Fresh Faces

The perfect nose. The perkiest breasts. For more and more teens, achieving the ideal look means scheduling time under the plastic surgeon's knife.

KRISTIN WANTED A NEW NOSE. A better nose. A resculpted, slightly smaller version of the original, with no bump on its bridge and a shorter, perkier tip. It wasn’t that she was ugly, or that her nose was so terrible: Kristin just wanted her features to be symmetrical. But doctors said she would have to wait at least a year before considering cosmetic surgery. After all, she was only 14.  

At 15, Kristin got her wish. A Boston plastic surgeon performed the long-awaited rhinoplasty during her school’s spring break. The petite, blond Newton native couldn’t be happier with the results. "It turned out exactly how I wanted it," Kristin, now 17, says, "I feel like my face finally fits together."

Others agreed. Most girls at her west suburban high school told her she looked pretty and praised her new look. And, influenced by a youth culture that is increasingly open to all things cosmetic, some did a little resculpting of their own. "My best friend just got her nose done last summer," says Kristin (whose name, like those of other young patients quoted in this story, has been changed). "And my other best friend is planning on doing it as soon as she can."

Plastic surgery is a national hot topic, thanks in no small part to television shows like ABC’s Extreme Makeover, Fox’s The Swan, MTV’s I Want a Famous Face, and a veritable bonanza of other media attention. Everywhere they look, young Americans are bombarded with promises of planned perfection. Ads for cosmetic procedures pepper magazines and newspapers, toned Hollywood actors sport wrinkle-free figures, and celebrity rags rave over young starlets with impossible combinations of tiny waists and huge breasts.

The pressure to look young and beautiful is at an all-time high, and more and more people are picking up the phone to schedule surgical enhancements. Americans spent $12.5 billion on cosmetic procedures last year, according to the American Society for Aesthetic Plastic Surgery. Since 1997, the number of both surgical and nonsurgical procedures performed annually has increased by a whopping 465 percent.

"The television shows have really captured the country’s imagination and attention," says Dr. James May, director of plastic surgery at Massachusetts General Hospital. "The sensationalism of those programs has brought plastic surgery to the minds of young people and their parents. It’s now a dinner-table conversation."

And the nation is changing its perspective. Whereas some Americans used to keep their tummy tucks and Botox shots a secret, they’re now showing them off with pride. Today, 60 percent of women approve of cosmetic surgery, while 82 percent say they would not be embarrassed by other people knowing that they’d had some. And these aren’t just aging narcissists: 34 percent of 18- to 24-year-olds say they would definitely consider surgery for themselves, the highest proportion of all age groups.

Many teens like Kristin already have. The plastic surgery society notes that Americans 18 and younger had 46,198 chemical peels, 17,233 rhinoplasties, 4,211 breast augmentations, and 4,074 Botox injections last year alone. All in all, teenagers underwent nearly a quarter million cosmetic procedures last year.

"Teenagers are the new market," says Sharlene Hesse-Biber, professor of sociology at Boston College. "Magazines have pushed the envelope on what it means to be beautiful, and surgery is now a way to deal with body issues. We’re a very visual and quick-fix society. Young people are now getting that quick fix, that instant body."

When he was 16, Brian started thinking about enhancing his appearance. He had breathing problems and was unhappy with his nose. So he did something about it. A surgeon performed a rhinoplasty. That same year, Brian paid for a chin implant. "What’s great about cosmetic surgery," says Brian, who went on to attend Boston University, is that "you have the ability to change what couldn’t otherwise be changed." He says he’d recommend surgery to other young people as a "self-esteem boost."

"All you have to do is watch any television show, and you will see relatively uncovered, young, supposedly ideal-looking Americans," says Chestnut Hill’s SkinCare Physicians co-director Dr. Jeffrey Dover. "Twenty years ago, liposuction didn’t even exist, but now young women are coming in for it. They’re looking at all the magazines, from People to Vogue to Seventeen. Large breasts with skinny bodies are very popular right now. Look at Christina Aguilera. She has very large breasts in a tiny body, and teenagers want to look like her."

It’s not just girls feeling the pressure. Young men, inspired by the metrosexual movement, are also taking shortcuts to better looks. Dover says his practice has seen a dramatic increase in the number of 16- to 19-year-old males who come in for laser hair removal. He says they might be prompted by GQ and Men’s Health, whose cover models sport nary a hair on their bodies.

