Will a scalpel satisfy self-esteem? The New York Times reports that the number of teens below 18 getting surgically enhanced has tripled in the last 10 years. Breast augmentations and liposuction have soared in popularity, increasing by six times their previous rates of procedure.

Differences in thinking between teens and adults
Unlike adults who may wish to spruce up a bit with cosmetic surgery and stand out youthfully at 40 or 50, teens wish to blend in with the crowd. This means any touch of individuality in appearance is fair game for elimination, because, according to media marketing standards, anything can be changed. In fact, most adolescents are unsure of their appearances, most wish they could change something about their looks.

Impossible standards
In the media world, the airbrush and enhancement rule. Lips pout and breasts are perky. Noses and ears are small, eyes are large, lashed and dewy, stomachs are flat and butts stand out in a crowd. The band of beauty is very, very narrow. Most humans do not and will not fulfill this standard of artificiality, but most adolescents do not have the insight to look behind the scenes.

Silencing the inner critic
Media and the possibility of changing appearance drastically can prey upon a young person's insecurities and perfectionism. The pressure on adolescents to be socially popular, to be thin, to be athletic, to be talented, is very heavy. Rising to all of these positive expectations is challenging for almost everyone, but, supposedly, appearance can be upgraded with the flick of a scalpel. Success is then gauged by how well the surgery turned out, how much more beautiful or handsome the teen looks afterwards.

Body dysmorphic disorder
Body dysmorphic disorder is a chronic, compulsive desire to change what are perceived to be bodily flaws. BDD is a psychiatric condition that appears gradually and is chronic. It is exacerbated by social stressors and possibly, a cosmetic surgery that did not satisfy. Unusual demands and possible litigation are made towards surgeons, and perfectionism keeps a person with body dysmorphic disorder from social interactions he/she perceives as personally critical.

Should all teen plastic surgery requests be denied?
Parental discretion should hold sway. However, not every request for cosmetic changes is based upon unrealistic demands and expectations. Like a person with an overbite requiring braces for dental alignment, a teen may have a legitimate request for cosmetic surgery. Very large ears, very large breasts or a nose too large for the face might be examples for legitimate change.

Should requests for changing negative features be immediately granted?
A number of steps should be taken before allowing a person needing parental consent to have plastic surgery.
1. A counselor should discuss with the adolescent about the need for change.
2. Parents and surgeon should address the request together, particularly how the change will fit into the body structure after full growth is achieved. In other words, is the nose too big, or the face simply not matured?
3. The young person should be educated as to just exactly what the particular surgery would entail, through videos and written material.

Parents want children to feel positive about themselves and to succeed. Changing a feature that encourages criticism and belittling is something most parents would wish to support. However, it is important to be very aware that the procedure is a surgery, with possible failure and complications.
It is optimal to widen our children's vision of what beauty really is and acknowledge that changing the outside does not necessarily change the way a person feels on the inside.