Some of the youngest patients who may be candidates for plastic surgery are adolescents and teenagers. These patients deserve special consideration because although there are a number of procedures that may benefit them, teenage years are also a time of physical; psychological, and emotional development. Most commonly, there is a functional or medical component that warrants correction with plastic surgery, an aesthetic aspect of the teenager’s body that he or she wishes corrected, or asymmetry that becomes noticeable during the physical development that occurs in adolescence.
The most commonly performed procedures for teenagers include:
- Rhinoplasty for girls and boys with nasal deformity or deviated septum, who suffered nasal trauma or fracture, who have visible distortion of the nose, or difficulty breathing
- Breast reduction for girls with gigantomastia or significant breast hypertrophy which impacts their ability to participate in physical activity, or athletes whose excessive breast size interferes with their sports performance
- Gynecomastia surgery for boys with breast tissue enlargement
- Breast augmentation in girls who have breast underdevelopment or breast asymmetry after they have completed breast development
- Labiaplasty in girls who have asymmetry or significant enlargement of the labia, resulting in physical and/or emotional discomfort
The nose in boys and girls develops from late childhood into early adolescence, reaching its full size and appearance around age 15-16 years in girls and 16-17 years in boys. At that stage in late adolescence, the full adult nasal features usually have fully developed. Elective cosmetic rhinoplasty may safely be performed in teenagers at that age.
Most commonly, patients seek to improve the appearance of their nose by reducing the dorsal hump, straightening a crooked nose, or refining the appearance of the tip by narrowing it or turning it up. In some teenagers, rhinoplasty is indicated after nasal trauma which can cause a broken nose or deviated septum. In these patients, if the nasal bones are obviously displaced, it may be necessary to perform corrective rhinoplasty and reduce nasal fracture immediately after injury.
Nasal surgery may be performed using either invisible internal incisions hidden inside the nose, called a closed technique, or using a small incision on the skin between the nostrils, which is known as open technique. Nasalplasty requires either local anaesthesia with sedation, or general anaesthesia. After rhinoplasty surgery, nasal packing may be kept in place for a day, and a nasal splint may be used to stabilize broken nasal bones for one week, after which sutures (if any) would also be removed.
To read more about rhinoplasty surgery, click here.
Normally, breast enlargement in girls occurs in response to hormonal influences and as part of physiologic changes in puberty. The process may begin as early as age 7 and continue for several years, usually around age 18 when breast maturity occurs and there is no further increase in breast size. Significant breast enlargement is referred to as breast hypertrophy or macromastia, and produces heavy, enlarged, low hanging breasts. It may result in debilitating symptoms such as pain in the neck and shoulders, headaches, shoulder grooving, and rashes under or between the breasts. In active and athletic teenage girls, who participate in sports and physical activity, enlarged breasts can hamper their performance on the field and during training. In some girls, breast enlargement is accelerated and breast tissue can grow extremely rapidly, resulting in massive breast enlargement in early teenage years. This condition is referred to as gigantomastia.
In both cases of breast hypertrophy and gigantomastia, breast reduction surgery can lead to a significant improvement in the symptoms that are caused by heavy, enlarged breasts. Breast reduction surgery may occasionally be performed using only liposuction, which requires tiny, imperceptible incisions hidden under the breast. In patients who would benefit from reduction of excess breast tissues as well as excision of excess skin and repositioning the nipples, surgery involving scars around the nipples and on the breast skin may be required. Limited incision or short scar surgery uses the shortest scars possible and is often the method of choice for teenage girls.
Breast liposuction may be performed using twilight anaesthesia, whereas formal breast reduction surgery requires general anaesthesia. Results are immediate and return to full physical activity is usually possible within 2 weeks after surgery.
To read more about breast reduction surgery, click here.
Gynecomastia is the growth of excess fatty and glandular breast tissue that develops in male individuals. In adolescent boys, hormonal changes in puberty may occasionally result in an imbalance between estrogen and testosterone, which can manifest as gynecomastia. This condition, which can affect up to half of boys ages 10-19 years old, often resolves on its own, but when it persists it can cause breast pain and social embarrassment. It most often affects both breasts although there may asymmetry or unilateral breast involvement. Use of alcohol, certain drugs such as steroids and marijuana, and hypogonadism may be implicated in causing gynecomastia.
