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Teen's daintier new nose carries bigger regret

By Madison Park, CNN
Sabrina Weiss says she was self-conscious about her nose as a teenager.
Sabrina Weiss says she was self-conscious about her nose as a teenager.
STORY HIGHLIGHTS
  • Doctors should assess physical and mental maturity of their teenage patients before surgery
  • Procedures are permanent, so there is no harm in waiting, says one Beverly Hills surgeon
  • Nose surgery is most common for teenage patients
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(CNN) -- Sabrina Weiss hated her nose.

"I felt it was a defect," she said. As a teenager, "It was a central obsession in my self-hatred. ... I felt like it was all anyone saw when they looked at me."

At 14, she asked her parents for surgery. A few years later, after she graduated from high school, Weiss got her wish -- rhinoplasty reduced the bump on her nose and pared down the tip.

Despite her new petite nose, Weiss began to regret her adolescent decision as she matured.

Having elective cosmetic surgery is life-changing. Experts say it's imperative that doctors assess both physical and mental maturity of teenage patients before agreeing to do the surgery.

"Whatever is done is permanent," said Dr. Richard Fleming, the facial plastic surgeon and co-director of the Beverly Hills Institute in California. "Nose job, breast work, they have to know it's permanent. They have to know if they decide not to do it at this time, they can get just as good result one year or 10 years from now."

"They have to know there's no rush in doing this."

The most common cosmetic surgery for teenagers is rhinoplasty- an operation to reshape the nose. The nose has usually completed 90 percent of its growth by the time girls reach the age of 14, and boys reach the age of 16, according to the American Society for Aesthetic Plastic Surgery.

Despite media reports that the popularity of teenage cosmetic surgery has soared in recent years, statistics from two plastic surgery societies show that is not the case.

The American Society for Aesthetic Plastic Surgery reported that the number of cosmetic surgeries for teenagers has remained fairly consistent for the last 12 years, hovering between 1 to 3 percent of total U.S. procedures.

Of the 203,308 procedures performed in 2009, 2 percent were under the age of 18. The American Society of Plastic Surgeons showed similar statistics.

For the small percentage of teenagers who decide to have surgery, the time after high school graduation seems to be ideal, Fleming said.

"It's a perfect opportunity to have it done before they get involved in a new circle of friends and colleagues, before going to college," he said.

"[Teenagers] have to be mature to undergo this and not do it because they saw their favorite celebrity getting a nose job or breast augmentation," Fleming said.

As a young high school student, Weiss hoped the surgery would be transformative and help her fit in.

"My fantasy was that I'd have this surgery and I would turn into the person that would easily be able to connect with others and have this social ease," she recalled. After the surgery, Weiss still felt painfully shy.

Elle.com: Read Weiss' first-person essay

Like adults, teenage patients need to have realistic expectations of how much cosmetic surgery can do, plastic surgeons said.

If a teenager says they want a procedure because of a failed relationship or the inability to get into the college of choice, that is a clear sign that the patient is still maturing and unable to handle the responsibilities of a major cosmetic surgery, Fleming said.

Dr. Laurie Casas, an associate professor of surgery at the Pritzker School of Medicine, University of Chicago, Plastic Surgery Division, said she looks for several factors when discussing cosmetic surgery with a young patient.

"During the interview process, I have to assess the level of maturity," she said. "What's involved with wanting that change? What's their expectation from the procedure? How do they want that body part to look?"

Sometimes, a teen patient will expect his or her parents to give all the answers. When the patient is asked what he or she dislikes about the nose, that person might respond, "I just don't like it," or "I just want you to fix the whole nose."

Those can be signs of emotional immaturity, said Casas, a plastic surgeon in Chicago, Illinois. About 10 percent of her teenage rhinoplasty patients are boys.

Casas said she won't operate on patients who are not emotionally mature, realistic and can understand the limitations of surgery.

"There might be BDD [Body Dysmorphic Disorder] or untreated psychological issues," she said. "Not that we can treat them, but we can say, 'I'm not the right person to do this surgery,' and in some cases I may recommend a psychological evaluation."

Weiss does not recall whether her surgeon asked her many questions before the surgery.

"Looking back, if anyone had questioned what my reasons for doing this, they would've seen it was irrational and a fantasy that having this surgery was going to somehow transform my entire life," she said.

When Weiss, 17 at the time, saw her new nose for the first time after surgery, she felt disappointed.

"To some degree, it helped," she said. "I felt less self-conscious that I had this massive bump in nose."

As she grew into her late 20s, Weiss began to regret her decision and felt she had the surgery for the wrong reasons.

"As a teenager, you're so myopic, you don't think about the long-term consequences of what you do," she said.

A better graduation gift for teenagers struggling with their body image would be to enroll them into programs or creative outlets like a painting class, Weiss suggested.

"It's on the shoulder of parents and guardians to ask a lot of questions of their teenagers to get to the root of why they're asking for this kind of surgery, to get them thinking about reasons below the surface for wanting this surgery.

"If you can, delay it for as long as you can."

The journey to self-acceptance takes persistence and patience, she said.

"Just stay the course. It can be painful, but it takes time. Eventually, you'll get there."

 
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