By Aileen Brabazon

There are probably a slew of things on your teen’s must-have list: A souped-up cellphone and an unlimited plan, later curfew, larger allowance and trendy clothes among them. But what if their gotta-have list also includes a nose job or breast implants? For a growing number of teens and young adults, that’s exactly the case.

According to the American Society of Plastic Surgeons, teen cosmetic procedures went up two per cent from 2011 to 2012. While there are no precise Canadian stats, the experts we talked to said their patient population definitely includes more youth. “In the last five years in my practice, it’s gone up probably by 25 per cent,” says Dr. Peter Bray, a plastic and cosmetic surgeon in Toronto.

What gives? If you saw the Dateline NBC segment about a bullied 15-year-old girl who got a pro bono nose job and chin implant — the video went viral after it aired in January — you might assume that merciless name-calling is driving more teens under the knife. But that’s not quite the case. It’s true that teasing is and has always been part of the landscape of facial and body differences, but that alone isn’t why the majority of teens seek change. “The most common thing that they tell me is that they want to increase their self-confidence — that they feel conscious about something they can’t change otherwise,” says Dr. Jamil Asaria, a Toronto-based facial plastic surgeon. The Internet has influence, too. With the popularity of image-dominated social media sites Instagram, Twitter and Facebook, teens are seeing a lot more of each other and that has increased the value of appearance — they’re more aware of their looks than ever before. Plus, as Dr. Bray points out, “now teens who may be self-conscious can quietly and anonymously research online to see what some of the options are [and decide if they really want to pursue them]. In the past, they would’ve been shuffled into the doctor, usually with their parent.”

The most desirable treatments
What do surgery-seeking teens covet? You may be relieved to know that boob jobs and liposuction aren’t on the most-popular list. “The top procedures for teen plastic surgery are rhinoplasty [nose jobs] and otoplasty [ear pinning],” says Dr. Asaria. Gynecomastic (enlarged male breast) reduction surgery and female breast reduction surgery, as well as birthmark or mole treatments are also in demand, says Dr. Bray.

Fit for a fix-it?
Before any scalpels or injections come into play, surgeons have serious tête-à-têtes with teens to determine if they’re suitable candidates for a treatment. They want to be sure that young Suzie or Steve is emotionally mature with a good head on their shoulders, is socially well-adjusted, performing well at school and has family support. It’s also vital that they want the change strictly for themselves and that they have realistic expectations of the surgery’s outcome. For example, it’s reasonable to assume that a more petite nose will make a teen feel less self-conscious, but unreasonable to expect that it’ll have the power to solve teasing for good or get them more dates. Age matters, too. Before going ahead with surgery, the body has to reach maturation. “In the case of rhinoplasty, at about 16 for females and 17 for males the vast majority of growth of their nose is done, so they’re stable to have it operated on without it changing more,” says Dr. Asaria.

The good and the bad
Correcting an out-of-proportion feature with plastic surgery can really make a teen feel good. “It can be liberating,” says Dr. Bray. “It can allow more comfort in doing certain activities and it can give self-esteem a nice boost.” But there’s some pain before the gain — after all, it is surgery. And as with any medical procedure there are some risks, albeit minor ones, involved. “Complications and risks are extremely rare. Depending on the circumstances, there might also be scarring, and we talk about all of that in advance,” he says.

Decisions, decisions
Most teens are very self-conscious and particularly vulnerable to wanting to change their facial features, says Sara Dimerman, a psychologist and author in Thornhill, Ont. But that doesn’t mean that every 16-year-old who pleads for a nose job should get one. So, as a parent, how do you decide whether or not to support a cry out for surgery?

“If you are objectively able to see that your child’s face is symmetrically balanced and there are no features that stand out as being overly dominant or overly recessive, then it’s wiser to let this phase pass without considering any intervention,” she says. But if your sweetheart has an atypical feature, then take the issue more to heart. “Often the request is as a result of how the teen feels about themselves — that he is different in some way,” she says. In those cases it’s worth investigating corrective procedures that may help your child feel like they blend in better with the crowd.

The price of plastic surgery
When and if you consider cosmetic procedures for your teen, keep in mind that your provincial health plan may cover some or all of the costs up to the age of 18, while others may require that you shell out the funds yourself. In the case of the latter, here are price tags for the top treatments, according to Dr. Bray:

Rhinoplasty (nose job): $5,000-$8,000
Otoplasty (ear pinning): $3,000-$5,000
Gynecomastic reduction and female breast reduction surgery: $5,000-$8,000
Breast asymmetry: $5,000-$8,000