May 19, 2007 -- Cheryl and her husband, Darryl Kushner, both had nose jobs in their 20s. About two decades later, their 15-year-old daughter, Robin, was unhappy with her similarly shaped family nose and knew rhinoplasty was in her future.
"We had been talking about it for a while," said Cheryl, 45, who thought her daughter was pretty, but plagued by that "Barbara Streisand hump."
Although she was initially scared about the procedure, after some serious thought, Robin decided to get a nose job in March, right before spring break.
Everything went smoothly, and before long she was text messaging friends photos of her face, complete with bandages and all. Robin's self-confidence has been "off the charts" since returning to school in Chico, Calif.
Now the couple's younger daughter, Rachel, 14, wants to follow in her sister's footsteps. But she'll have to wait until she's in 10th grade, her parents said.
Plastic surgery has become a family affair over the years. Experts say children are more likely to consider it if another family member has had it done. And some parents are even giving it to their kids as graduation presents. Forget the trip to Cancun or even a brand new set of wheels. Some high schoolers are opting for cosmetic surgery instead.
Charlie Baase, a spokesperson for the American Academy for Cosmetic Surgery, said although he doesn't have any definitive statistics, the organization's member surgeons have reported a slight increase in the number of teens wanting to change something about their appearance around graduation time -- both surgically and nonsurgically. Common procedures range from ear pinning and nose jobs to less invasive procedure such as microdermabrasion or Botox.
"That was definitely not happening before," Basse said.
Dr. Darrick Antell, a New York City surgeon, said that graduation, as well as other big life changes, may act as catalysts.
"That's the event that pushes you to do it," he said.
For example, he recently pinned back a patient's ears because she wanted to wear her hair up for prom and graduation.
Graduation gift or not, one thing is for sure: There is a slow, steady rise of teens getting cosmetic surgery, with an average annual increase of about 2.5 percent over the last four years, according to Dr. Richard A. D'Amico, president-elect of the American Society of Plastic Surgeons. Breast augmentations among young women ages 18 to 19 rose about 12 percent between 2005 and 2006.
"I've seen an increase in teens having plastic surgery, and certainly for graduation," said Dr. Stephen T. Greenberg, a New York plastic surgeon and the author of "A Little Nip, A Little Tuck."
The timing doesn't come as too much of a surprise. High school seniors are getting ready for a brand new start, and with that comes a desire for a clean slate. Summer provides ample recovery time too.
"That's logical because cosmetic surgery is performed at times of transition, and graduation is a time of transition," said D'Amico.
"It is true that we see teens that come during this time of year," said Dr. Walter Erhardt, past president of the American Society of Plastic Surgeons, who currently practices in Albany, Ga. "I've actually seen three teenagers in high school this week who were interested in cosmetic surgery -- all three in rhinoplasty."
But experts say that it's important to fully think things through before making that appointment.
"Parents buy this as a gift because the child has everything else," said Dr. Diana Zuckerman, president of the National Research Center for Women and Families. "It should be considered with the same seriousness as any other surgery, not with the same seriousness as buying a graduation dress."
Zuckerman added there's a difference between getting a nose job, for instance, and wanting breast implants as a teen. Liposuction and breast augmentation, she warned, can have more immediate and dangerous complications, including allergic reactions. She also said it's important to remember that the U.S. Food and Drug Administration has not approved the marketing and use of silicone gel-filled breast implants for women under 22.
Nowadays, it's not uncommon to come from a family with a history of cosmetic surgeries like the Kushners. By now, grandparents, parents and kids alike have all had work done.
But sometimes it's the parents who urge their kids to go under the knife.
"I saw someone today, and I am sure she came to the office because her mother wanted the child to be seen," said Erhardt. "I feel fairly confident that she wasn't as interested in the procedure as much as her mother was."
Long Island, N.Y., surgeon Dr. Peter L. Schwartz said he's also been seeing more cases in which parents are encouraging their daughters to get breast implants. After going through a consultation, he decides whether they are ready to have the surgery based on their maturity level and how long they've been considering it.
"Sometimes, I tell them they're too young," he said.
Then he sends them home and asks them to think about it for a while.
Erhardt agreed, adding, "The interest needs to be self-motivated."
Patients under 18, for example, need parental consent before getting breast augmentation. Adolescent psychologist Lisa Boesky said it's important for parents to take part in the decision-making process. But they must do it for the right reasons.
"Parents today want to please their kids," she said. "They don't want to say no. It's easier to pay for plastic surgery than to take them to talk therapy."
Boesky said it's important to understand the difference between corrective and elective surgery.
"Parents considering this for their teens want to look at if there's something that's damaging," she said. "For example, a nose is out of whack, or men who were born with breasts. Elective surgery among teens is often more a symptom of a bigger issue that needs to be addressed. So even after the surgery, the teen sometimes doesn't feel good about themselves."
Also important to keep in mind is a patient's maturity and readiness for change. Experts say that some young people looking to have cosmetic surgery may suffer from body dysmorphic disorder, a preoccupation with a perceived defect in one's appearance.
"Individuals who suffer from body dysmorphic disorder -- who turn to cosmetic surgery -- almost uniformly report no improvement of their bodies after surgery," said Dr. David Sarwer, associate professor of psychology at the Center for Human Appearance at the University of Pennsylvania School of Medicine. "They then become preoccupied with another aspect of their appearance."
But for some patients, like Robin, the surgery has made all the difference in terms of her confidence. Her friends say that she looked good before, but looks even better now.
"It's easy for people to say to look on what's on the inside, not the outside," said Antell. "That's being naive. We all judge books by the cover. I'm not saying its right, and I'm not saying it's wrong. I'm saying it's reality."
But most doctors agree that all cosmetic surgery needs to be considered seriously.
"It's not a substitute for a personality disorder or social difficulties," said D'Amico.