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As cosmetic procedures have become much more pervasive, advertised in the mass media and the subject of numerous prime time television programs, it has become increasingly difficult for health professionals to agree on when it is appropriate or necessary [2,3]. This literature review focuses on data-based articles regarding the risks and benefits, as well as the need for improved standards for screening and informed consent. We reviewed data from all articles on these topics listed in the PubMed and PsycINFO databases from 1985 through June 2007, in addition to books, book chapters, and materials on the Food and Drug Administration (FDA) and plastic surgery medical association Web sites. This literature review focuses on two of the most popular cosmetic surgical procedures performed on teens: breast augmentation and liposuction. Although less popular for children under 18 than ear pinning or nose reshaping, they are more controversial because of higher complication rates, longterm financial and health risks, and concerns about “body *Address correspondence to: Anisha Abraham, M.D., Department of Pediatrics, 2nd Floor PHC, Georgetown University Medical Center, 3800 Reservoir Road, Washington, DC 20007. E-mail address: axay@gunet.georgetown.edu Journal of Adolescent Health 43 (2008) 318 –324 1054-139X/08/$ – see front matter © 2008 Society for Adolescent Medicine. All rights reserved. doi:10.1016/j.jadohealth.2008.04.018 sculpting” on bodies that are still developing. Despite the rising popularity of cosmetic surgery for teenagers, there are no empirical studies on the cultural and economic factors that are causing the increase. Breast Augmentation Although the FDA approved saline breast implants only for women ages 18 and older [4], and silicone gel breast implants for women ages 22 and older [5,6], it is legal for doctors to perform breast augmentation using either type of implant for teens under 18, as an “off-label” (i.e., not approved) use with parental consent [7]. It is FDA policy to approve medical products for specific uses for which they are proven safe and effective, and to allow physicians to determine if they want to use those products for other medical purposes. It is not possible to determine exactly how many procedures are performed each year on teens, although estimates are available. The ASPS and the American Society for Aesthetic Plastic Surgery (ASAPS) each provide estimates of the number of plastic surgeries performed by their members on children ages 18 and younger. The estimates are based on surveys of their members, vary considerably because of differences in membership criteria, and do not include the many plastic surgeries performed by other physicians. The ASAPS, which includes dermatologists and other disciplines that perform cosmetic surgery and procedures, estimated more than 11,300 breast augmentations for teens 18 and under in 2003 [8]. In contrast, ASPS, which only includes plastic surgeons, reported approximately 4000 procedures for teens ages 18 and younger in the same year. Through 2005, both medical societies reported approximately 3000 – 4000 breast augmentations for teens 18 and younger [1,9]. Of note, in 2006, ASPS calculated procedures for ages 19 and under. Adding age 19 resulted in more than a doubling in the number of procedures to more than 9100 [1]. Breast augmentation is performed under intravenous or general anesthesia, usually on an outpatient basis. A pocket is created under the breast tissue or in the pectoralis major muscle. The breast implant, a silicone envelope filled with silicone gel or saline, is placed in the pocket and then the soft tissue is closed. these practices. Another reason as to why the demand is higher in these countries is simply that individuals are able to pay for the high cost of these procedures. Though researchers are keen to differentiate between ―Real self (actual or objective self)—the way the person actually is, 2. Self-image (subjective self)—the way a person sees herself or himself, 3. Ideal self (selfactualization)—the way she or he would like to be, 4. Looking-glass self (social self)—the way she or he thinks others regard her or him,‖5most researches have shown that body image (as picturing own physical appearance in own mind), is the prevalent reason behind seeking cosmetic surgery in both genders, and both women and men regardless of age are attracted to cosmetic surgery procedures to modify body looks for either reconstruction or enhancement. Teenagers currently are not exempt from this phenomenon either. Thus, it is crucial to look into the real reasons behind such decisions, in addition to understanding their socio-cultural and economic background and the type of cosmetic surgery they opt for, as well as taking into considerations the objectives they want to achieve. What is Body Image? The German writer Schilder first formulated the concept of ‗body image‘ as an important and integral phenomenon in 1935. 1Umberto Eco, History of Beauty. Rizzoli International Publications, Incorporated, 2010 2The Concept of Beauty in Ancient Egypt.Retrieved from: http://www.ancientfacts.net/the-concept-of-beauty-in-ancientegypt/ . Date: [6/2/2018] 3Umberto Eco. Ibid 4 Phaedrus by Plato.Retrieved from http://sfbay-anarchists.org/wp-content/uploads/2013/07/Plato-Phaedrus.pdf . Date:[6/2/2018] 5On visit, S., & Shaw, J. (1987). Self-concept and image congruence: Some research and managerial implications. Journal of Consumer Marketing, 4, 13–23. Pg. 17 International Journal of Humanities and Social Science Vol. 8 • No. 10 • October 2018 doi:10.30845/ijhss.v8n10p14 131 Recent literature, which is greatly shaped by applied clinical concerns, has expanded on this idea by explaining that ‗body image‘ has been greatly influenced by specific ‗neurological disorders‘ in which patients exhibit a faulty perception of their own body image, body image distortion (BID) and delusional misperception.6 It is also defined as the mental representation one creates about his looks, but it may or may not bear close relation to how others actually see you. Body image is subject to all kinds of distortion from internal elements such as our emotions, moods, early experiences, attitudes of our parents, and much more. Nevertheless, it strongly influences behaviour. Preoccupation with and distortions of body image are widespread among women in particular and, to a lesser extent, among males.7 Charles Horton Cooley (1902), has coined the concept of the ‗looking-glass‘, in which he claims that, the development of one's self and of one's identity is materialized through one's interpersonal interactions within the context of society. This means that one‘s definition of self contains ―definite imagination of how one‘s self appears in a particular mind, particular mind of others.‖ 8 Why Cosmetic Surgery? ―Cosmetic surgery‖ is used in reference to the ability of surgeons to reshape the appearance of the human body parts through special techniques in order to improve their appearance. It is known among the plastic surgery practitioners that plastic surgery has two branches: cosmetic surgery, which aims to improve the aesthetic appearance of a person, and reconstructive plastic surgery, which aims to restore the function; however, it may also involve correcting the deformities to normalize the appearance, but that is not its primary function.9 Thoughthe roots of cosmetic surgery- the reconstructive type in particular- can be traced back to ancient civilizations -particularly in ancient Egypt, India and other parts of the world-, these medical procedures have become a highly demanded option in the modern world of today, sought by many people of different genders, ages and from all walks of life. Statistics show that more men are going under the knife10 due to social and economic transformations in the society. Industrial developed communities in particular place high value on living healthy and looking good, which leads to men and women, young and old, to request cosmetic surgery for aesthetic reasons. Furthermore, the dominance of human rights and freedom helped to wipe away many taboos related to handling one‘s body especially in western societies. Traditionally, males seeking cosmetic surgery have been considered more psychologically disturbed than their female counterparts.11 In an early inquiry by a Japanese research team, it was found that 82.3% of the male subjects began to be preoccupied with what is perceived to be a ‗deformity‘ between teenage years and early adult lives. 12According to Dr. Douglas Steinbrech, a Manhattan-based plastic surgeon, there are four types of men who normally seek maleoriented cosmetic procedures. 13 First, there is ‗the male model‘ who wants a sharper jawline and nicer abs (defined abdominal muscles). 6 Peter David Slade. (1993). Invited Essay; What is Body Image. Elsevier Science Article. [Internet] 1993 [cited 2016 May 10]. Available at
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