Newbury Street surgeon Dr. Ramsey Alsarraf agrees that cosmetically enhanced celebrities’ looks are affecting the way teenagers view themselves. "I’ve had young boys bring in 10 pictures of Brad Pitt and his nose from different angles and say ‘I want to look like this.’ Those are unrealistic expectations. Generally if someone says they want to look like Britney Spears or J.Lo, that puts up a red flag."

Lisa sees red flags, too. Now a 21-year-old college senior at the University of Maryland, Lisa had plastic surgery as a teenager. She, too, is pleased with the results of her rhinoplasty, which she’d been contemplating since middle school. But she says she’s seen the cosmetic culture shift since then. Lisa thinks more people find surgery acceptable and that invasive procedures have become "easier than the alternatives, such as making an effort to accept yourself as beautiful or physically working hard to lose weight." Teenagers who want to look like models or celebrities they see should think again, she says.

That’s what many plastic surgeons say, too. But all too often, they say, teenagers brush off any long-term implications in favor of immediate results. This blasé attitude, coupled with widening acceptance, helps young people gloss over the potentially ugly details of surgical procedures. Nor do many Boston doctors outright refuse to perform most such surgery on teenagers, though some ask the kids to wait a few years.

"I want a 17-year-old to understand that if she’s going to have breast implants, she might need a new procedure at age 27," May says. "Then at age 47 she might have another revision. I would say the likelihood of her needing to have these other procedures is around 50 percent. It’s very important to send the message loud and clear that surgery early in life is heading the patient down the pathway of having more operations."

Some wonder if even teenagers who have smaller, noninvasive procedures such as laser hair removal or microdermabrasion might become mentally predisposed to surgery. While there is no solid research to support this theory, the notion that kids can become "addicted" to cosmetic alteration doesn’t come as a surprise to sociologist Hesse-Biber.

"We’re entering this cultlike status," she says. "Every time we have a little wrinkle, we want to run in for some Botox. We’re becoming addicted. I’m not saying that women shouldn’t look beautiful, but when surgery becomes the fix and you still don’t feel good about yourself, what then?"

Alarmed parents are asking similar questions in response to a perceived nationwide increase in teenage plastic surgeries. And the media is fueling the fire. Nearly every major American newspaper and magazine has run stories on teenage breast augmentations and liposuctions, or procedures gone horribly wrong.

The attention rose to such heights that in February the American Society of Plastic Surgeons released a statement attributing the teenage cosmetic surgery "epidemic" to overblown media hype. A recent study found that only 5 percent of college-aged women have had cosmetic surgery. But that same study revealed that more than 60 percent
of the same group surveyed could see themselves having at least one procedure in their lives.

Back in Boston, teenagers’ cravings for physical perfection appear not quite as high as those of teens in places like Miami and Los Angeles, where breast augmentations are reported to be popular high-school graduation gifts. Despite its liberal airs, Boston remains steeped in conservative tradition and shrouded by a hush-hush mentality about cosmetic surgery. Many people here still consider cosmetic procedures déclassé. But local doctors say they have many teenagers come in for rhinoplasties, hair removal, and Botox, though requests from teens for breast augmentation are rare. Even rarer are doctors who would perform the procedure the Food and Drug Administration does not approve for girls under 18.

"You’d have to look hard in Boston for someone who’s pushing breast implants on 16-year-old girls," Alsarraf says. "If you can’t vote or smoke, should you really be able to have a synthetic piece of plastic put into your chest? That doesn’t make much sense to me."

It doesn’t make much sense to Kristin either. But while her mother says she would be shocked by a high school student having a breast augmentation, Kristin seems nonplused. "At my school, it doesn’t happen enough for people not to be surprised," she says. "But it wouldn’t be like ‘Oh my God!’" Cosmetic procedures have simply become part of the culture, something she says her friends all talk about briefly before moving on to the next topic.

Kristin’s mother admits she knows at least one parent who would let her own daughter get much-desired bigger breasts. And May says that although the media reports may be exaggerated, all the fuss does represent a fear that soon kids will be planning their dream bodies at an alarmingly young age.

Asked if she would consider having additional cosmetic procedures, Kristin nods enthusiastically. "Yeah, definitely," she says. She says there’s nothing wrong with wanting to feel better about yourself. "I’m not going out searching for things to do, but if there was something I wanted to change, wanted to be different, I would do it."  

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