There are differing opinions and much controversy around the topic. One group says it is best to let teens have cosmetic surgery if they wish. Others believe there should be age restrictions for cosmetic surgery, that allowing teens unlimited access opens them up to exploitation and fosters unhealthy values. Who is right? Should teens themselves have a say? And where does Australian law stand on the matter?
Should teens have cosmetic surgery? That depends. If there is a medical reason, or some factor that is clearly affecting the physical, emotional or psychological wellbeing of a child or teen, then cosmetic surgery should clearly be an option on the table.
If there is no medical reason or justification that makes the procedure urgent, but the teen expresses the desire for social or self-esteem reasons, some hard thinking needs to be done.
Also, should teens themselves have a say? Where does Australian law stand on the matter? These are all important issues to explore in this article.
Let’s start with what cosmetic surgical procedures are common among teenagers.
What do teenagers want?
According to the American Society for Aesthetic Plastic Surgery (ASAPS), the most common cosmetic surgical procedures for teens include ear correction surgery (otoplasty), nose reshaping (rhinoplasty), breast reduction (reduction mammoplasty) in teen girls, correction of breast asymmetry, and male breast reduction surgery in teen boys with excessive breast development or gynaecomastia.
You can read more about the ongoing dialogue and justifications concerning breast reduction surgery in our article, should breast reduction be available to teenagers?
What if the parents are OK with it?
Sure, some parents willingly pay for a cosmetic breast enhancement for their daughter or for their son to have nose-reshaping surgery. Some are even willing to let teenagers have liposuction. But should this be allowed?
One camp says that letting teens who want it have cosmetic surgery if their parents see no problem with granting approval and paying for the procedures. Similar thinking exists everywhere in the world, but we are increasingly hearing about cases in the US and the UK.
Here are a few stories:
- Surgeon Gave Teen Daughter Breast Implants – An ABC News story from February 2012.
- Teenage victim of online bullying resorted to plastic surgery to silence teasing – A story from the U.S. about a 13 year old girl named Nicolette having nose reshaping surgery (MailOnline, October 2011).
- Two videos from the American Society for Aesthetic Plastic Surgery tell the stories of Allison, a young teen who had nose reshaping surgery (rhinoplasty) and Wills, a teen boy with gynaecomastia who underwent treatment for male breast reduction.
Aside from the ‘ick’ factor, the first story received the most publicity and public backlash, possibly because breast augmentation is considered purely cosmetic. The teenagers in the other stories appear to have benefited greatly from their surgery, facing less bullying, less embarrassment and possibly feeling better about themselves after their procedures.
The question then is whether these teens’ lives and the lives of numerous others like them should be made difficult by outright bans on cosmetic surgery for teenagers, or whether age restrictions, with some leeway for cases such as these, should be put in place.
Age related cosmetic surgery ban
Those in the opposing camp want a blanket ban on cosmetic surgery for kids and teenagers. They would like to place restrictions on when young people can decide for themselves when they need cosmetic surgery.
They rightly claim that the lack of restrictions make children and teenagers vulnerable to manipulation and exploitation by unscrupulous elements. They also say that obsession with physical features and physical beauty at an early age fosters unhealthy values, setting up kids for problems with body image and self esteem.
Who is right?
It seems to us that both sides are right, at least in part. And perhaps, in certain aspects, each side could be wrong.
There are valid points in the argument for an age-related ban, but is a blanket ban justified? Then what happens to teens like Wills, Nicollette and Allison, and to numerous other kids who are bullied for their unusual features? In a perfect world the bullying would be corrected, not the physical features, but we—and our children—live in the world we have.
Who decides?
When the annual survey of the Cosmetic Physicians Society of Australasia (CPSA), conducted through Costhetics, included a question about age, 76 percent of the respondents felt that 21 is the most appropriate minimum age to start surgery for aesthetic purposes. Nearly 20 percent of people felt 18 to 21 were appropriate ages. Compare that figure with the 4 percent who felt that ages 16 to 18 was appropriate and to the mere 1 percent who said 16 years or younger was okay.
