Embedded Files
an adolescent’s psychopathology or distorted body image may result in the pursuit of plastic surgery, and the comparative effectiveness of cognitive behavioral therapy and other approaches for adolescents with negative perceptions of their bodies. Because there are no empirical studies on the cultural and economic factors that are causing the increase in cosmetic surgery, differences related to race, age, socioeconomic status, and ethnicity could also be enlightening. Improved data collection would provide useful information about the number of adolescents 21 and under that are undergoing liposuction and breast augmentation. The two professional associations for plastic surgeons estimate the number of procedures each year, based on annual surveys of their members. Until 2007, both reported data on patients 18 and under and 19 –34. Because the age of majority is 18, it would be useful to have data on the number of procedures performed on patients under 18, as well as the presumably larger numbers performed on patients who are 18, 19, 20, and 21. Starting in mid-2007, ASPS now reports breast augmentation for ages 18 –19 and for 20 –34; however, they use “13–19” and “20 –29” categories to report liposuction and all other cosmetic procedures. ASAPS continues to use “18 and under” and “19 –34” for all cosmetic procedures. Plastic surgeons are aware of concerns about teen breast augmentation, and in December 2004 the ASPS released an official statement that “Adolescent candidates for purely cosmetic breast augmentation should be at least 18 years old. The procedure should be delayed until the patient has sufficient emotional and physical maturity to make an informed decision about cosmetic breast augmentation” [45]. The restriction does not apply to “reconstruction” for “deformities” such as asymmetry, which is a common condition. Nevertheless, the reported number of teen breast augmentations has stabilized after that policy statement, and both medical societies have directly responded to media criticism about cosmetic procedures among teens, with ASPS stating that the numbers have stabilized in recent years and ASAPS stating that they have decreased since 2001 [46,47]. If ASPS and ASAPS both revised their age groups for data collection, as recommended above, or if all physicians were required to maintain a registry of teen patients, this would improve data collection regarding the number of teens undergoing cosmetic procedures. Given normal pubertal development, adolescent medicine providers may recommend that a teenager “wait and see” before undergoing breast augmentation with either saline or silicone gel breast implants. They also may recommend exercise rather than liposuction, because physical activity habits provide life-long health benefits that liposuction does not. Standardized screening for BDD and psychological problems needs to be implemented. The high rates of teenage risk-taking behaviors involving alcohol, drugs, unprotected sex, or reckless driving are examples of how the decisions that adolescents make are difficult for adults to predict or control. However, because adolescents under 18 are not able to have cosmetic surgery without parental consent, and older adolescents are unlikely to be able to afford cosmetic surgery without parental support, parents and physicians have more control over adolescent cosmetic surgery than they have over other adolescent decisions. Effective screening could potentially improve the process by which decisions are made about whether adolescents should undergo breast augmentation or liposuction. The next steps regarding screening and counseling may include a position paper by organizations that are actively involved in promoting the health and well-being of teenagers. Although ultimately the decision to perform cosmetic surgery on a teenager is a decision that should be made between the physician, patient, and family, it is clear that additional research in a number of areas is needed before fully informed consent is possible regarding whether the benefits are likely to outweigh the risks for specific types of cosmetic surgery. References [1] American Society for Plastic Surgery. National clearinghouse of plastic surgery statistics. Available at: http://www.plasticsurgery.org/ media/statistics/index.cfm. Accessed March 21, 2008. [2] Sarwer DB. Plastic surgery in children and adolescents. In: Thompson JK, Smolak, L, eds. Body Image, Eating Disorders, and Obesity in Youth: Assessment, Prevention, and Treatment. 21, 2008. [5] Allergan, Augmentation Patient Labeling. Important information for women about breast augmentation with INAMED silicone-filled implants. 2006. Available at: http://www.fda.gov/cdrh/pdf2/ P020056d.pdf. Accessed March 21, 2008. [6] Mentor, Augmentation Patient Labeling. Important information about breast augmentation with Mentor MemoryGel silicone gel-filled breast implants. 2006. Available at: http://www.fda.gov/cdrh/pdf3/ p030053d.pdf. Accessed March 21, 2008. [7] Department of Health and Human Services, Food and Drug Administration. FDA Drug Bulletin, Vol. 12. Washington, DC. Department of Health and Human Services, Food and Drug Administration, 1982;1:1. [8] American Society for Aesthetic Plastic Surgery. Cosmetic surgery
Google Sites
Report abuse