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Cosima Marriner reports.  The Sydney Morning Herald

Noses, breasts and tummies.  It’s now the norm to want – and get – the best on offer.

A young woman recently showed up at Dr Howard Webster’s plastic surgery practice seeking breast implants.  In the surgeon’s opinion, the woman’s natural breasts were perfect.  But to the woman’s eyes, accustomed to the sight of surgically enhanced chests, they weren’t.

“Her ideal of good breasts was implanted breasts.  Her normal is a distorted normal,” says Webster, who is the president of the Australian Society of Plastic Surgeons.

Health professionals, social commentators and even politicians are becoming concerned about the growing number of young people using cosmetic surgery to rectify their poor body image.  Cosmetic surgery has become almost mainstream in the 21st century, but, for most, the notion of vulnerable teenagers going under the knife remains troubling.

Once the preserve of the middle-aged trying to achieve eternal youth, cosmetic surgery is now coveted by teenagers keen to emulate the celebrities they look up to.  “It’s now seen as … not just a way of turning back the hands of time and looking younger, but looking better,” says Mia Freedman, a social commentator and former magazine editor.

“It’s the evolution of eating disorders, in terms of how young women harm themselves in a bid to meet unrealistic expectations.”

While there are no nationally collected statistics on cosmetic surgery patients and procedures, surgeons report the number of under-19s seeking surgery has risen steadily in the past five years.  A recent Dolly magazine survey of 4000 girls aged 11-18 found 27 percent would have cosmetic surgery if they could, and 2 percent had.  Surgeons say the trend is most prevalent in Sydney and south-east Queensland.

The Queensland Government this week signaled it could become the first Australian state to regulate or even ban breast implants, nose jobs, tummy tucks, liposuction, botox and even solariums for under – 18s.  Its discussion paper suggests enforcing a “cooling off” period between consultation and surgery requiring parental consent, and compulsory medical and psychological evaluation of prospective patients.  Alternatively, there could be a ban on purely cosmetic procedures for minors.

“I can appreciate that adolescence can be a difficult time, when body image is a very important part of development.  But resorting to a surgeon’s blade is an adult response, and it should be a decision that an adult makes,” said Queensland’s Premier, Anna Bligh.

Still waiting for the NSW Government to implement the recommendations of an eight0year-old report on the industry, health professionals, including the plastic surgeon’s society have welcomed Queensland’s move to regulate cosmetic surgery.

No one is suggesting banning plastic surgery to fix abnormalities or deformities, such as asymmetric breasts or prominent noses.  Indeed, the most common procedure for minors is pinning back ears. 

But health professionals are horrified by girls in particular seeking out purely cosmetic procedures such as liposuction and breast implants when their bodies are still growing.  Women do not achieve their final breast size until they are at least 20, while nose jobs are not recommended before the age of 17 at the earliest. 

“From a purely medical point of view, body contouring procedures on adolescents is completely inappropriate, “ Webster says.

Roberta Honigman, a clinician based at the Mental Health Research Institute in Melbourne, regularly has young prospective cosmetic surgery patients referred to her for counseling.  “When girls and boys look pretty normal, you have to question why people would advise or allow them to access cosmetic surgery, especially if they are under 21.  It’s the body’s peak changing and developing time, “ she says.

Often teenagers seize on cosmetic surgery to assuage self-esteem issues, when counseling would be more appropriate.  One of the most disturbing cases Webster has seen was a clearly anorexic girl who was desperate for liposuction.  Reputable surgeons will refer such patients to counsellors.

“At this age you are really ripe for the picking,” Honigman says.  “You think you are not going to be accepted or liked if you don’t look a certain way.  Individuality has gone out the window – there is this homogenous look people feel they need to attain.”

As older and wiser heads know, time cures many ills.  The teenager suffering from poor body image today is likely to have developed far more self-confidence by the time they are in their 20s.  “At 17,18,19, there are lots of big changes ahead.  You may be a very different person psychologically and physically by your mid-20s,” Honigman says.

Too often teenagers focus on the simplistic outcome of “looking better”, without fully appreciating the adjustment they will subsequently need to make to “looking different”. “They are at a very vulnerable age looking for a quick fix, and there is no guarantee they are going to like what they get,” Honigman says.  “If the perception of themselves is skewed before surgery, their acceptance of change is les likely.”

