Apr. 21, 2008 -- With one Australian state's announcement that cosmetic surgery will soon be banned for most teenagers, some surgeons in the United States applauded the move, saying similar legislation in this country would make sense.
Others, however, said such a move here would do little if any good — and it could even make it more difficult for kids who have a legitimate need for cosmetic procedures to get the surgery they desire.
The decision, which was made late last week, would place cosmetic surgery and tanning beds out of the reach of those under 18 in Queensland, beginning in the middle of this year. The new rule would not affect a teen's ability to have surgery to correct deformities or disfiguring injuries, and it would still leave room for an undefined list of procedures to improve medical, psychological or social well-being.
But, in most cases, appearance-centered procedures like breast implants and liposuction will be off the table.
"This is not about becoming a nanny state," Premier Anna Bligh told parliament on Thursday, according to the Australian paper "The Age."
"I appreciate that this can be a difficult time, especially in a young woman's development, but to resort to a surgeon's blade is an adult response best left until one is an adult."
The move has already received the blessing of the Australian Society for Plastic Surgeons, Australia's preeminent professional plastic surgery professional organization.
In the United States, many plastic surgeons said such a ban makes sense. Dr. Pete Costantino, a craniofacial specialist and reconstructive surgeon at St. Luke's-Roosevelt Hospital in New York, called the ban a "great idea."
"If they aren't old enough to sign their own surgical consent for a medically necessary procedure, then they shouldn't be able to induce their parents to do it for cosmetic surgery — which is a personal, subjective, value-based decision, not a decision of medical necessity," he said.
"The percentage of teens having surgery is low; however, I fear television showing [young female celebrities] and their antics as well as others will have a tendency to increase the numbers," Atlanta plastic surgeon Dr. Brian Maloney said. "As we have seen a boom of cosmetic procedures as a result of reality TV shows. It is unfortunate that a parent would consider letting a 16-year-old daughter have a breast augmentation."
But others worry that similar legislation, if it ever comes to pass in the United States, would draw a largely arbitrary line — and could needlessly restrict some teens from procedures that would help their self-esteem.
Dr. Malcolm Z. Roth, director of plastic surgery at Maimondes Medical Center in Brooklyn, N.Y., said he believes that some teens are intelligent and mature enough to comprehend the risks and benefits of cosmetic surgery.
"I believe the government should stay out of the mix, and I would encourage patients to seek out the advice of a board-certified plastic surgeon who is trained in not just the surgical aspects of cosmetic surgery, but just as important, the psychological aspects of the decision," he said. "If the teenager is not a good candidate, for physical or psychological reasons, the physician is the best one to make that determination."
"The age 18 is an unrealistic marker," agreed Dr. Garry S. Brody, professor emeritus of plastic surgery at the University of Southern California's Keck School of Medicine in Los Angeles.
"The decision for any such surgery depends upon the maturity of the patient, their motivation and realistic expectations. Is the girl with asymmetric breasts any more deserving than the girls with very small breasts, who won't go to gym or swim because of her 'deformity'?"
Teens Under the Knife
Though the phenomenon of teen cosmetic surgery naturally garners a great deal of attention, the numbers suggest that it may not be as common in the United States as many would guess.
Teenagers represent only 2 percent of U.S. cosmetic surgery patients, according to 2007 statistics compiled by the American Society of Plastic Surgeons. And in these patients, ear reshaping operations — not boob jobs — are the most popular procedures, with rhinoplasty coming in second.
And though the Queensland ban is likely the most sweeping action taken by a government yet, the U.S. is not without its prohibitions on cosmetic surgery procedures for young patients.
The U.S. Food and Drug Administration, for example, has deemed all breast implants inappropriate for patients under 18 and has approved silicone breast implants only in patients older than 21.
And New York plastic surgeon Dr. Frederick Lukash said that even absent an outright ban on cosmetic surgery for teens in the United States, the situation set up by the Queensland law already somewhat resembles what is happening in this country.
"Very few under 18-year-olds are making their own decisions regarding surgery," said New York plastic surgeon Lukash, who wrote the position paper on teenage plastic surgery for the American Society of Plastic Surgeons. "They do not have the financial independence to do so. Parents are involved in the decision-making process and usually maintain good judgment.
"Responsible surgeons will use good judgment and operate on appropriate individuals for the proper situations. A law banning surgery will not alter that."
Who Should Decide?
For this reason, some surgeons said a ban in the United States would only complicate the situation, making it harder for doctors by forcing them to justify helping patients who have a legitimate need for cosmetic surgery.
"As in most cases, the devil will be in the details," said Dr. Thomas J. Gampper, vice chair of plastic surgery at the University of Virginia in Charlottesville. "The law allows procedures to correct deformities would be allowed, along with undefined procedures to help a teenager's medical, psychological or social well-being. Those three exceptions are the reasons for the vast majority of all our adult cosmetic procedures, so theoretically, it may not ban any procedures on teens."
Such sentiments extend even to some surgeons who applaud the ban in theory.
"I agree with the concept of limiting cosmetic surgery in teenagers; however, I believe that the proposed ban is too restrictive," said Dr. Ronald M. Friedman, director of the West 4694891 Plastic Surgery Center in Plano, Tex.
But, Friedman added, "Although I believe that the Australian ban is overly restrictive, it has already provided benefits: it has stimulated much-needed public discussion about teen cosmetic surgery in the United States."