The Balancing act of helping your patient's make the "better" choice

1. plastic surgery
Teens
&
plastic surgery
Plastic
plastic surgery
Surgery
atnt
THE BALANCING ACT
OF HELPING YOUR PATIENTS
MAKE THE “BETTER” CHOICE
By Jeffrey Spiegel, M.D.
Contributing Editor & Advisor
What is the purpose of plastic surgery? Sounds Even if the definition of “better” is hard to
like an easy question, but like many easy questions, pin down, we know instinctively that some plastic
the more we consider the answer, the more surgery must be wrong. When an anorexic person
complex the answer appears. feels he or she is overweight, we know that
The easy answer is to make oneself look something is wrong. Similarly, when an attractive
better. Of course, “better” is a very subjective word
when it comes to appearance. Does piercing with a
gold loop in the nose make a person look better? Even if the definition of “better” is
Does a flower tattoo on the ankle make one look hard to pin down, we know
better? Different people will offer very divergent instinctively that some plastic surgery
opinions. Perhaps the same person will even offer
different opinions, depending upon when you ask must be wrong.
them. A 16-year-old girl who wants to fit in with
her friends may feel one way while a 32-year-old person changes too many things and looks
woman with small children who is trying to work unnatural, we wonder if he or she had some sort of
her way up the corporate ladder may feel very image problem, such as body dysmorphic disorder
differently. (bdd).
aesthetictrends.com | may ● june 2011 1

2. In general, we all agree it and has suffered some juvenile There are no ways to
plastic surgery
that when you show certain signs teasing about her nose over the know the answers to these
of aging (e.g. jowling), certain years. If she were 22 years old, questions. If she were younger,
procedures, for example the decision to proceed with the decision would be easier.
tightening the skin such as with a rhinoplasty would be clear. She Medically, we can decide that it
facelift, are something that a comes to the office with Dad, who makes good sense to wait on
reasonable person could consider. has the same nose, though it fits some cosmetic surgery until the
Perhaps they feel younger than better on his 45-year-old face. body is more matured.
they look and are frustrated with There are some women Certainly, we would not
being treated as old beyond their with large noses who are want to do surgery, then watch all
capabilities. But, what if the confident and vivacious, while our good work go undone as the
patient grows, or worse, have
negative effects on facial growth
We would not want to do surgery, then watch all our because of the surgery. This is a
good work go undone as the patient grows, or worse, commonly used reason to delay
plastic surgery on certain
have negative effects on facial growth. adolescents and teenagers. While
a convenient and comforting
reason, I am not sure that there is
person with jowling wants a others are shy and meek. Did strong medical evidence that there
facelift because his or her spouse growing up with a large nose cause are negative effects on growth
thinks they look too old and the the meekness? Why for some following rhinoplasty.
spouse wants to have a younger and not the others? Maybe both Animal studies have
looking partner? How do we feel suffered ridicule and some shown no problems with facial
now about the indications for developed stronger personalities surgery on growth, and many of
surgery? because of it. Which way will the us have experience in surgical
patient in your exam room go? repair of traumatic injuries where
TEEN PATIENTS
The questions get even
trickier when the patient is a
teenager. Teens have strong
opinions and are more likely than
adults to both act on impulse and
misread emotions and social cues.
They are also less likely to
consider the adverse
consequences of any decisions.
So, what do we do when a
teenager decides he or she does
not look good and needs plastic
surgery?
Consider this example.
A 14-year-old girl comes to the
office for a rhinoplasty. She’s a
pretty girl but has a large nose.
She’s shy and self-conscious about
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3. no unexpected craniofacial mature, it is perhaps only need to wear a plastic splint on
plastic surgery
abnormality resulted from the the experience of the suffering their nose for a week after
surgery (or the initial trauma). that allows us to better identify surgery, or a headband following
Nonetheless, it is generally and handle similar stresses. an otoplasty for several weeks.
considered wise to wait until after When a person feels low They will know if they want
most growth has occurred before self-esteem and suffers bullying as surgery or not after hearing about
performing a procedure such as a teenager over a physical the aftercare.
rhinoplasty. This helps us avoid characteristic, it is logical to want Transition periods end up
sticky issues with some patients as to change that aspect of the being a convenient and advisable
we can simply request they wait appearance. Unfortunately, time for plastic surgery in
until they are older. changing one’s appearance to teenagers. These include at the
The real problem here is appease a bully is unlikely to be start of summer vacation and
in deciding when a teenager is successful. Worse, it can cause a particularly between school years
mature enough to make an person to lose what could when they are changing from one
irreversible decision. In the law, eventually be a source of pride. school to another. The ability to
teens are typically emancipated at There are no clear cut enter a new place without the
age 18, although not all 18-year- answers to determining when teen concerns of the old can allow a
olds are emotionally mature. surgery is appropriate; however, formerly introverted young
Furthermore, people are the questions posed above will person to shine.
capable of bad decisions hopefully place you into the right At my office, I have
throughout their lives. As in frame of mind when considering greatly enjoyed helping people
much of facial plastic surgery, the how to evaluate these requests. maximize their quality of life and
key is to investigate goals and Like with all plastic surgery, it has self-esteem through
motivations. to be done for the patient only, improvements in their
Studies have shown that and not to please a friend (or appearance. Seeing the smile on
higher than 50% of young women parent!) or appease a bully. That a teenager’s face when she
desire to have plastic surgery of being said, there are a few recognizes her own beauty makes
some type during their lives. guidelines that can help. all the efforts involved in sorting
Hopefully, this trend represents a through the motivations
generally increased WHEN IS THE RIGHT TIME? worthwhile.
understanding, acceptance, and Correction of a congenital
comfort with the science and deformity (e.g. asymmetry, cleft,
services available by well trained or similar) that still remains as a
aesthetic surgeons. Perhaps the About
teenager can be corrected at any
youth of today recognize that time that is medically advisable.
the
eating right, staying fit, and finding Scar revisions, keloid treatments, Author
meaning in their lives are and the like can similarly be
important, and that plastic surgery addressed at any time.
can occasionally provide Rhinoplasty and otoplasty
improvements to areas that are are two common requests in this Jeffrey H. Spiegel, M.D., is Chief of
not readily corrected otherwise. age group. Once growth issues the Division of Facial Plastic and
Undoubtedly, though, for some have been decided, I prefer to Reconstructive Surgery at the Boston
the desire to have plastic surgery carefully discuss the nature of the Medical Center and holds academic
represents a desire to change or appointments in the Departments of
surgery with the patient and
run from their sense of self. Peer Otolaryngology and Head and Neck
explain the recovery process. Surgery and Plastic Surgery at the
pressure and the pain of taunting Teen patients are very good at
and bullying become magnified Boston University School of
making appropriate decisions Medicine. Visit Dr. Spiegel’s website
during the teen years. As we once they know that they will and blog: www.drspiegel.com.
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