One young woman Honigman has counseled is struggling to come to terms with the results of her cosmetic surgery.  The woman had a nose job after she was told she had a nose “so long it just kept on going”.  But she doesn’t like her new nose, because it is “too short” – even though she was not sure how she wanted it to look.   Her unhappiness has been compounded by her critical sister’s reaction: “I don’t know why you wasted your time.”

Another of Honigman’s clients received breast implants at 19, and by the age of 26 had had them removed and then re-implanted four times as she kept changing her mind about the breast size she wanted.  Each time she was exposing herself to the risk of infection, scarring and botched surgery.

Many blame the media for normalizing cosmetic surgery for girls.  They point to the fervour for digitally retouching photographs – shaving centimeters off hips, boosting cleavage and smoothing out lines – that presents a warped ideal of beauty.

The penchant of young Hollywood stars such as Lindsay Lohan, Jessica Simpson and Britney Spears for silicon breasts and botox – pumped lips sends a message to teenagers that cosmetic surgery at their age is acceptable.  This notion has been reinforced by reality TV shows such as Extreme Makeover.

“Every celebrity in their age group that they aspire to is already doing it,” Freedman says.  “The scary thing is you end up with a bunch of clones.  The Hollywood starlets all look the same.”

She also believes the trend for under-18s to seek cosmetic surgery is symptomatic of their generation’s desire for instant gratification.  “Their mentality is: ‘I want to change something and I want to change it instantly.  Instead of joining a gym or stopping eating junk food, I’ll get plastic surgery.’”

Procedures have become less invasive, so you can nip in for a botox injection at lunchtime, just as you would for a manicure.

But parents can also be to blame for teenagers turning up at cosmetic surgery practices.   Parental or guardian consent is required by law for any surgery performed on patients 16 or younger, and most teenagers rely on their parents to fork out the thousands of dollars required.  Some parents grudgingly acquiesce to their child’s desire for surgery simply to keep them happy, but others have more complex reasons.

Webster is unnerved by over-enthusiastic mothers who are determined their daughters not experience the same unhappiness with their body shape they felt at that age.

“When they’re in the consultation they try to talk over the child, and answer all the time.  It’s quite difficult – you can never figure out the child’s motivation,” he says.

He believes most cosmetic surgeons are careful about performing any work on under-18s.  With so much work around, they can afford to knock back troubled teens.  But in the absence of any regulation of the industry, shonky operators can and do flourish.  Some entrepreneurial doctors will prey on teenagers’ vulnerability and suggest additional surgery.  “It’s a very corrupt industry because the code of conduct guidelines are not particularly strong,” Webster says.

Surgeons and counsellors believe there should be a compulsory “cooling off” period of at least three months between the time minors decide to have surgery and when the procedure is performed.  They want mandatory counselling, and think patients should be required to consult at least two surgeons.

The medical profession is scathing of the NSW Government’s inaction on the issue.  In 1999 the then NW health minister, Craig Knowles, ordered a report on the industry.  The Cosmetic Surgery Report found 7.5 percent of patients were aged 15-24.  Liposuction was the most popular procedure, followed by breast augmentation, rhinoplasty and peels or injections.  The report made several widely supported recommendations, including establishing an industry body to independently verify surgeons’ qualifications and training, and making face-to-face consultations, cooling-off periods and consent forms compulsory.  This has not happened.  Guidelines for appropriate patient selection, consent and advertising were established, but they are not government-regulated.

On the eve of this year’s state election, John Hatzistergos, the minister for health at the time, announced a review of cosmetic surgery advertising “to determine whether we nee extra protections for potential cosmetic surgery patients”.

A spokeswoman for the current Health Minister, Reba Meagher, said that a meeting in July of the Regulators Forum (comprising officials from NSW Office of Fair Trading, NSW Food Authority,  the NSW Health Care Complaints Commission, the Australian Competition and Consumer Commission and NSW Health) “agreed to review approaches taken by other states”.

The Department of Community Services is looking at greater protection for young cosmetic surgery patients as part of its review of the Children and Young Persons Care and Protection Act that was ordered last December.

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