich comments in a review-related ASPS press release that he’s concerned about the surge in injectable use in young patients to achieve augmented cheeks and lips, despite no evidence proving these filler procedures are safe for teens.

The authors write that their research exposes the need for stringent guidelines. In the meantime, they make these recommendations:

  • Otoplasty for children as young as ages five to seven years.
  • Cosmetic rhinoplasty for girls ages 15 to 17 and boys ages 16 to 18 years, for teens who experience significant peer ridicule.
  • Cosmetic breast augmentation, breast reduction and liposuction should be reserved for teens older than 18 years and liposuction for patients whose fat is unresponsive to diet and exercise.
  • Chemical peels, cosmetic laser treatment, botulinum type A and filler injections should also be performed on patients older than 18, unless patients have early tear troughs, small lips, weak cheeks or premature frown lines.

Cosmetic surgeons should also carefully evaluate teen patients for emotional and physical maturity prior to performing cosmetic procedures, according to the authors. Among their recommendations for properly selecting teen patients: the teenager initiates the request, has realistic goals and sufficient maturity.


Rohrich RJ, Cho MJ. When Is Teenage Plastic Surgery versus Cosmetic Surgery Okay? Reality versus Hype: A Systematic Review. Plast Reconstr Surg. 2018 Sep;142(3):293e-302e. doi: 10.1097/PRS.0000000000004630.