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Surgical procedures to correct cleft lips and palates, for example, are not controversial.Plastic surgery to correct unattractive facial features that can attract ridicule, such as prominent noses and ears, are generally accepted in the United States.One of the concerns about plastic surgery on adolescents is that their bodies are still maturing.
However, cultural phenomena such as surgical makeovers on numerous television programs and unrelenting pressures on teens to conform to beauty standards make it increasingly difficult to agree on what constitutes a “normal” appearance and when the desire to improve one’s appearance is questionable or even crosses the line to psychopathology.
In this commentary, I will focus on elective, cosmetic procedures on an otherwise healthy adolescent with no illness or impairment.
In 2017, more than 229,000 cosmetic procedures were performed on patients between 13 and 19, including nearly 65,000 surgical procedures such as nose reshaping, breast lifts, breast augmentation, liposuction, and tummy tucks.
Very few studies have been conducted to examine the risks for teens of these increasingly common surgeries.
Unrealistic expectations or having the surgery to please a boyfriend is considered inappropriate, but having surgery so that “I will feel better about myself” or “clothes will fit better” are considered reasonable responses.
By the same token, teenagers who use drugs, drive while inebriated, and have unprotected sex may also make those decisions to please themselves, and not others, so that response alone is not sufficient evidence of a mature decision.Liposuction also carries potentially serious risks, including infection, damage to skin, nerves, or vital organs, fat or blood clots (that can migrate to the lungs, leading to death), and excessive fluid loss that can, rarely, lead to shock or death.Liposuction is also associated with eating disorders and distorted body image.Despite the documented risks, the general public has an inflated sense of the benefits and a minimized sense of the risks of plastic surgery.Teenagers are often oblivious to the well-documented long-term health consequences of smoking, tanning, and other risky behaviors, and are likely to pay even less attention to the risks of cosmetic surgery, making informed consent difficult.Little is known about whether or how effective these surgeries are on young women.Potential complications include infection, altered sensation, painful penetration, adhesions, and scarring.In addition to the influence of persuasive and pervasive advertising and television makeover programs that stimulate demand, it is difficult for a physician to neutrally present both the risks and benefits of an elective procedure that he or she is simultaneously selling.Requiring parental consent for patients under 18 does not ensure informed consent, since research is lacking on long-term risks for many cosmetic procedures.There are no epidemiological studies or clinical trials on the safety and long-term risks of these procedures for adolescents.Although the FDA approved saline breast implants for women ages 18 and older, it is legal for physicians to perform breast augmentation for anyone under 18 as an “off-label” use.