The Kindest Cut? Teens and Plastic Surgery

When she was 13, Maggie, then an eighth grader living on the Upper East Side of Manhattan, convinced her parents

When she was 13, Maggie, then an eighth grader living on the Upper East Side of Manhattan, convinced her parents to let her get a nose job. She told her friends she broke her nose playing softball. When Maggie was 17, she convinced her parents to let her liposuction the fat under her chin and have her buccal fat pads removed.

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“Most people don’t even know what their buccal fat pad is,” said Maggie, describing the pockets of skin above the molars in each cheek. “But it’s the kind of thing you notice every day when you look in the mirror. At most, someone might think you lost a tiny bit of weight, but you see it yourself.”

Then Maggie decided she wanted bigger breasts.

“My mom was more agreeable than my dad,” said Maggie. “My dad was more like, ‘You’re beautiful the way you are, blah blah blah,’ but my mom was more able to understand. I struggled a lot in middle school and was very unhappy. I guess she understood that if there was something that would make me feel better, what was the harm?”

Maggie waited until she finished high school and had her breasts enlarged from a small B cup to a 34 C.

“I had gotten to a point where I was fairly satisfied with my body,” said Maggie. “I finally got over thinking you had to be super skinny, but I still felt disproportionate, and that that subtracted from my femininity.”

“I was totally fine with it,” said Maggie’s mom, who had her own nose done decades ago. “I could see what she was perceiving, I thought there would be an improvement, and there was. She never thought it was a way to get happy or get guys. When we talked about it, I told her you can’t just work on the outside, you have to work on the inside as well. And I feel like she’s done that.”

The days of the basic nose job on your 16th birthday are over. Rhinoplasty may still be the most customary procedure for teenagers, but many New York City teens see no reason to stop there. Between advertising, the Internet, daytime talk shows and reality TV, plastic surgery has become about as mysterious as a haircut. In rising numbers, teenagers are having procedures that include neck liposuction ($3,500), buccal-fat-pad excisions ($3,500), collagen injections ($450), Botox injections ($500), gynecomastia (male breast reduction) ($6,000), eyelid surgery ($3,500), otoplasty (ear surgery) ($4,000) and laser hair removal ($600). In New York, they come loaded with their parents’ money and tell doctors that they want to look like Jennifer Aniston, Christina Aguilera, Britney Spears, J. Lo. Interviews with several plastic surgeons who practice in the world capital of cosmetic surgery-the East Side of Manhattan-indicated that teens in search of medically enhanced beauty are on the upswing.

“It’s a decades-old ritual in certain parts of the United States for a 15- or 16-year-old to have rhinoplasty,” said Dr. Lawrence Bass. “But now that we have a constellation of faster, safer, more reliable cosmetic procedures, reasonable body modification is being adopted by more and more teenagers.”

“It’s unfortunate, but not really a surprise,” said Ophira Edut, editor of Body Outlaws: Young Women Write About Body Image and Identity . “Teenagers are a big demographic that marketers are targeting, and they’re being given a very difficult standard to achieve. It’s a very airbrushed, glamorous look; it’s not an image you can hit the gym and get. The direction the beauty standard is going in is one that probably does take surgery to achieve.”

“You have to be ready to deal when you do have a procedure, especially with guys with breast augmentation,” said Maggie (whose name, like those of the other young women quoted in this article, has been changed). “But I feel great about it and would definitely keep doing this.”

The teens, of course, are just following a trend eagerly embraced by their parents and older siblings. According to the American Society for Aesthetic Plastic Surgery, there was a 48 percent increase in cosmetic procedures in the U.S. between 2000 and 2001. Most of the surgery (44 percent) was for people between 35 and 50. And while kids 18 and under were responsible for just 3.5 percent of surgeries, that represents an increase from 2.9 percent in 1997.

The American Society for Aesthetic Plastic Surgery has no official position on teenagers and elective plastic surgery, but parental consent is required to operate on anyone under 18. It’s up to the surgeon to evaluate whether a child is emotionally mature enough for surgery. Sometimes it’s hard to determine exactly who it is that wants the surgery.

