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Children and Aesthetic Treatment Dr Nestor Demosthenous explores the motivations and appropriateness of aesthetic treatment in patients under 18 There is a rising concern about reports of cosmetic interventions on children1 and the appropriateness of children undergoing cosmetic interventions (surgical and non-surgical) is controversial. There are few studies looking at the psychological factors of minors who seek cosmetic treatments, or studies that look at the appropriateness of performing these procedures. Considering the increased rates of aesthetic intervention worldwide, this article will discuss the professional and legal obligations that practitioners have when children, and their parents, present to clinic seeking cosmetic interventions. In Scotland, those between 16-18 can be considered adults.2 However, in most of the UK a child is regarded as anyone under the age of 18, so for the purpose of this article, those under the age of 18 years are considered a child.
Why do children seek treatments? The desire for cosmetic interventions is prevalent in both males and females of varying socio-economic backgrounds and ages.3 The International Society of Aesthetic Plastic Surgery found a total of 31.6 million plastic surgery operations performed in 2016, with more than 63,000 surgical procedures performed in children (13-18 years) in 2013.4 According to more recent stats from The American Society of Plastic Surgeons, 227,000 cosmetic surgical and nonsurgical procedures were performed on patients aged 13 to 19 in 2018, although it should be noted that this was only 1% of the total procedures.5 As medical aesthetic practitioners, it is our professional responsibility to understand the motives of young people seeking treatments, to protect them from harm, support them in accepting themselves, and explaining the importance of prevention, helping them to live healthier lives. In today’s society, there is an emphasis on physical appearance, idealising beauty which is often unattainable.3 Media, the internet and social media play a key role in supporting the idea that our appearance is related to our success, burdening us, especially children, with psychological pressures to improve our looks.6 The greatest physical and psychological changes occur during the developmental years of adolescence. French plastic surgeon Duquennoy-Martinot identified reasons children present for cosmetic surgery, which included wanting to be ‘normal’, to feel better about themselves, be more beautiful, or emulate celebrities.7 Glamourised celebrity lifestyles portrayed in the media are recognised to drive children to seek treatments.8 A survey of 2,265 adolescents between the ages of 13 and 18 found that around 75% seek treatment to emulate celebrities, while it also suggests that girls compared to boys show greater dissatisfaction of their bodies (78%), with 31.3% wanting cosmetic surgery.9 The most common procedures were breast augmentation followed by rhinoplasties, then breast reduction and otoplasty.4
Appropriateness of aesthetic interventions Aesthetic treatments may be considered unnecessary, as cosmetic interventions, surgical and non-surgical, do not address disease or ill health. However, the World Health Organisation describes good health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’.10 This validates the idea that cosmetic procedures that are carried out can improve a patient’s psychological and social wellbeing. For example, cleft lip procedures that are not life threatening are often sought for this reason. Similarly, acne treatments are highly sought-after treatments by adolescents and it can have a profound psychological effect on children’s self-confidence.11 Acne itself is a skin ailment requiring medical treatment. The residual scarring it can leave, however, may be seen by some as purely cosmetic, yet addressing these scars can improve an adolescent’s psychological wellbeing.11 Treatment is therefore reasonable. However, where psychiatric illness is at the core of seeking interventions, treatments are not appropriate. Body dysmorphic disorder (BDD) is most common in teenagers and young adults – see BDD section.12,13 Appropriate treatment for such psychological issues involve referral to a psychiatrist/psychologist. Treatments that would alter a child’s development, for example breast or nose surgery, should be refused. Many individuals seek otoplasty procedures to correct protruding ears. As a child’s ears have fully grown to 90-95% of their full size by the age of eight years,14 surgery is not altering their development and therefore the intervention is appropriate. Surgical correction may help avoid psychological stress in early and/or later years. It should be noted that practitioners must understand who exactly is seeking the procedure – child or parent/ guardian. The parent may be seeking treatments for their child for their own reasons/prejudice (for example protruding ears), however this anomaly may not bother the child at all. Ultimately, it is the responsibility of the practitioner to decline treatments deemed inappropriate, such as a sixteen-year-old patient seeking botulinum toxin for ageing concerns when facial lines are not present. Girls do not attain adult lip dimensions until the age of 17/18 and boys 18/19 years of age. Treating them with lip fillers before this should therefore be considered inappropriate.15 All surgical and non-surgical interventions carry the risk of complications/harm. One of the four pillars of Good Medical Practice is ‘do no harm’ so to perform a treatment such as botulinum toxin for cosmetic reasons on a child as an elective procedure, where the risks outweigh the benefits, would be wrong.16 This moral compass should be present in every decision a practitioner makes. A child may lack the maturity to appreciate that the requested treatment may cause harm. For example, Ellart et al. found that 14% of sixteen-year-old girls wanted a breast augmentation procedure, often to a size that could cause complications such as postural or respiratory problems.17
Reproduced from Aesthetics | Volume 7/Issue 2 - January 2020
