Most teens love the mirror, spending hours in front of it experimenting with hairstyles, makeup and fashion. But thousands of them are so deeply dissatisfied by what they see each year that they try to permanently change the image reflected in the glass; through plastic surgery.
"I have really low self-esteem," Caitlin Clemons, 18, said in the days before her breast augmentation surgery.
Watching her mother and sister gain confidence after undergoing their own breast enlargements convinced the Galveston, Texas, woman that the surgery could do the same for her.
"Once I saw how happy she was, I knew I could be that happy," Clemons said of her sister. "I'll have confidence. It definitely made me want the surgery more. Once my mother got hers and I saw it can be done, it really clicked in my mind that I can do this."
Nearly 210,000 cosmetic plastic surgery procedures were performed on people age 13 to 19 in 2009, according to the American Society of Plastic Surgeons. While adults tend to have plastic surgery to stand out from the crowd, teens tend to have surgery to change the parts of their body they believe are flawed so that they can fit in with their peers, experts say.
Clemons is no exception. "I have always been the friend with small breasts, unlike everyone else," she said. "I was tired of being teased about it. I've always judged myself. I've always looked at my friends, my sister and just kind of picked at myself, picked at my body and pulled out every imperfection that I could find."
The most popular procedure among teens is a nose job, also known as rhinoplasty. Nearly 35,000 U.S. teenagers had their noses surgically reshaped last year, according to the American Society of Plastic Surgeons.
Teens sometimes emboldened by the results of one plastic surgery opt for another procedure on a different body part. Tracey Karp is one of them.
Happy with the results of her breast enlargement at age 17, she returned to her plastic surgeon two years later for a nose job.
"He did a breast augmentation on me two years ago," said Karp, who also lives in the Houston area. "And that went super well, so he made me feel very comfortable."
Teens' Favorites: Nose Jobs, Breast Enlargements
Karp was scheduled for surgery for a deviated septum when she asked her parents for permission to add rhinoplasty to the procedure. Knowing her yearning for the procedure, they agreed, in part to ensure that she was in the hands of a qualified surgeon.
"The fact that she was going to be shortly coming of age, where she could go out and do it behind our backs, we didn't want that to happen," her father, Jeff Karp, said.
Looks are a top concern for his daughter, who works out frequently at her gym. She calls herself "definitely obsessive" about her physical image.
"I put pressure on myself to look a certain way for sure, as, I would assume, most girls do at my age," Karp said. "I can always find things to change. I'm like, ugh, I'm only 19 and I have wrinkles."
Another favorite procedure among teen girls is breast augmentation, despite the Food and Drug Administration's having approved implants only for people 18 and older, although doctors are free to use their discretion for girls.
About 8,000 girls age 13 to 19 had their breasts enlarged last year, according to the American Society of Plastic Surgeons. And 2,953 of them were age 18 and younger.
"I was barely a double A cup. I just really didn't feel feminine at all," said Karp, who was 17 when she and her older sister both had their breasts enlarged.
Their mother, Caroline Karp, said the physical change has sparked an emotional transformation. "It has definitely changed their self-esteem," she said. "They feel much better about themselves."
Clemons was looking forward to a similar metamorphosis as she was wheeled into surgery, having instructed her doctor to make her breasts big enough to fill a voluptuous C-cup size bra. That morning, she faced the mirror and said her final goodbyes to her old image.
"I was like, 'Goodbye, old body,'" she said.
After the surgery, she said she was in pain but was certain she'd be happy in the end.
"It feels like somebody's been throwing bricks at my breasts," Clemons said. "The pain won't last forever. So I do think it will be worth it."