“One of the most important things in dealing with teenagers is to know what their motivation is,” said Dr. Lawrence Reed. “Sometimes the child is just sitting in the chair and I say, ‘What do you think?’ And they say, ‘Whatever my mom thinks.’ That’s not good enough for me. Even the most well-meaning parents have visions that are not shared by their children. It’s one thing to make them take piano lessons, but surgery’s different.”

“It’s not uncommon to see kids brought in by a parent who is pushing a surgery because they’re compulsive about their own weight,” said Dr. Robert M. Goldwyn, a clinical professor of surgery at Harvard University. “It’s amazing how it breaches common sense. I remember a mother who brought her child in for rhinoplasty because she was concerned that her child wasn’t popular enough.”

“Sometimes you’ll see a family in which the parents have relatively normal-appearing noses, and you can’t figure out where the kid got his nose,” said Dr. Alan Gold. “And then it turns out both parents had their noses done growing up.”

Dr. Kenneth Francis said he thinks cosmetic surgery for teenagers can be seen as a welcome trend. “I’m all for it,” he said. “Sometimes it brings them out of a social shell that they’re stuck under. I’ve seen a number of teenagers become extroverts after having been introverts their whole life. There’s controversy in everything that we do as plastic surgeons. I just happen to be of the camp that if I can make someone feel better about themselves, then I should do that.”

Liposuction, traditionally a procedure for the extremely overweight, has gone micro and is now one of the most fashionable procedures for 18-and-unders.

“It’s not so much about changing your weight; it’s about changing your shape,” said Dr. Howard Sobel, who said he sees between 15 and 20 teens a week, up about 30 percent from five years ago.

Dr. Sobel said he performs lipo for the neck, hips, thighs, chin, arms and even ankles.

“We had a couple of kids who had these big ankles, those ones where your calf runs into your ankle,” he said. “Kids who didn’t want to put on a short skirt because they have funny-looking legs. Or they think they do.”

In micro, or “designer,” liposuction, metal rods the size of small straws are used to remove the fat.

“Some kids are just genetically predisposed to have a certain shape,” said Dr. Sobel. “And they’re trying to change their love handles and double chins with this small little half-hour procedure. They have a bruise for three to five days, and then they go back to school.”

Wanted: J. Lo’s Butt

Dr. Bass said that anyone perceived as attractive in pop culture is in demand for imitation.

“I see a lot of Jennifer Aniston’s nose,” he said. “Which, of course, is an operated-on nose.”

He said there’s been a wave of teens requesting Jennifer Lopez’s round bottom and curvy hips.

“I personally don’t do buttock or calf implants on teens or adults,” said Dr. Bass. “But we will sometimes do fat injections. If you leave the saddlebags when you cut into the waist with lipo, you’re reducing, but also getting a curvier look.”

“I’ve had several requests for buttock augmentation,” said Dr. Francis, “especially in the Hispanic teenage population. But I’ve not recommended an operation for any of them.”

“A few years ago, everyone wanted to look like Sharon Stone,” said Dr. Alan Matarasso. “Now, younger teenagers are coming in asking for Britney Spears’ figure and facial features. Most teens want the lip enlargements and the buccal fat pad removed. They do this to look thinner in the face, which has always been desirable. But the surgery didn’t exist. Thirty years ago, they would take out their wisdom teeth; 20 years ago, they’d get cheek implants; today, they do this.”

Many plastic surgeons refuse to perform the buccal-fat-pad extraction.

“You don’t want to make them look great at 17 and not at 22,” said Dr. Gerald Pitman.

“Buccal fat pads should never be removed, because you really need them when you’re old,” said Dr. Patricia Wexler. “It gives a sophisticated look, which is great when you’re 26-but when you’re 46, you look gaunt.”

She said that teenagers come to her for liposuction of their saddle bags and love handles, but frequently it’s body-appropriate.

“Rather than have eating disorders, they’d rather deal with that one body area than starve themselves all over,” said Dr. Wexler.

