- The Washington Times - Tuesday, February 1, 2000

Pick up any teen magazine and enter a world where faces are beautiful, bodies are thin and breasts are big. For the teen who sees a big nose, fat stomach and microscopic breasts reflected in the mirror, stories and ads offer rapid remedies.
On the Internet, a computer search using "teens and plastic surgery" yields hundreds of sites promising a quick transformation. One site, BreastaugUSA, even promises cut-rate prices on breast-surgery consultations hawking them like empty seats on an airliner.
A recent media splash also trumpets a growing trend in teen cosmetic surgery, drafting pop star Britney Spears as its unwilling poster child. (She has denied published reports that she had breast augmentation surgery at age 16.)
In teen speak, everyone is getting plastic surgery. But everyone isn't, according to plastic surgeons and their professional organizations.
There is no doubt that adults in record numbers are nipping, tucking, sucking and augmenting. Unprecedented affluence, a baby-boomer fixation on youth and an aggressive advertising blitz by media-savvy doctors have sent the number of cosmetic procedures soaring. But the American Society for Aesthetic Plastic Surgery (ASAPS) reports that less than 3 percent of those nearly 2 million surgeries were performed on minors a percentage that has held steady since record-keeping started in 1992.
Plus, experts say, only 11 percent of the nearly 25,000 cosmetic surgeries on minors were for such sexy procedures as breast augmentations, tummy tucks or liposuction.
Media-created story
"It's easy for the media to take these numbers and turn it into a hot button that gets a lot of people excited," says Dr. William Little, a plastic surgeon in the District. "It turns into another media-created story that society is going to hell in a handbasket. The truth is that teens have been getting plastic surgery for generations, and that hasn't changed much."
He says rhinoplasty surgery on the nose is a classic example of "a sound practice at the right time" and virtually all of the breast surgeries he performs on minors are to correct a problem of asymmetry or to bring an overly developed teen into proportion with the rest of her body.
Leida Snow, a communications officer for ASAPS, says she was mystified by a rash of media reports about the growing trend in teen cosmetic surgery. Her Manhattan-based association includes among its members plastic surgeons, dermatologists and ear, nose and throat surgeons.
The 5,000-member, Chicago-based American Society of Plastic and Reconstructive Surgeons (ASPRS) has reported that the number of surgeries performed on minors nearly doubled from 1992 to 1998 from 13,312 to 24,623. The number of teen-agers in the United States also grew by 11 percent in the same time period, according to the U.S. Census Bureau but did not keep pace with the increase in plastic surgery.
Ms. Snow says media emphasis on breast augmentation and liposuction distorts the picture. She says rhinoplasty continues to be the most common procedure, followed by cosmetic ear surgery, breast reduction and correction of breast asymmetry in girls and then gynecomastia to correct breast development in boys.
"It's far easier and certainly more exciting to look at these numbers and call it a trend and to use examples, such as breast augmentation, to tell the story," Ms. Snow says. "But the real story is much more complex."
She says the percentage of rhinoplasties on teens has increased from 11 percent of the total in 1992 to 14 percent of the total in 1998, while breast augmentations have decreased from 3 percent of the total in 1992 to 1 percent in 1998.
Dr. Little agrees that adolescent interest in purely cosmetic procedures has increased, but he says he believes that is a response to unrelenting media focus on the issue.
Not a quick fix
"The thing that has changed is now we're seeing teens who are looking for a quick fix to their problems," Dr. Little says. "The girl who says, 'I'm a bit overweight, and why should I exercise or diet when I can just get it sucked out?' This comes from this media-generated electronic bombardment of images of idealized proportions."
Media watcher Matthew Feller from the District-based Center for Media and Public Affairs agrees that news coverage can spin a story out of control.
"The press brandishes a double-edged sword," he says. "By telling and retelling and retelling cautionary tales such as [stories about] teens and plastic surgery they're actually turning into an advertisement for that very thing."
Mr. Feller says the irony is that while "the nature of news reporting is focusing on what goes against the norm, the practice of describing it again and again makes it a norm of its own."
Impressionable adolescents, who are still forming their self-images, are very susceptible to this media barrage. That worries Dr. Ann Kearney-Cooke, a physician-scholar with the Partnership for Women's Health at Columbia University.
In a study funded by Seventeen magazine and Procter & Gamble's Secret antiperspirant division, she recently conducted an Internet survey of 4,000 teens. She says one of the study's most alarming findings was that nearly half of the 14- to 18-year-olds said they were not satisfied with their bodies, and a third of the teens who answered the survey said they were considering some type of plastic surgery.
"What's most disturbing to me is that this is a time when their bodies aren't fully formed, yet teens feel so much pressure to be instantly perfect," Dr. Kearney-Cooke says. "Plus, an adolescent girl's feelings about her body change as much as her body changes. One day they're the belle of the ball, and the next day they're too ugly to go out in public."
A multimedia image of unachievable perfection assaults children from the time they first watch television, she says. "The teen years used to be the time to find yourself and form your beliefs. 'Who am I?' has been replaced with 'What do I look like?' "
Why wait?
Media attention is not all bad, says Dr. Allen Rosen, a practicing plastic surgeon in Bloomfield, N.J., and assistant clinical professor at the University of Medicine and Dentistry of New Jersey. "It's healthy that teens now feel that they have more control over their appearance," he says.
Improvement in medical techniques, such as laser surgery, and anesthesia practices have made elective surgery safer, Dr. Rosen says. The properly motivated teen can benefit tremendously from cosmetic surgery.
"It's a question of weighing the risks and benefits," he says. "I've operated on boys who had breasts that looked like girls', and their life was hell. They couldn't take off their shirt for gym at school or at the beach in the summer. After a safe surgery, they regained their sense of self and saved years of misery. Why wait until they're older? That's just unnecessary cruelty."
Most teens are not looking for Hollywood-style breasts or stunning looks, Dr. Rosen says. "At this age, kids don't want to stand out in any way. The ones that come to see me just want to look normal."
Dr. Rosen says baby boomers, who are causing a downward curve in the age of cosmetic surgery, are beginning to bring in their teens after their own positive experiences.
"I had a woman who was very petite but was always unhappy because she had a small belly. She finally came in for liposuction and after a 45-minute in-office procedure, was delighted with the change. Now her daughter is 13 and has the same small belly, and she wonders if she can prevent her [daughter] from years of unhappiness with her body when the solution is so simple."
Liposuction is the single most popular cosmetic treatment. According to the ASPRS, 172,079 liposuctions were performed in 1998 although only 1 percent of them were on teens.
A recent report published in the journal Plastic and Reconstructive Surgery cautioned that liposuction also carries the highest fatality rate, claiming a life for every 100,000 cases. Experts consider a single fatality for every 100,000 cases a tolerable level.
Dr. Gerald Pitman, a Manhattan plastic surgeon who is considered an expert in liposuction, says he rarely treats teens, although he has had a few patients as young as 14.
"Liposuction is a serious medical procedure," he says. "It sounds simple, but it is not. Every case must be considered individually."
Most surgeons evaluate their young patients not just by their age, but by their need, maturity and longtime desire for the proposed change. Some people wait their entire lives. A Catonsville, Md., woman in her 40s recently had a breast reduction and says she regrets having waited decades for something for which she had longed since her teen years.
"That's my biggest regret," says the woman, who didn't want her name used. "My teen years were so painful because I didn't have the self-confidence to face down the teasing. I have a son, but if I had a daughter and she had the same problem, I'd back her all the way."
Other surgeons agree that the teen years, when bodies heal fast and psyches are fragile, can be an excellent time for a number of common surgeries.
"I've a young man who came back to me after he was grown and told me that fixing his nose when he was 15 was the catalyst that changed his life for the better," Dr. Little says.
But surgery should never be viewed as a quick-fix panacea, he warns. "There's a danger in any surgery, and it should never be taken lightly. When someone comes in after seeing an ad, we know that they're not a good candidate. Plastic surgery is not an impulse buy."