In considering where public opinion stands on this matter, it is important to remember that those who took part in the survey appear to be very open to cosmetic treatments—which is probably what drew them to Costhetics and to the survey in the first place. Yet even they felt that teenagers are not old enough to make their own cosmetic surgery decisions; that age restrictions are appropriate.
Surprisingly though, the Australian public appears to be more broadminded on the matter. When a March 2012 survey in the Herald Sun ran a survey asking its readers “Should plastic surgery have an age restriction?” the cumulative results showed that around 84 percent of its readers answered ‘yes’ and only 16 percent said ‘no’.
But does that mean Australians welcome a total ban on cosmetic surgery for those under the age of 21 years? Or do they want guidelines, with room for case-by-case evaluation? It will take time to find a balanced answer.
Meanwhile, Australian lawmakers seeking to better regulate cosmetic surgery to ensure safe conditions for consumers have recognised the complications of this question.
Australian laws on cosmetic surgery for kids and teenagers
At present, laws differ from state to state on how cosmetic surgery is regulated for kids and teens. Queensland has the strictest laws, restricting cosmetic surgery for those below 18 years, subject to a ‘best interest’ requirement.
The National Framework on Cosmetic Medical and Surgical Procedures (2011) contains measures meant to safeguard those below the age of 18. The supplementary guidelines in relation to cosmetic medical or surgical procedures recommend measures for adults as well as those below 18. These specific recommendations were directed at the Australian Medical Board.
Here are the key features:
- The first consultation should be with the operating doctor, rather than with an agent or patient advisor.
- In determining the suitability of a procedure, the doctor is required to undertake an exploration of why the surgery or procedure is requested. The doctor should explore both external reasons—such as a perceived need to please others—and internal reasons—such as strong feelings about appearance. Doctors are also required to look into the person’s expectations of the requested surgery or procedure to ensure they are realistic.
- The guidelines state that “If there are indications that the person has self-esteem or mental health problems, the person should be referred to a GP or an appropriately qualified health professional” such as a psychiatrist, psychologist or specialist counsellor for review. However, when the Medical Board of Australia invited public comments on the proposed guidelines, the Australasian College of Cosmetic Surgery submission pointed out that “a self-esteem ‘problem’ could imply anything from a normal response to some aesthetic concern, which a cosmetic procedure might ameliorate, to body Dysmorphic Disorder”. Therefore, the College recommended changing that requirement to include a phrase requiring a doctor to refer for evaluation those whom they believe “may have an underlying psychopathology such as Body Dysmorphic Disorder or other mental health condition or concern which may make them an unsuitable candidate for a cosmetic medical or surgical procedure”.
- A pre-procedure consultation within a reasonable time before the day of the procedure that includes informed written consent from the patient. The informed consent should be reconfirmed on the day of the procedure.
- Guidelines also encouraged a cooling-off period between the initial consultation and the date of procedure.
In addition, there are specific recommendations for those under 18 years of age:
- A ‘cooling off’ period of 3 months if the requested surgery or procedure has no medical justification. There should be a second consultation at the end of the ‘cooling-off’ period during which the request is further explored. Doctors should not schedule the surgery or procedure at the initial consultation.
- Doctors are asked to encourage prospective patients to discuss their desire for the surgery or procedure and any concerns they have during the cooling-off period.
- The requesting person should be assessed by an appropriately qualified health professional such as a psychiatrist, psychologist or specialist counsellor.
The Supplementary Guidelines on Cosmetic Medical and Surgical Procedures that will be part of “Good Medical Practice: A code of conduct for doctors in Australia” are yet to be issued in final form. Once they are issued, regardless of state laws, all medical professionals seeking registration in Australia will be obligated to adhere to those guidelines.
As things stand, this area is in constant flux. At present, if your teenager wants cosmetic surgery you may be confined by your state laws and the ‘best interest’ clause in the current code of conduct for doctors in Australia.