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outcomes as they continue to Global Journal of Otolaryngology ISSN 2474-7556 Should Children and Adolescents Undergo Plastic Surgery? 0044 Global Journal of Otolaryngology How to cite this article: Saraiva J ,Rodrigues C. Should Children and Adolescents Undergo Plastic Surgery?Glob J Otolaryngol; 14(2): 555883. DOI: 10.19080/GJO.2018.14.555883 perceive the reported flaw or simply become fixated on another body part, asking for more and more surgeries, as if the perceived abnormality kept moving (for more information see DSM 5) [8]. So, I do defend that some cosmetic surgery like rhinoplasty, otoplasty, chin augmentation or reshaping or breast correction can be done in an appropriate age that should be individually determined, as they can prevent peer victimization and improve psychological wellbeing. Peer victimization or bullying acts as a childhood trauma, negatively affecting the psychological development and the construction of a secure body image and self-concept. This effect on psychological development causes children who are bullied to be more anxious, have more depressive features, avoid school or social meetings. In extreme cases they may have suicidal thoughts. Adolescents who seek cosmetic surgery for other purposes should be advised against it, as it is known that as they progress to adulthood their body image may improve. The decision about cosmetic surgery should be postponed for after 18 years old [9]. In conclusion, I do defend that a mental health team should be involved in both pre-operative and post-operative periods, helping to evaluate the presence of the conditions required to perform the operation and to support the patient on its adaptation to the new body image on regular consultation. But I also think that there is a lot of work to be done in schools to prevent bullying in this situation. Children and specially Adolescent desire for cosmetic surgery: associations with bullying and psychological functioning Introduction Between 2014 and 2015, 15.9 million surgical and minimally invasive procedures were undertaken in the US; 226,000 of those procedures were undertaken in 13-19 year olds.(1) Rates of cosmetic surgery are similarly increasing in the UK(2) and across the globe.(3) As the prevalence of cosmetic procedures has risen, so too has an interest in the drivers that lead people to desire a change in their appearance. Drivers examined so far include individual factors (e.g., sex),(4-7) psychological factors (e.g., body image), (5, 8-17) sociocultural factors (e.g., media influences)(5, 18-22) and interpersonal factors (e.g., peer influences). (11, 18, 19, 23-26) Some(21) have found that peers have a strong influence on body image and several studies have found that a large proportion (around 50%) of adults seeking cosmetic surgery report a history of teasing or bullying.(5, 11, 24-26) Bullying, defined as an imbalanced relationship characterized by intended and repeated aggression, (27) can have a range of adverse effects on children and adolescents. (28-32) For bullying victims, the negative effects may be similar to those caused by adult abuse or maltreatment. (33) There are several gaps in knowledge regarding the relationship between cosmetic surgery and bullying. Firstly, most studies have used a retrospective design in adult samples. Retrospective studies have generally found that cosmetic patients or candidates report appearance teasing more frequently than controls.(11, 13, 24, 26, 34) However, retrospective studies are problematic because current or prior psychological problems can lead to biased recall. (35, 36) In young adults (e.g., undergraduate students), teasing history can uniquely predict interest in cosmetic surgery. (5, 25) Most bullying occurs during childhood and adolescence(24) but there has been little concurrent investigation of the extent to which adolescents currently involved in bullying desire cosmetic surgery. 2 Secondly, it is unknown whether all of those involved in bullying are more likely to desire cosmetic surgery or particularly those who are bullied. Adolescents who are purely bullied (i.e., victims) and those who are bullied but also bully others (i.e., bully-victims) tend to suffer the poorest outcomes. (37, 38) We might therefore expect that victims and bully-victims have an increased desire for cosmetic surgery because of poorer psychological functioning (e.g., low self-esteem, body esteem or high depressive symptoms). Those who purely perpetrate bullying (i.e., bullies) tend to have good psychological functioning and suffer few negative long term consequences.(37, 38) Some suggest that bullies harm others as a means to achieve dominance and social status, which may increase romantic and sexual opportunities. (39) We therefore hypothesized that bullies may also have an increased desire for cosmetic surgery as another strategy to achieve their status goals, irrespective of psychological functioning. Thirdly, the majority of research has focused on females, which is understandable considering the sex ratio of cosmetic procedures is highly skewed (e.g., over 90% of procedures are performed on females). (1) However, boys, and especially those who have experienced bullying, may want to increase their muscle bulk and appear stronger, through body building or potentially cosmetic surgery. (31) In adolescents, bullying and victimization amongst
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