In the age of selfies, more teens are requesting plastic surgery. Some parents wonder if these cosmetic procedures are wise.

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Experts say some plastic surgeries can improve a teenager’s self-confidence. Getty Images

Juli* first began thinking about plastic surgery for her son shortly after he was born.

He had a condition called Stahl’s ear, which essentially caused his ear to look folded over and misshapen.

When he was 7, his family decided he should have surgery to fix the problem. A doctor had told them the best time to have this type of corrective surgery was between the ages of 5 and 9.

“We were getting within a year of my husband’s retirement from the military and I knew Tricare would cover the entire cost,” Juli explained.

The timing was right. The one drawback?

Juli’s son had never before expressed a desire to have his ears fixed.

The same wasn’t true for Gena*, who, at age 15, badly wanted the nose job her parents allowed her to get.

“My sister had her nose fixed at 17 years old,” she told Healthline. “For as long as I could remember, she would tell me I had a big nose and I would have to get it fixed. She pounded it into my head. I always felt that my nose was too big for my face and made me look unattractive.”

Having grown up in an affluent suburb of Detroit, Gena explained that her decision was not an uncommon one among people she knew.

In fact, a number of her classmates had opted to have a range of cosmetic surgery procedures in their teens.

Looking back, she says she has no regrets about her decision to have the appearance of her nose surgically altered.

“If changing something about yourself will improve your confidence and make you look and feel better, why not?” she said.

Whether or not plastic surgery actually improves self-confidence is a matter of opinion.

The American Medical Association Journal of Ethics reported in 2005 that studies showed a similar increase in body-image satisfaction with and without cosmetic surgery, suggesting self-confidence improves with time regardless.

But with more than 229,000 teens between the ages of 13 and 19 having cosmetic surgeries in 2017, it would seem that for a lot of families, surgery is becoming a more viable option — with some even presenting the opportunity for a change as a graduation gift.

Dr. Manish Shah of Shah Aesthetic Surgery in Denver, Colorado, recently took the time to discuss this phenomenon with Healthline.

“I think plastic surgery is becoming more popular for teens because there’s been an increase in bullying in the cyber years,” he explained. “Teens take an enormous number of selfies, and there’s greater acceptance in society for plastic surgery.”

Most professionals say there’s a difference between the type of surgery. Juli’s son received to fix a congenital defect, while Gena received cosmetic surgery.

“Plastic surgery can involve reconstruction of a body part to correct certain types of defects, such as birthmarks, cleft lips, ear deformities and other things such as scars from burns or animal bites,” Elaine Ducharme, PhD, a board-certified clinical psychologist, explained.

When it comes to more cosmetic procedures, she told Healthline, “Another type of surgery, generally referred to as cosmetic, is done to make a person feel more satisfied with their body and appearance. This type of surgery includes breast implants, tummy tucks, rhinoplasty and others.”

Ducharme also notes the lines between reconstructive and cosmetic surgery can sometimes be blurred.

“Some would suggest that rhinoplasty is also reconstructive and actually can improve breathing, but also feels more like a deformity to a teen and could be the source of teasing,” she said.

And for some people, even reconstructive surgeries can seem cosmetic in nature.

Juli had one friend who opposed plastic surgery for cosmetic reasons. She told that friend it was no different than getting children braces.

“If this was something that could be fixed, and he wanted it fixed, then we were willing to do it,” she said. “Why? Because he could get teased. Because I noticed it more and more as he got older, and others did as well, because first impressions matter. There’s a number of reasons.”

Juli explained that she pushes her kids to be the best versions of themselves.

“I feel like that includes giving my children the option of braces or Lasik or plastic surgery for congenital defects or injuries if we have the means to do it,” she said. “Two of my children have also had their tonsils out. Do we argue the medical necessity of that?”

In his practice, Shah says the most common procedures he sees teens seeking out are rhinoplasty, ear pinning (otoplasty), breast reduction, and skin care procedures to help with acne and acne scaring.

“Any procedure that doesn’t affect the growth of the body could be considered safe,” he explained.

But when it comes to the vast majority of cosmetic procedures that adults undergo, he says many are not appropriate for children and teens.

“Most procedures require a maturity level and full understanding of the risks and benefits involved,” he said.

The American Society of Plastic Surgeons agrees, spelling out specific guidelines for the types of surgeries teens might consider.

But how should a parent react if their child comes to them requesting plastic surgery?

“It’s important for parents to listen to their child’s concerns,” Ducharme said . “If a teen says they want something and a parent just says ‘no,’ they miss an opportunity to discover what’s really going on.”

She suggests parents use questions to engage their teens in a meaningful conversation about what it is they really want.

“When adults have plastic surgery, they are often looking for a way to be noticed more,” Ducharme said. “Kids and teens are generally trying to fit in and look more like their peers.”

Once you have a better understanding of what it is your teen is hoping to achieve, you can determine the best course of action, whether that’s therapy to manage unrealistic body expectations or visiting with a doctor to determine what could be realistic.

“I think therapy is indicated whenever the parent, or doctor, thinks the teen has unrealistic expectations or has other [psychological] issues that need to be addressed,” she said.

She also points out that, generally speaking, cosmetic surgery isn’t going to change a person’s life.

“Kids’ brains, their frontal lobes (which are responsible for reasoning and judgment), aren’t fully developed until the early 20s,” she explained. “It is very important that a person understands why they are doing something that will alter their physical appearance, what results they expect, and what the possible consequences may be.”

Ducharme wants to make sure parents are helping children to fully understand the risks of surgery.

“Many teens think they can have surgery and will immediately look and feel better and life will be great,” she said. “They have no understanding that surgery is risky business.”

She explained that those risks can be related to anesthesia and to the fact that wounds take time to heal — often involving initial bruising that may be hard for a teen to accept.

“There can be a lot of pain and discomfort,” she said.

Cosmetic surgery can also be expensive and is rarely covered by insurance.

“TV makes it all look glamorous,” Ducharme noted. “Kids need to know that what may make them feel a bit different now, may be the very thing that makes them stand out in a positive way in the future.”

Her hope is that plastic surgeons are doing a lot of screening when it comes to cosmetic surgery, regardless of whether people are young or old.

Shah acknowledges how important it is to consider the pros and cons.

“The benefits of surgery need to outweigh the risks,” he said. “Surgery is permanent. You never want to risk buyer’s remorse for you and your teen.”

He says that before having any surgery, teens “really need to be mature enough to truly grasp the magnitude of risk involved with surgery and anesthesia. This has to be balanced against the stress the teen feels when they look in the mirror.”

Juli was initially concerned about being the one to bring up the idea of surgery to her son before he had considered it himself. But once the idea was presented to him, he “was excited about the prospect and shared with his school mates that his ears did not match and he was going to get them fixed and would be out a couple days.”

Today, she says they are happy with the outcome.

“We had no drawbacks. My son remained happy about it the entire time, and still is,” she said.

While surgery for Stahl’s ear is recommended at younger ages, Shah says that in general, “if the teen can wait until they are over 18 years old, that is always ideal.”

But he also gets what is driving teens to push for surgery earlier today.

“I was a teenager once myself,” he said. “The times teens live in today are much more stressful and complicated than in earlier teenage years.”

He explained that with the pressures of social media, it’s important for parents to help their teens navigate questions about plastic surgery when they come up.

“Consulting with board-certified plastic surgeons is the best way to clear up any confusion and to be able to help a teen make the right decision about plastic surgery,” he said.

*Full name withheld to protect privacy