Thorough consultations are critical when assessing teenage patients seeking aesthetic procedures, experts say.
Teens may represent only a small percentage of cosmetic patients at dermatologists’, cosmetic and plastic surgeons’ offices, but they are by no means simple cosmetic cases. Often driven by hormones, social pressure, short-term desires and the belief they’re invisible, teens tend to be challenging patients for physicians who are trying to help, not harm.
Vivian Diller, Ph.D.“Adolescents are actually most similar to peri-menopausal women in certain ways because of their fluctuating hormones,” says Vivian Diller, Ph.D., a New York City-based psychologist who works with adolescents and does research on the psychology of beauty and aging. “I often will talk to those women [mid-lifers], reminding them that this is a phase of their life, probably most similar to adolescence because so much is in transition. Plastic surgery is one of the things the aging woman has turned to to try to stop time. For adolescents, it’s actually one of the ways they want to control the changes they are experiencing.”
Adolescents are strongly influenced by unsettling internal and external change, including raging hormones, according to Diller.
“As a dermatologist or plastic surgeon, you have to consider not just what you see, but what’s going on inside the adolescent,” Diller says.
Demand for cosmetic procedures is on an upward trend, in general, but not among teens.
The American Society for Aesthetic Plastic Surgery (ASAPS) released its 2013 multispecialty statistics (including plastic surgeons, dermatologists and otolaryngologists) in the U.S. and reported a 12 percent overall increase in cosmetic procedures. In 2013, Americans spent the most on cosmetic procedures since the recession in 2008.
In the same year, cosmetic procedures among 18 and younger patients reached a long-time low, at 1 percent of total surgical and nonsurgical procedures. The 113,924 procedures in this age group, according to the 2013 ASAPS Cosmetic Surgery National Data Bank Statistics, is a far cry from the 220,000 aesthetic procedures 18-and-unders had in 2002.
The most recent statistics suggest the top nonsurgical procedures among teens are: hair removal, chemical peels and microdermabrasion. The most popular surgical procedures in the younger set are ear surgery, nose surgery and breast revision (not augmentation, which registered as zero procedures in 2013 among patients 18 and under).
Michelle Welch, M.D., a dermatologist practicing in Lexington, SC, says she sees a lot of teenagers.
“I think for the majority of teenagers, they are concerned with their facial skin (acne, bumps, acne scars). I would say [I see] a majority of female versus male patients. But we’re having an increase in the amount of male patients…,” Dr. Welch says.
Very rarely will Dr. Welch get a teen who is requesting something she thinks is more of an adult procedure, like Botox injections for wrinkles.
“I’ve had a few ask for that and, to be honest, I was floored. A beautiful young person, no. [She] doesn’t need something like that,” Dr. Welch says.
John M. Hilinski, M.D., a facial plastic surgeon in San Diego, Calif., says his cosmetic teen patients typically request nose reshaping or cosmetic ear surgery.
“Rhinoplasty is hands down one of the most popular that we’re seeing in the late teen patients coming out of high school-mostly, in seniors going off to college who want to have their noses redone before going off to a new environment,” Dr. Hilinski says.
And while cosmetic ear surgeries come in a close second, it’s not only ear pinning that Dr. Hilinski says is popular among people in the younger set.
“In the last couple of years, I’ve been doing a lot of gauge repairs,” he says.
Gauge repairs are an emerging need among teens who want or need to repair earlobes damaged by the big holes, according to Dr. Hilinski. He says teens do their research to find physicians like Dr. Hilinski, who have developed a reputation for restoring natural-looking lobes.
“You can do gauge repairs and, if you’re not very good at it, you can make the lobes… look like an earlobe, but not really. If you really want to do it right, and you finesse it, and you do a lot of them, you learn how to make a natural looking earlobe,” Dr. Hilinski says.