Kids Plastic Surgery: When is it a ‘Go', and When is it a ‘No'?

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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


April 22 2008

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Cleft lip and palate, a malformed or missing ear, deformities of the chest or limbs - if your child is born with any of these anomalies, reconstructive plastic surgery is most probably in their future. Likewise, if your son or daughter suffers a serious injury, burn or medical treatment that leaves scars, you'll likely consult with a pediatric plastic surgeon about available treatment options. Reconstructive procedures – that is, taking a part of the body that is deformed and making it more normal through surgery – are generally accepted by society, especially when the patient is a young child whose health and self-esteem could be dealt critical blows if forced to live with a deformity.

But what about the child whose ears protrude prominently? The condition doesn't affect the ears' function, but he or she may benefit from an otoplasty ("ear pinning" surgery) to help blend in with their peers. And what about the teen who's unhappy with the shape and/or size of her nose and wants to alter it, even though it works just fine? Cosmetic procedures like these start with a body part that's unimpaired, or "normal", which makes their suitability for children questionable for many people. The bottom line becomes: When do the benefits of a purely cosmetic procedure outweigh the risks of surgery?

"You have to go case by case, patient by patient," says Fernando Burstein, MD, an Atlanta physician who is board-certified in both otolaryngology and plastic surgery. "But as a general rule, as a physician and a plastic surgeon, you've got to consider the patient's wishes. You've got to have some empathy."

Dr. Burstein, who is also the immediate past president of the plastic surgery section of the American Academy of Pediatrics, adds that the child, not the parents, should be the driving force behind cosmetic surgery. Age is also less of a determining factor than it used to be. Surgeons today are more interested in whether the bones and other features have matured enough that further growth won't change the outcome too much, he says.

Dr. Burstein also recommends that parents not make light of their child's concerns. "If a parent tells a kid with a big bump on their nose, ‘It'll give you character', they're being naïve at best," he notes. "I had a patient the other day, a young lady in her mid-teens, who everybody at school was calling Squidward after the character on Sponge Bob Square Pants. This is not a trivial matter."

Mark Urata, MD, DDS, director of craniofacial surgery at Childrens Hospital Los Angeles, operates on children with congenital abnormalities and scars from burns and cancer treatment. He says he and his colleagues focus on bringing their young patients back into what he calls "a normal realm".

"There's a certain built-in meter for their parents not to be too obsessed with things that they shouldn't be – they just want to get their kid whole again," he explains. However, when he steps outside the hospital, the situation changes drastically. "Do the expectations and desires of our society have a tendency to warp the views that some parents have? Absolutely! I think we've become focused on little things that will make our children perfect in every way," he continues. "It's not ‘Let's remove this mole because there's a potential for cancer', but ‘Let's remove this mole because it's not in the same place as Cindy Crawford's.' Those are concerns that have overlying implications on our society."

The American Society of Plastic Surgeons has no formal position on plastic surgery for teenagers, although it advises parents to evaluate the teen's physical and emotional maturity before making a decision. The best outcomes, it says, generally occur when the teen initiates the request and when he or she has realistic goals and sufficient emotional maturity to deal with the pain and recovery period that plastic surgery entails.

With younger children, the decision-making is left up to the parents, who must weigh the consequences of their decision against the potential surgical outcome. However, Dr. Urata notes that there are advantages to addressing some cosmetic concerns at an early age.

"It's actually better to have little things, like excision of moles, done when you're younger rather than when you're a teenager because your skin is in much better shape and your ability to heal with a less perceptible scar is better," he says.