Teen Plastic Surgery: A Controversial Medical Practice
According to the American Society of Plastic Surgeons, in 2007, more than 87,000 teenagers had cosmetic surgery; and that number has grown exponentially since. Although aesthetic cosmetic surgery is popular amongst United States teens, physicians and plastic surgeons worry that such invasive surgery on teens' still growing bodies can be dangerous. Other developed countries, including Germany and Australia, are considering banning all but medically necessary plastic surgery for anyone under the age of 18. However, the question remains, if such a measure were taken like that in the United States for minors stem the tide of teenagers going under the knife? This paper will address the controversy associated with teenagers and aesthetic cosmetic surgery in the United States, and the business of plastic surgery for teens, from a legal, ethical, and social responsibility standpoint.
In a country, and dare say a world where image is everything, it's not uncommon for adults, and particularly those in the public eye, to elect cosmetic surgery to meet the expectations of a demanding society that perpetuates the importance of physical image (Ali & Lam, 2008). But what about teenagers? Each year thousands of teenagers elect to have plastic surgery. In the past, when an adolescent had plastic surgery, it was most often to correct birth defects such as cleft palates, for example, or to reconstruct after serious injury.
In most recent history, however, more and more adolescents are seeking and receiving elective plastic surgery. In 2003, more than 223,000 cosmetic procedures were performed on patients under the age of 18. More than 39,000 were surgical procedures such as nose reshaping, breast augmentation, liposuction, breast lifts and tummy tucks (ASAPS, 2003). But are there more than simple aesthetic reasons for a teenager to want plastic surgery? And as the consideration is made regarding adolescents and plastic surgery, there must be some thought given to under what circumstances plastic surgery is appropriate for teens.
Monica had always been very self-conscious about her nose. For as long as she could remember, she wouldn't leave the house without applying make up that would make her nose appear smaller and more narrow. During her high school years, to draw the focus away from her nose, Monica admits to wearing padded bras and shirts with her stomach exposed. However, after her fellow classmates began to post derogatory comments about her on Facebook, Monica made the decision to make a permanent change to her nose. She met with a counselor to determine if she was emotionally prepared for her decision. Monica had rhinoplasty at 15. Now she maintains that she is more comfortable with her appearance, and is more happy and confident.
Jacob, in elementary school, was frequently called "Dumbo" because of his ears. He maintains that he would just turn away to avoid fighting. In the 6th grade, Jacob began to grow his hair out that conveniently covered his ears, and in his own words, "kept him out of trouble." Jacob wanted to join a youth fire service program, but learned that short hair was a prerequisite. He was reluctant to cut his hair and didn't join the organization he had been so very excited about. Jacob realized that how he felt about his ears was detrimental to his life and lifestyle.
His mother was supportive of his decision to have elective plastic surgery. Today, Jacob is pursuing a fire science degree.
Teens like many adults, expect that plastic surgery will garner greater self-confidence, but does it? At present, there are no empirical studies that examine the long-term benefits amongst adolescents who have undergone elective plastic surgery. Current research indicates that patients who receive breast augmentation are four times as likely to commit suicide compared to other plastic surgery patients (Brinton, 2001); which raises significant questions about the mental and emotional health of women who choose implants and the psychological benefits of the surgery. For many, liposuction is an elective surgery that presents specific concerns because of its association with eating disorders (Rauste-von, 1989). Moreover, there is a concern regarding any form of aesthetic surgery and Body Dysmorphic Disorder (BDD); defined as "preoccupation with an imagined or slight defect in appearance that leads to significant impairment in functioning"; particularly when the average onset of BDD is 16 years of age. The difficulty, however, likes in the fact that since the goal of cosmetic surgery is to transform and improve appearance, there may be difficulty in distinguishing between desire and pathological preoccupation (Thompson, 2001).
"Surgery during the teenage years should be performed only to correct impairments and traumatic injury," says Dr. Asha Manaktala, a pediatrician in Connecticut. Dr. Manaktala iterates the sentiments of a number of health professionals, parents, and people in general. However, the Federal Drug Administration approved saline breast implants for women under the age of 18 more than a decade ago (FDA, 2000). It is legal for a plastic surgeon to perform for anyone under the age of 18 as an "off label" use; and between 2002 and 2003 the numbers of adolescents having this kind of surgery tripled.
The American Society of Plastic Surgeons did not take an official position regarding breast augmentation for patients under 18 until December 2004; at which time, the organization collectively expressed that they were against it (ASAPS, 2005).
The long-term emotional, physical and economic implications of the most popular plastic surgeries, including liposuction and implants are unknown. Despite the documented risks of these elective surgical procedures, the general public seems to have an inflated sense of the benefits with a minimized sense of the risks of plastic surgery (Thompson, 2001).
Another consideration that must be made when considering the issue of teens and plastic surgery is the role of the surgeon himself. Will most plastic surgeons make an objective and accurate judgment about whether an adolescent is an appropriate candidate for plastic surgery? Furthermore, if plastic surgeons are performing surgeries that many psychologists and physicians would question, is there some obligation on the part of medical societies and ethicists to provide more guidance than is currently being provided by the very organizations that benefit the most financially from plastic surgery's being performed? The purpose of this paper is to analyze the issue of teen plastic surgery through the contextual and value-based framework of law, ethics, and social responsibility.
Where does the law come into play when considering the issue of adolescent cosmetic surgery? Who has the ability to make the ultimate decision? Is it the adolescent, the parent(s), the courts; or is there any clear legal instruction with regard to this issue?
Newman, in his article, "Adolescent Consent to Routine Medical and Surgical Treatment: A Proposal to Simplify the Law of Teenage Medical Decision-Making" argues that there has been substantial in congruence in the law regarding adolescents and their right to give legitimate and valid consent for routine medical procedures. An adolescent can be emancipated by a judge, based on no personal knowledge of the teen, but information provided third party and suddenly have the capacity to make medical decision; but in other circumstances with an adolescent of the same age, no such decision making power exists (p. 502). Newman argues further that juveniles, more and more, are treated as adults by the criminal justice system; however, juveniles of the same age with no criminal involvement cannot make the decision as to what will happen with their bodies; particularly when ill or injured (Holmes, 1989).
Newman posits that a deontological rule in the Kantian mode should be adopted with regard to this issue; suggesting that all minors over the age of 16 should have the opportunity and right to make their own independent choices and decisions as to what should be done to and with their bodies. Newman maintains that he favors this approach with specific regard to routine medical (non-life threatening as determined by a physician), and surgical treatment (p. 504).
The recognition of children's rights in the United States can be attributed to the Supreme Court case of In re Gault in the 1960's, wherein the court upheld the decision that "the right to freedom from physical confinement was held applicable to children" (Teitelbaum, 1999). This, Newman argues, began the recognition of children's rights being protected. As there is no categorical requirement for parental consent with regard to a minor using contraception or abortion, there still exists "the greater authority to regulate decisions and conduct of minors which does not entail assumptions about equal capacity" (Zailkind, 1996).
Susan Hawkins point out in her comprehensive law review article regarding the rights of competent minors in litigated medical treatment disputes, that there is a disconnection between the staunchly held beliefs in the United States when it comes to the parents' incomparable authority to make their children's medical decisions and the continually evolving notion of autonomy for all competent humans, including those under the age of 18 (p.2076).
Michele Oberman, in her article, "Minor Rights and Wrongs," makes the distinction between…