- Apps let children perform procedures such as liposuction, nose jobs
- Some experts say that children lack the proper context to understand the games
(CNN)Plastic surgery isn't a game, but some apps have turned it into one for kids.
Children can simulate procedures such as liposuction, nose jobs, lip fillers and double-eyelid surgery using such apps.
They are directed at children, featuring bright colors and cartoon characters.
"This type of app is often free, which is often something parents look for first," said Christine Elgersma, senior editor for parent education at Common Sense Media, a nonprofit that addresses tech and media issues in a family context. "Also, there are some that aren't obviously cosmetic surgery apps at first glance, so parents may download first and find out later.
"Most importantly, though, the content isn't developmentally appropriate. It's confusing and scary for little kids and sends a potentially harmful message."
Andrea Mara, a mother of three in Ireland, discovered plastic surgery games when her 9-year-old daughter found one on her Kindle tablet after searching for free games for kids. Her daughter showed her how it worked by carrying out a cosmetic surgery on the cartoon patient's nose. The surgery involved making incisions with a scalpel, moving bones, gluing and stitching.
Mara said she was shocked that such an explicit app was being marketed toward children.
"Not only is it graphic and gross, it's also sending a really negative message to little girls. Don't like how you look? Just go under the knife, because you are nothing beyond your appearance," she said.
Elgersma says children may lack the necessary context. "First and foremost, surgery out of conceptual context looks like violence; it involves cutting people with sharp objects. In the cases of these apps, the scene plays out in a medical environment, which is a place we want kids to feel safe.
"We wouldn't let our little kids watch a surgical procedure on television, so we certainly don't want to let them simulate it in an app."
Sending a message about body image
Board-certified plastic surgeon Dr. David Cangello of New York, who has two girls, says he never wants them to believe that their appearance is a top priority.
"There have been times when my 5-year-old daughter picks up my iPad and sees before/after photos of my patients who've had surgery, and I am very conscious about how I respond to her when she asks what the photos are for or what Daddy does for a living," he said.
"While there is no question plastic surgery can be transformative for some young people, these are very specific instances, and it should never be taught as a means to an end or that 'perfection' is the only answer to happiness."
Cangello believes that plastic surgery -- specifically cosmetic surgery -- is a complex adult topic that children should not be exposed to, because it will negatively affect their self-esteem. "It is unhealthy to teach our kids about this at such an early age," he said.
Many of the apps equate cosmetic surgical procedures with going to the salon to get your hair or nails done, Cangello says. This is concerning to him because although plastic surgery procedures are generally safe, there can still be risks and complications.
He doesn't want children to think plastic surgery is "no big deal," "commonplace" or "normative."
At such a young age, they are not really thinking about cosmetic issues, and Cangello suggests that they should not be introduced to them any earlier than necessary.
"Issues of self-esteem and appearance should be confronted as they arrive naturally, not because we are introducing them in an unnecessary way," he said of the plastic surgery apps.
Elgersma agreed: "Really little kids might not pick up on the messages around altering your appearance to fit social norms of beauty, but they may still get the general idea. Girls as young as 5 already express dissatisfaction with their appearance, so we definitely do not need to reinforce those messages."
"It reinforces that there is a standard beauty ideal that must be conformed to," says Alyson Schafer, a family counselor, author and parenting expert.
She says the apps do not encompass other beauty ideals, cultural variabilities and size differences. Rather, she says, they imply that anything outside of Western beauty ideals is less than OK and that instead of embracing and liking your differences, you should undertake surgery to fix yourself.
What can parents do?
If you choose a free app for your children, take the time to open it and try it out first, Elgersma suggests. Apps that have strange or disturbing content or lots of ads or are pushing purchases may not be the best for kids. Elgersma suggests sticking with reputable developers like PBSKids or other nonprofits.
"(Parents) can be proactive about monitoring the media their kids choose and creating shared experiences around it to try and make sure kids get the highest-quality content possible and aren't exposed to disturbing images and damaging messages," she said.
Schafer also recommends knowing what your kids are downloading and watching their browser history.
Having an open dialogue or conversation with your child about apps like a plastic surgery game is important, she said.
"Make it a teachable moment, not a preachable moment."
Schafer believes the developers of these plastic surgery games are intelligent enough to understand that they are marketing apps to children that send negative messages about self-identity, body image and beauty.
"We need to have humane technology," she said.
Elgersma suggests that companies like Amazon, Apple and Google, address these issues by making sure that these types of apps do not fall into children's categories and cannot be surfaced as easily.
Endangered Bodies, an initiative that confronts the promotion of negative body image, launched a petition calling for those three tech giants to stop marketing plastic surgery games to children. Its aim is to make sure future generations live in a body-positive world.
According to Mara, a member of the organization, Endangered Bodies joined forces with the Twitter account Everyday Sexism in January 2014 to ask that Google and Apple remove plastic surgery apps from their stores. Within 24 hours, the apps had been removed. But Endangered Bodies says they have reappeared and in greater numbers.
Endangered Bodies has over 100,000 signatures from around the world on the petition and says it will continue petitioning until it gets confirmation that Google, Apple and Amazon will implement policies for app developers stating that these games are no longer acceptable for children.
Apple spokesman Tom Neumayr said, "We do not want nor allow these types of apps on the store. We have rules in place against these apps and do not offer them on the App Store."
Google said, "While we don't comment on specific apps, we do have strict policies in place to prohibit apps in the Families collection on Google Play that promote negative self-image or low self-esteem, regardless of theme or intended user age group.
"We're taking the feedback from the community very seriously and are working to ensure that these apps are in compliance with our policies."
Amazon and Bravo Kids Media did not respond to requests for comment.