Extreme Teen Makeover or Self-destruction?

by Lucy Rimalower, M.A.

Plastic surgery has infiltrated the teen playground. An industry once reserved for Joan Rivers and discrete appointments in doctor's offices has now become part of the mainstream zeitgeist. Showcased by pop stars, pop-up ads and suburban malls, plastic surgery offers a retail solution as ubiquitous and accessible as The Gap. While parental consent is required, our culture has planted the seed that a quick-fix solution to low self-esteem is readily available. However, to quote Lily, a wise 15-year-old from Los Feliz, CA, "Very few things in life can be gotten really quickly and easily, and if they are gotten quickly and easily, they're usually not particularly rewarding."

The Growing Trend In response to the pressure from peers, parents and the media to be perfect, more teens are turning to plastic surgery to correct perceived flaws, boost self-esteem, and ease the intense pressure of body image. According to the American Society of Plastic Surgeons, 244,124 teens had cosmetic procedures in 2006. Some of these cases were reconstructive, procedures to correct defects or deformities from birth or traumatic injury, such as cleft palates or burns. However, many of these were teens electing to have cosmetic plastic surgery to alter a part of the body that they're not satisfied with, as in breast augmentation, rhinoplasty, or liposuction.

Unspoken Consequences The effect of cosmetic procedures on people under the age of 18, in regard to both physical and emotional consequences, has not adequately been studied. Consider Botox, a toxin for the treatment of wrinkles, which is surprisingly sought out by teens and is readily available in many malls. However, what most teens and consenting parents don't know is that Botox has been used without formal FDA-approval in children and has resulted in botulism, leading to difficulty breathing and/or swallowing and even death in several cases, according to Public Citizen (i), a national, nonprofit consumer advocacy organization. And that's just an outpatient procedure. With surgery comes the known risks of infection, bleeding, and scarring. But plastic surgery presents the additional risk of unsatisfying results and even lower self-esteem. Can teens really grasp these realities when they're judgment is clouded by the challenges of adolescence?

Developing bodies and identities can be a painful experience for adolescents. According to Rudolph's Fundamentals of Pediatrics (ii), a person gains approximately 50% of their ideal adult body weight during puberty, which would be a strain on anyone's body image. Meanwhile, cognitive, emotional, physical and social growth all happen at different rates, introducing factors like mood swings and confusion. With teens in such major flux, it's hard to imagine being able to make a clear decision that takes into account the risks and consequences. A 16-year-old (who chose to remain anonymous) from Woodland Hills, CA made the case for toughing out the changes and insecurities rather than turning to plastic surgery: "In 5th grade, I wondered why I fit into an adult size. I was like, 'Mom, why do I have hips?' But I'm glad I went through it then. Now, I have more experience. I'm able to deal with things a little bit better because I've had a longer time with my body changing." The dissonance between developing aspects of mind and body can create a particular conundrum for a teen thinking about plastic surgery. First, their still developing body poses a physical risk after surgery. Consider breast augmentation on a girl whose breasts are still growing. Second, their ability to reason abstractly and consider long-term consequences is still developing. To that end, a combination of insecurity and impulsivity may further inhibit a teen's judgment and ability to fully consider the risks and outcomes of plastic surgery.

Battling the Media Onslaught Even if a parent takes the stand that plastic surgery is not the best option for the teen, the media poses tough competition. Teen icons like singer Ashlee Simpson, actress Lindsay Lohan and High School Musical's Ashley Tisdale have been rumored to have had plastic surgery. This is dangerous. A recent Australian study (iii) found media-portrayed idealized images negatively impact the self-esteem of adolescents. Another recent study out of the U.K. (iv) showed that girls who viewed ultra-thin models became dissatisfied with their own bodies. This led to poor body image and damaged overall self-esteem. Other factors contributing to low self-esteem may also seem uncontrollable, such as academic and peer pressure. It stands to reason that teens may take comfort in the idea that physical problems can be controlled or "solved" through plastic surgery. In the mind of a teen, plastic surgery may promise relief, a way to correct the physical trait that seems to wield the key to happiness. According to the American Society of Plastic Surgeons, teens want plastic surgery to fit in with peers, whereas adults have plastic surgery to stand out. As teens grapple with what pioneering developmental psychologist Erick Erickson (v) called "identity vs. role confusion," plastic surgery may offer an opportunity to blend in by fixing "flaws." While this may provide reprieve from the pain and shame surrounding the dissatisfying body part, it might not. Again, there's the risk that the teen won't be satisfied with the results of the procedure. Many surgical changes cannot be undone. Perhaps more saliently, the procedure may offer a myopic solution for a physical trait while reinforcing a teen's distorted belief that he or she needs to be flawless. A successful procedure may fortify the notion that there is no room for him to have flaws, inhibiting his ability to tolerate his own mistakes and adding to the pressure to be perfect. When asked what factors might contribute to a teen's desire to get plastic surgery, Delia, a 15-year-old from Sherman Oaks, CA, shared, "For me, mostly, I would think it's just the media and all the images, what's perceived as beautiful. There's not very much room for imperfection and I think that needs to change."