More info:

Teen books

* "Bodypride: An Action Plan for Teens: Seeking Self-Esteem and Building Better Bodies," by Cynthia Stampler Graff, Griffin Publications, 1997. This easy-to-use book provides a daily plan for teens that includes a clinically tested 28-day diet.

* "The New Teenage Body Book," by Kathy McCoy and Charles Wibblesman, Per-igee Press, 1992. This book won the American Library Association's Best Book for Young Adults award and offers constructive tips to help both young men and young women develop a healthy body image.

* "Body Image: A Reality Check," by Pamela Shires Sneddon, Enslow Publishers, 1999. The mother of nine children, the author discusses the dangers of eating disorders, dieting, steroids, cosmetic surgery, piercing and tattooing. She also offers teens tips on how to feel better about themselves and improve their body image.

Adult books

* "The Body Image Workbook: An 8-Step Program for Learning to Like Your Looks," by Thomas Cash, New Harbinger Publishers, 1997. The author, an authority on body image, gives tips on overcoming self-destructive body views.

* "Someone to Love: A Guide to Loving the Body You Have," by Leslea Newman, Third Side Press, 1992. The book provides 42 ways to rethink how you feel about food and the people around you.

* "Love the Body You Have," by Marcia Germaine Hutchinson, Crossing Press, 1999. This workbook helps readers feel comfortable in their own bodies.

* "Appearance Obsession," by Joni Johnson, Health Communications, 1994. The author helps readers withstand societal pressures that she says make "every day [feel] like a walking Miss America contest."

* "Love the Body You Were Born With: A 10-Step Workbook for Women," by Monica A. Dixon, Berkley Publishing Group, 1996. The author provides a step-by-step guide to emphasize positive attributes and downplay negative ones.

On line

* Tami Brannon, a family counselor, and Lisa Licavoli, a nurse-nutritionist, have put together a Web site (www. healthybodyimage.com) dedicated to helping others improve their body image. Healthy Body Image offers advice, resources and links to related sites.

* New Moon Magazine (www.newmoon.com) is a site devoted to girls from ages 8 to 14. Subscriptions also can be ordered by calling 800/381-4743.

* Three Rivers Free-Net (https://trfn.clpgh.org/Populations/ yabodyimage.html) is an on-line clearinghouse in the Pittsburgh area that also has an extensive listing of nationwide links relating to health and body image.

* Butler Hospital in Providence, R.I., offers a Web site on body-image issues (www. butler.org/ bdd.html). The site includes a list of symptoms and a questionnaire so parents can determine whether their teen has a body-image disorder.

* The Hemangioma and Vascular Birthmark Foundation, located in Latham, N.Y., has a site (www.birth mark.org) that provides information, resources, support and chat areas, references and links to other sites relating to a variety of birthmarks.

* The American Society for Aesthetic Plastic Surgery sponsors an educational Web site (www.surgery.org) that explains various procedures and offers nationwide references of board-certified surgeons. Address: 36 W. 44th St., Suite 630, New York, N.Y. 10036. Phone: 212/921-0500. Toll-free referral line: 888/272-7711.

* The American Society of Plastic and Reconstructive Surgeons represents 5,000 board-certified surgeons and also offers information and references. Address: 444 E. Algonquin Road, Arlington Heights, Ill. 60006. Phone: 847/228-9900.

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