Plastic Surgery In Adolescents

In recent years, plastic surgery on adolescents has increasingly become an accepted procedure (ASAPS, 17). For the plastic surgeon this causes the problem of deciding whether or not to operate during a period of rapid physical and psychological development with uncertain outcome. However, plastic surgery may offer significant benefits to the adolescent's self-confidence, provided that these adolescents are properly psychologically evaluated before the operation.

In focusing on body image dissatisfaction, we follow recent literature about the psychology of plastic surgical patients, suggesting that research on body image dissatisfaction, and not overall psychopathology, is the most fruitful way to assess this problem. Irrespective of the plastic surgical patients' level of dissatisfaction, it is unknown whether their dissatisfaction is focused on the body parts considered for operation, or whether they are dissatisfied with their appearance overall. Generalised dissatisfaction may be a contraindication for surgical intervention on specific body parts.

In surgical practice, the assessment of adolescents' satisfaction is difficult, because the increased self-consciousness and dissatisfaction about physical appearance are characteristic for the adolescent age period (Thompson, Coovert, Richards, Johnson, & Cattarin, 19-25), for girls more so than for boys. Up to now, patient data have been inconclusive in this respect. Studies show that adult plastic surgical patients undergoing either cosmetic or reconstructive operations tend to exaggerate their deformity (Hay, 10; Napoleon, 93), whereas studies on children and adolescents undergoing cleft lip and craniofacial surgery showed that they tend to underestimate their deformity as compared to their surgeons' and their parents' appearance ratings. However, a previous study on the same sample, comparing adolescents', parents', and surgeons' views, suggested a realistic appearance-perception of adolescents undergoing plastic surgery for a broad range of deformities.

Assuming that they do not differ from their agemates in the general population, we may expect that adolescents who apply for plastic surgery will be as dissatisfied with their appearance as those from the general population, and that girls in this group would be more dissatisfied about their appearance than boys (Raust-von Wright, 89). Alternatively, the dissatisfaction might only focus on the body parts that are the object of the operation.

This would favour the conclusion of their making a realistic evaluation of their appearance. Impediments in psychosocial functioning are the primary motivation for plastic surgery in children, adolescents, and adults. The task for the plastic surgeon is to weigh the patient's psychosocial problems against the limitations and risks of surgery (Harris, 12). It has been stressed that the adolescent's perspective on the problem is the only perspective that really matters in the consideration of surgeons to operate or not.

Since body image dissatisfaction is strongly related to lower self-esteem and depression, it is hard for the surgeon to assess which adolescent-reported psychological or social problems are age-appropriate and which may be increased due to appearance dissatisfaction. In studies on plastic surgical patients, standardised psychological measures usually demonstrate only mild or no psychosocial problems. By contrast, clinical reports, semi structured interviews, and study-specific questionnaires do reveal that child and adolescent patients encounter a large ...