Just seven years old, Samantha Shaw of Sturgis, S.D. is about to experience something very grown-up: she's going to have cosmetic surgery.
It's not because she has a serious facial deformity or a life-threatening medical condition. Samantha is having cosmetic surgery because she gets teased about her protruding ears.
"The kids at school always ask her about her ears, and sometimes adults can be worse," said Cami Roselles, Samantha's mother. "One lady walked up to her and said, 'Oh my God, what happened to your ears?'"
When people ask, Samantha just tells them she was born that way, but Roselles said the questions really bother her daughter.
"She always asks me why people ask questions. She's very sensitive, so it really does get to her."
Samantha's doctor thought her ear deformity would get better as she got older, but Roselles said nothing changed. After doing some research, she looked into a type of cosmetic procedure called otoplasty, more commonly known as "pinning back" the ears.
Samantha, who will have her otoplasty on April 5, isn't the only child to undergo cosmetic surgery because of bullying. Statistics from the American Society for Aesthetic Plastic Surgery show that the number of children and teens who get cosmetic surgery increased nearly 30 percent over the past decade. Experts believe an increase in bullying behavior is one reason for the upward trend.
Brian Donoghue, an 11-year-old from Long Island, N.Y., had the surgery last summer.
His mother, Valerie, said kids at school would often ask Brian why his prominent ears looked the way they did.
"He would turn it into a 'Look what I can do with my ears' sort of thing and he'd kind of fold up his ears. The kids thought it was funny," said Donoghue.
But even though Brian was able to use a defense mechanism to fend off the taunts, his mother, who is an assistant principal at a high school on Long Island, said she's seen the effects of bullying and didn't want her son to go through that.
Experts say bullying can cause problems like depression in victims, and eventually, bullied children may start to lash out, feel depressed, and have academic difficulties.
"If we had gone much longer, we might have started to see some of those other behaviors," said Donoghue.
Dr. Frederick Lukash, the plastic surgeon who handled Brian's case, said he could tell from drawings Brian did that he was tormented by the teasing.
"His drawings showed exaggerated ears while other kids had normal ears. I could tell there were some deep-seated issues," Lukash said.
Before doing surgery on a child, Lukash said most surgeons will talk to the child during multiple consultations to find out how the child feels, and how he or she interacts with peers. He encourages them to draw pictures. In many cases, like Brian's, it's clear children are upset by constant teasing.
As kids get older, teasing can take a turn for the worse and turn into bullying. In the age of social media and the Internet, parents say it's reached a new level.
"Bullying is very different now with Facebook and sites like that," said Donoghue. "I didn't want him to go through that."
But other experts say doing plastic surgery on a child sends the wrong message.
"Changing appearance is not the solution," said Cheryl Rode, director of clinical operations at the San Diego Center for Children. "We never want to hold the victim responsible for the bullying."
Rode said the responsibility must lie with schools and other places where children are as well as with society.
"It is our responsibility on a national level, not the responsibility of parents of victims to make change happen."
Roselles said she decided to go through with the surgery because she's worried the teasing may turn into more serious bullying.
"Having it done now is probably the best, instead of when she gets older and they make fun of her more."
Otoplasty isn't covered by insurance, though it used to be.
"If it's not causing a functional problem, then it's not covered," said Lukash.
Otoplasty can cost between $5,000 and $10,000. That is more than Roselles could afford, so she reached an organization called the Little Baby Face Foundation. Surgeons working with the foundation operate for free on children with facial deformities, and the foundation covers other expenses, like Samantha's trip to New York City.
Otoplasty is the most common cosmetic operation done on children. In addition to cleft lip or cleft palate surgery, it's the only cosmetic procedure acceptable for young children.
Dr. Steven Pearlman, a facial plastic and reconstructive surgeon in New York, is scheduled to perform Samantha's surgery.
"She's going to have two related procedures. The general one is otoplasty for children whose ears stick out. We set back the ear and make it look more natural and normal," Pearlman said.
The other procedure will be on her right ear, which is folded over. That condition is called lop ear. Both surgeries have a high success rate.
"The ideal age is about six years old," said Pearlman. "The ear is 90 percent of adult size, so we can operate successfully and a child is old enough to understand why the operation is important."
Samantha said she is nervous about having surgery, but excited about her trip to the Big Apple. She's also excited about doing things many little girls her age get to do.
"She wants to wear her hair like other girls in her class do," said Roselles, "and she wants to get her ears pierced."