The Vital Role of Mom & Dad Taking on the risks of plastic surgery supports the idea that physical appearance is at the top of our values list. Because these procedures require a parent's consent, the impact of a parent's choice to support plastic surgery must also be considered. When interviewed about her experience with rhinoplasty at age 15, Emily, a now 30-year-old woman from Encino, CA stated, "My parents thought I was too young but when the doctor said I wasn't, they consented. Even though they didn't think I needed a nose job, they allowed it, which leads me to believe that on some level they wanted it for me." Amy, a 19-year-old girl who got liposuction as a high school graduation gift, reports, "It was the most traumatic moment of my life…to see that part of your body that black and blue, horribly bruised." She added, "When I woke up in so much pain, I screamed at my mom. I couldn't believe that she would let me do something that was this painful." While your teen might not be considering plastic surgery, she or he might be wishing for an "extreme" makeover. The low self-esteem associated with poor body image can lead to anxiety, depression, eating disorders, impaired academic performance, struggles in peer relationships, substance abuse and other potentially dangerous issues. Teens may suffer in silence, fearful that family or peers will shame them for being abnormal. While plastic surgery may seem like a way to fit in, to become normal, parents and peers can provide a positive influence to help teens learn how to strengthen self-esteem without going under the knife.

ADVICE TO TEENS FROM TEENS: Here are some words of wisdom from some esteem-savvy teens:

Lily, a 15-year-old from Los Feliz, CA, said, "It's a big diss to your body to want to get plastic surgery, especially when you're young…when you're old you're gonna look back and wish you looked like you did. With the risks, it's almost destructive to the natural body that you have."

Emma, a 15-year-old from Los Angeles, stated, "It's a sad thing when somebody feels like they need to change the way they look and the way they are just because they think it will make them happier." When asked if she could think of alternatives to plastic surgery she suggested, "Any other way would be better - getting help and talking to somebody, changing something less drastic like their hair."

Delia, a 15-year-old from Sherman Oaks, CA said, "You need to at least try to like yourself and like your body and be ok with it and get used to it. I don't know how but I think that's so important. It's important to have good self-esteem because without that you're not going to be completely happy, and part of that is being ok with your body and how you look."

TIPS FOR AN EXTREME ESTEEM MAKEOVER Although your teen may not be speaking to you this week, research continues to demonstrate the power of a parent's influence on self-esteem. Here are some ideas to help your teen to build positive self-esteem with respect to body image:

Know What Messages You Are Sending Be careful not to talk negatively about appearance, weight or other physical features - your teen's or your own! Establish a no-teasing policy in your home. Encourage your teen's values and traits beyond appearance - help them appreciate the full range of who they are.

Understand What Messages Your Children Are Taking From The Media Show your teen how to become a critical consumer of the media by opening a dialogue about TV, movies, and magazines. Help your teen to distinguish between his or her values and those portrayed in the media. Keep the communication lines open - listen and provide support when your teens want to talk.

How To Respond If Your Teen Asks About Plastic Surgery Do not dismiss their painful feelings. Ask them to help you understand what they're going through. Help them understand the risks and costs involved with plastic surgery and determine if their expectations are realistic. Honor their experience and, if appropriate, share some of your own struggles from adolescent and teenage years.

References

(i) Public Citizen (2008). Petition to the FDA requesting regulatory action concerning the possible spread of botulinum toxin (Botox, Myobloc) from the site of injection to other parts of the body (HRG Publication #1834). Retrieved February 10, 2007, from http://www.citizen.org/publications/release.cfm?ID=7559.

(ii) Rudolph, A.M., Kamei, R.K., & Overby, K.J. (Eds.) (3rd ed.). (2002) Rudolph's Fundamentals Of Pediatrics. New York: McGraw-Hill Professional

(iii) Monro, F., & Huon, G. (2005). Media-Portrayed Idealized Images, Body Shame, And Appearance Anxiety. International Journal of Eating Disorders, Pgs 38, 85-90.

(iv) Clay, D., Vignoles, V.L., & Dittmar, H. (2005) Adolescent Girls: Testing The Influence Of Sociocultural Factors. Journal of Research on Adolescence, Pgs 15(4), 451-477.

(v) Erickson, E. H. (1994). Identity and the Life Cycle. New York: Norton Paperbacks.

Lucy Rimalower, M.A. is a psychotherapist in private practice in Beverly Hills, under the supervision of Dr. Jenn Berman. She also has an upcoming journal article that will be published in Sex Education. She conducts groups on body image and self-esteem with teens and adults. For more information about Lucy, go to www.lucyrimalower.com