When Is Teenage Plastic Surgery Versus Cosmetic Surgery Okay?

Reality Versus Hype: A Systematic Review

Rod J. Rohrich, M.D.; Min-Jeong Cho, M.D.


Plast Reconstr Surg. 2018;142(3):293e-302e. 

In This Article

Abstract and Introduction


Summary: Plastic surgery in teenagers has become popular in past decades because of an increase in self-awareness and desire to "fit in" with their peers. In 2016, over 229,551 cosmetic procedures were performed in patients who are younger than 19 years. The trend of plastic surgery in adolescents is increasing, and it is important for plastic surgeons to perform safe and appropriate procedures in this group. To this date, there is a myriad of literature on the psychological and ethical issues concerning plastic surgery in teenagers. However, studies regarding the safety of performing plastic surgery in this population are scarce. The rationale for this article is to study this issue in depth by means of a systematic review. The authors discuss the current indications, safety, patient satisfaction, and ethical considerations of teenage plastic surgery and make recommendations for future studies on this important area.


Social media, the Internet, and the use of smartphones have changed everything for the teenager.[1] No longer is anything truly personal or private anymore. It has become very easy to post photographs of oneself, see the photographs of others, and compare one's body image through various means (e.g., Twitter, Instagram, Facebook). Therefore, this generation of adolescents is more exposed to peer appearance-related feedback from their social media use than the previous generation.[2,3] It is well established that body image is strongly associated with self-esteem and psychological functioning.[4,5] This generation of adolescents is more vulnerable to being bullied or teased, which are critical factors in desiring cosmetic surgery.[5–8] The average millennial takes over 25,000 selfies in his or her lifetime, which is astronomical and one of the major reasons for the self-esteem issues in this age group.[5,9] The studies show that selfies can lead to overvaluation of shape and weight, dietary restraint, body dissatisfaction, and internalization of the thin ideal in adolescent girls.[10,11] Moreover, the standard selfies have exaggerated lower facial features such as nasal or lip or chin problems, leading to increased interest in this age group for cosmetic medicine and cosmetic surgery.

According to the 2016 American Society of Plastic Surgeons database, the number of adolescents undergoing cosmetic surgery has increased.[12] It is estimated that approximately 229,551 cosmetic procedures have been performed in adolescents (age, 13 to 19 years) during 2016 (Figs. 1 and 2). Of these procedures, rhinoplasty is the most commonly performed procedure (31,255 patients), followed by breast augmentation (8076 patients), and breast reduction in men (7099 patients).[12] Currently, this group of patients accounts for 4 percent of surgical procedures performed in the United States.[12] In addition, the number of nonsurgical procedures in this group is rapidly growing. They account for 1 percent of total nonsurgical procedures, and the top three nonsurgical procedures are laser hair removal, laser skin resurfacing, and botulinum toxin type A injections.

Figure 1.

2016 Cosmetic surgical procedures for those aged 13 to 19 years. (Statistics courtesy of the American Society of Plastic Surgeons.12)

Figure 2.

2016 Cosmetic nonsurgical procedures for those aged 13 to 19 years. (Statistics courtesy of the American Society of Plastic Surgeons.12)

Although there are numerous proven benefits such as improved body image and appearance satisfaction, meticulous preoperative evaluation is required in this group, as there are limited studies on the safety and outcomes of performing elective plastic surgery in this group.[3,4,7,13–15] In this review, we discuss the safety of performing plastic surgery versus cosmetic surgery, and the role of cosmetic medicine such as botulinum toxin type A and fillers in adolescents.