New York, N.Y.
Last week I discussed the scientific background for who and why we can and should offer rhinoplasty to teenagers with big noses. I will now discuss the more personal aspect of caring for these sensitive individuals. Teenagers are under a lot of social pressure as they are finding themselves, establishing social skills and interacting with peer groups. It is easy for an outsider to criticize cosmetic surgery as unnecessary, but for a teen who has endured ridicule from the outside or put up a wall of self isolation due to lack of self confidence from a large nose, it can be a huge issue, no pun intended. Rhinoplasty is not about popularity but more about social acceptance.
All too often the consultation starts with the teenager staring at the floor because they are shy about their looks, yet they also may be embarrassed about the concept of having cosmetic surgery. We reassure them that this is a confidential consultation and that we plan to answer any and all concerns that both patient and parents have. Consultations usually last around 45 minutes or more. It is important to emphasize that we strive to create a natural nose. No one wants a scooped, pinched nose. Even parents can be reluctant since their generation was subjected to cookie-cutter, overdone noses. Today’s nose should fit the face, which the vast majority of our rhinoplasties do.
Computer imaging is an excellent tool as well for the consultation. Teenagers are very visual. Seeing potential results and discussing what we both feel looks right for them can help alleviate their apprehensions. We review healing time and how fast they can get back to school or embark on their summer activities. The minimum time I prefer is 2 weeks before going back to school. By that time, the swelling is down enough so that the nose often looks like the original and gets gradually smaller over the ensuing month. Patients are cautioned that they can’t participate in gym for 2 months (most love this and ask for more) and need to be careful about hitting the nose; today every teenage girl hugs and kisses their friends who they haven’t seen in two whole weeks.
What can result? The transformation I have seen is often amazing. Teens come back with new attitudes; chins lifted up, improved eye contact and they smile a lot more. The psychological changes often outdo the physical changes we made through rhinoplasty. For the teenagers who already were outgoing and social, it only serves to support their already well established self confidence.
Steven J. Pearlman, M.D., F.A.C.S.
Rhinoplasty can be very rewarding for teens
New York, NY
Discussing teenagers and plastic surgery always elicits deep emotional reactions from all sides. Those in favor of it realize that it can go far in enhancing one’s self image at a time when self confidence and social acceptance can be very important. Others feel that it is too early for teenagers to be having any purely elective surgery. I will be addressing rhinoplasty only; which comprises over 10% of facial plastic surgery procedures according to a survey by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Basically, I have seen so many teenagers come out of their shells after rhinoplasty that I support this procedure for a properly motivated teen.
Why the nose? Our face defines who we are, how others see us and who we see. The nose is the most prominent feature on the face. An important scientific study on physical attractiveness and peer perception states that “physical attractiveness may be an important personal characteristic primarily during adolescence…when social acceptance by a peer group is a particular salient issue.” (Dion KK, Bersheid, E. Physical attractiveness and peer perception among children. Sociometry journal 1974 vol. 3). Following cosmetic surgery, adolescents can gain self satisfaction from changes in their appearance which is beyond what would otherwise occur with natural development (Sills KH, et al. Plastic and Reconstructive Surgery Journal Vol .109, 2002).
What age should we consider rhinoplasty? The general teaching, going back decades, has been that girls can have rhinoplasty as soon as 15 years of age and boys by 16. This is when they are almost fully grown. What is more important than physical growth is the age at which teenager can make a mature responsible decision to undergo surgery. Given changes in society, this age is getting younger and younger. What I do during the consultation is gauge the teen’s level of maturity and motivations for surgery. Teens are also very visual. Computer imaging is an excellent tool for visualizing potential results and provides a positive reinforcement for the planned surgery.
One of the biggest obstacles is reluctant parents who saw too many overdone noses. I am about the same age as many of these parents and too many of my peers have pinched “fixed” looking noses. Today’s nosejob should look natural, one that fits the face. One of the most common and gratifying comments I get from former patients is that they saw old friends from camp or school and the remarks were: “you look great, did you lose weight? Change your hair?” NOT, oh, you had a nosejob. The other rewarding experience is seeing a once introspective quiet teen, one who barely looked up, now standing tall with pride and self confidence; often with changes far beyond anything I did for their nose.
Steven J. Pearlman, MD, FACS