Can you describe what happens at a typical consultation?
When a teenager who is younger than 18 comes in for the consultation, he or she must be accompanied by a parent or guardian. We first sit down and discuss the patient's request—in this case it would almost always be rhinoplasty—and we make sure it's something the teenager actually wants. You can tell when people want something or if they're simply there because mom has expectations of the teenager's appearance. Those things come out in the discussion. We find out if the teenager's expectations are realistic and ask them point-blank why they want the surgery. They have to be able to talk and communicate their desires and not just parrot what someone else told them.
If their reason is just that their boyfriend wants it or because some friends tease them, then that's inappropriate and I wouldn't offer that family the surgery. In that case, I would postpone the discussion until they're really ready. What you want to hear is that the teenager wants the surgery for themselves. And as we talk to them, we determine what their self-esteem is.
If I don't think they're ready, I'll tell the parents that yes, there may be an issue with the teen's nose, but I don't think this young person is ready yet. Let's talk again next year. If the teenager believes that if only she got her nose done, she would no longer be ostracized, then I'd refer her for counseling. I also look at the level of parental support. You really have to look at personal maturity and make sure that the expectations are realistic. Certainly parents can seek a second opinion, but they must treat what the surgeon says very seriously.
What are the main considerations a parent and teenager should take into account when deciding on plastic surgery?
No matter what someone's age is, patients should always choose a plastic surgeon certified by the American Board of Plastic Surgery. The second critical element is to make sure the surgery is carried out in a licensed hospital or accredited facility because complications can happen to people of all ages.
Make sure you sit down with the plastic surgeon and have a thorough consultation that goes beyond just the area of concern, particularly with teenagers. This includes a thorough physical exam and all preoperative testing. The doctor should get to know the teenager and make sure he or she is emotionally ready and will be able to deal with complications if they come up. I see all of my patients twice before I do surgery, and I think it's a good idea to have the patient come back after the first discussion. It shows perseverance and drives home the point that this is a serious decision.
And if the patient is 18 and older, but still young, I encourage parents or guardians to be involved in the decision making, even though it is the patient's legal choice.