In teenage boys in whom other factors have been ruled out as causing gynecomastia and in whom the condition persists for 6 months or more, surgery may be considered. Most often, liposuction alone is sufficient to remove excess tissue and create a flatter chest. In some patients, a small additional incision around the pigmented part of the nipple, the areola, may be necessary in order to allow for removal of excess breast tissue. Gynecomastia surgery is usually performed under local anaesthesia with sedation, and patients often wear a compression garment for a short time after surgery. The results are immediate and patient satisfaction is generally extremely high.
Breast Asymmetry Correction
In select teenage girls, most often those at least 18 years of age, breast asymmetry correction may be considered to increase breast size in patients whose breast are underdeveloped or to correct asymmetry. Sometimes associated with congenital syndromes such as Poland’s syndrome, significant breast asymmetry may develop during adolescence. In girls whose breasts remain underdeveloped throughout adolescence, bilateral hypoplasia may persist. In cases of asymmetry, unilateral breast augmentation may provide a solution for improving symmetry and overall appearance of the breasts. Teenage patients with bilateral hypoplasia may benefit from bilateral breast augmentation.
In most cases of breast hypoplasia or underdevelopment, whether unilateral or bilateral, breast augmentation is performed using breast implants. Currently, only saline filled breast implants are FDA approved for use in women under age 22 years for cosmetic purposes. Saline implants are available in a vast array of varying sizes, diameters, projections, and shell surface options. Saline implants may be inserted using very small incisions (approximately 2-3cm, or 1 inch) placed either in the axilla (armpit), under the breast (inframammary), or around the nipple (periareolar). Saline breast implants may be located either directly under the breast (subglandular) or under the pectoralis major muscle (submuscular). There are numerous alternatives and advantages to each option, and a comprehensive discussion of the various possibilities is essential prior to proceeding with surgery. Dr. Hutchinson will assess each patient for their specific needs and expectations in order to determine the best surgical plan for you.
Breast augmentation is most often performed under general anaesthesia. Results are immediate and recovery usually requires at least 2 weeks before return to full activity.
To read more about breast augmentation surgery, click here.
Teenage girls develop secondary sexual characteristics throughout puberty, and part of this process includes development of external genitalia. In some adolescent girls, the labia minora become enlarged, thickened, or protuberant, and this may contribute to both physical discomfort and emotional embarrassment. In some girls, asymmetric development of the labia minora results in significant discrepancy between the two sides. Excess tissue may be visible in clothing, and friction between the labia may result in inflammation and ulceration.
Labiaplasty surgery is indicated to improve either asymmetry or overall tissue excess of the labia. Several surgical techniques are safe and effective in reducing hypertrophy and bulk of the labia. Dr. Hutchinson has extensive experience in performing labiaplasty surgery in adolescent girls and will discuss which option is best for you.
Labiaplasty is most often performed under local anaesthesia with sedation, although in select cases local anaesthesia alone will suffice. Results are immediate although recovery will take at least 2 to 4 weeks before full activities may be resumed.
To read more about labiaplasty surgery, click here.
Additional considerations in teenage plastic surgery patients have to do with the patient physician relationship, which in the case of minor patients also necessarily involves a parent or guardian. When a teenager under the age of 18 years old is seen in consultation by the plastic surgeon, their parent or guardian must be present, and must also give consent for any surgery. Pre-operative consultations include discussions with both the patient and parent or guardian in order to address all possible aspects of the surgery. They are also essential in establishing that the patient is an appropriate candidate for surgery, can express their expectations, and understands the necessary aspects of the pre- and post-operative instructions. Patient compliance is extremely important in maximizing chances of best results after plastic surgery. Dr. Hutchinson has extensive experience performing surgery on adolescent girls and boys, and will discuss all options with both the patient and parent or guardian in order to strive for the best possible results.