Dr. Danny Fong performs eyelid surgery on teenagers.

“The eyelid surgery is mostly for Asian kids who have single eyelid folds and want a double eyelid fold,” said Dr. Fong. “It creates a fold in the upper eyelid-about 50 percent of Asian people don’t have that fold.”

Dr. Debra Jaliman said lip injections are trendy for teens in her office.

“The other thing I found interesting is girls having laser hair removal for their bikini line,” she said. “Even young kids, starting at 12, who don’t want to ever have to shave or wax.”

After a life spent hating her small lips, Jane, a senior at a private school on the Upper East Side, started getting collagen injections from Dr. Jaliman when she was 16. On her first visit, she asked the doctor not to make her look like Goldie Hawn in The First Wives Club . Dr. Jaliman applied numbing cream, gave her a stress ball for the pain and injected the collagen with tiny needle pricks. Jane was pleased with her new lips-enough to repeat the process every four months for two years. Until a few weeks ago.

At the beginning of Jane’s last visit, Dr. Jaliman told her about a new solution called cymetra, which lasts more than twice as long as collagen. Jane agreed to try it, and then immediately regretted her decision.

“An hour after I got it, I was just like, ‘Oh my God.’ I don’t know, I’ve been O.K. with my looks for a while now, and I guess I realized it wasn’t really a big enough deal to bother with any more. I realized I’m going to have these for nine months, when I start college. I guess I’m stuck with them. Also, knowing how much money it costs, it just felt ridiculous. I actually could have bought a car.”

Jane said photos of models hang from the walls of her school’s senior lounge.

“People have a lot of money on the Upper East Side and are obsessed with that sort of thing,” said Jane. “It’s all over the place. Plastic surgery isn’t that normal, but pretty close to it.”

Alicia, a teenager on the Upper West Side, started gaining weight at 15. She joined a gym, but hated the way her body was changing. She researched liposuction online and scheduled a consultation with a doctor whose Web site she liked. The week after she turned 18, she used her birthday money to have chin and stomach lipo and her buccal fat pads removed.

“I just wanted to do those areas,” said Alicia. “I don’t have a problem with other areas; I just thought those protrude a little bit too much.” She said her boyfriend didn’t want her to do it, that he told her to diet and exercise.

“But I guess I just wanted a quick fix,” said Alicia. “I was so pumped to do it, I wasn’t even scared.”

She hasn’t told any of her friends and is wearing baggy sweat clothes for now.

“No part of me regrets it,” said Alicia. “I feel great. It depends on how low your self-esteem is. If you feel like, ‘I’m ugly because I have this fat,’ then don’t do it. But I don’t have low self-esteem. I just wanted to look nice, and you can’t wear nice stuff if you have a stomach.”

Like their Vogue- toting older sisters, teen girls are also having Botox injections (freeze-dried botulinum that temporarily paralyzes facial muscles)-even though they’re years away from having any wrinkles to smooth.

“They’re starting Botox early because what happens is, some of them have a tendency when they smile or frown to wrinkle,” said Dr. Sobel. “So even if you do it later, you’ve already etched your skin. If you do the Botox early, then the skin won’t wrinkle on itself and you won’t get an etched line.”

“Anybody who does Botox on a young person should be shot,” said Dr. Helen Colen, who said she regularly turns down requests from teenagers. “Today’s kids have been forced to grow up so quickly. Everybody wants to be perfect, and everybody is judged according to what they look like. I’ve had kids who come in and want their old nose back. Or they bring a picture of what they used to look like and say that they want to restore it.”

“I’m Italian, German and Greek,” said a young woman, Hannah, who started having Botox injections when she was a senior in high school on the Upper East Side. Hannah’s mother helps pay for the injections, around $500 dollars every three to six months.

“When I frown, there’s a huge hunk of skin that makes like a third person,” said Hannah. “First I tried not making that face, but then I got the Botox in between the eyebrows, and when I made the face, it was like the most amazing thing. It didn’t paralyze me or look unnatural. I look the way I was supposed to look.”

The Kindest Cut? Teens and Plastic Surgery