In 2015, more than 226,000 cosmetic surgeries were performed on teenagers eighteen and younger (Zuckerman). The perception of the ideal physical body has changed dramatically over the past few decades. Young women today feel they must conform to such unrealistic standards as a perfect hourglass shape, long lean legs, large breasts, and petite noses.  Teenagers, in particular feel the need to conform. There is a constant struggle between needing to fit in and trying to form their own identity. Many teens look outside themselves for approval and acceptance. Between the ages of thirteen and nineteen, teens put a lot of emphasis on peers and what they think of them (Singh). In addition to this peer pressure to be perfect, modern social media can be a very prominent stressor on teenagers. Cyber-bullying and unrealistic portrayals of the teenage body in magazines and online can lead teenagers to believe they are inferior and lower their self-esteem. There have been studies showing that the extent to which teens are exposed to unrealistic body pictures lead to unrealistic concepts of what is normal (Giussy et. all). The pressure young people feel to be perfect has lead to more teens undergoing elective cosmetic surgery than ever before.  Cosmetic surgery was once exclusive to older women, but now it is a fad among young teenagers (Singh). Breast augmentations, nose jobs, tummy tucks, and female genital cosmetic surgery are becoming more common amid developing teens. What they do not realize is that cosmetic surgery is a very serious and life-altering procedure. There are many risks and drawbacks that a teenager may not be able to understand or foresee and these risks outweigh any possible positives. This type of surgery in teenagers should be limited to medically necessary procedures recommended by doctors or with parental consent. 

There are many reasons why teenagers feel the need to undergo elective cosmetic surgery. Low self-esteem is one of the main reasons. The age range thirteen through eighteen, when kids are in middle school and high school, is when self-confidence and self-image are most fragile.  It is also a time when not being a part of the popular crowd, change in financial situation, and divorce can negatively affect a teenager’s self-esteem (Singh).  A teen’s perception of their body has everything to do with their inner self-confidence. “Some past research suggests that both American girls’ and women’s perceptions of their bodies is more predictive of their weight concerns and desire to change their bodies than more objective assessment of their body weight” (Markey and Markey). If a teen looks in the mirror and does not like what they see, then nothing and no one will be able to change their minds. 

Peer pressure and the need to fit in and conform are struggles every teenager faces. No one this age wants to stand out too much or be different in any way. Teenagers are willing to go to drastic measures in order to be included in their desired friend group.  Kathy Davis discusses in her book, Reshaping the Female Body, a conference she attended at a Dutch medical center.  She talks about how one of the speakers referred to a fifteen year old Moroccan girl who got a nose job because she was being harassed in school for “having a nose like that” (Davis).  Davis, being a feminist, was outraged because she believes that girls should be completely comfortable in their own bodies.  She quotes, “Women are instructed that their bodies are unacceptable: too fat, too thin, too wrinkled, too old and, now, too ethnic” (Davis).  At no other time in a person’s life is peer pressure more pronounced than when they are a teenager. Making the decision to better conform to their friends by having a nose job, breast augmentation or even liposuction is a hasty and premature decision that may not even result in the teen’s ultimate happiness or sense of belonging. 

The increase in the popularity of social media has also contributed to teenagers feeling the need to have cosmetic surgery.  In a study done by Patrick and Charlotte Markey, they assess the many reasons that teenagers would want to get such a serious surgery so early in life. One of the main effectors of their decision was social media with a correlation of 0.94 (Markey and Markey). Social media can be an innocent and fun thing for teenagers to engage in, however, it can also be the main source of their insecurities. Teenagers may have an Instagram, Twitter, Snapchat, or Facebook account, or all four.  Many teenagers have all four of these accounts. There are downsides to these types of online accounts, though.  Insecure teenagers can become even more self-conscious about their appearance in the photos they post, people can post harmful comments on their photos, and even more severe cyber bullying can occur. Meaghan Ramsey speaks in her TEDTalk about a YouTube phenomenon where teenagers post a video of themselves asking their viewers if they are ugly (Ramsey). If a teenager is asking for strangers’ opinions on their appearance, that is a clear indicator social media has too much influence on what we think of ourselves. 

Other media outlets such as television, movies, magazines and even the news can also lead teenagers to have an unrealistic ideal of a “normal” body and consequently want cosmetic surgery.  Models and celebrities pose half-naked in magazines and after they are airbrushed, they look literally perfect.  Young teenagers, at their hormonal peak, see these pictures and naturally compare themselves to the celebrity or model.  They feel they will never measure up.  

Diana Zuckerman quotes: “Cultural phenomena such as surgical makeovers on numerous television programs make it increasingly difficult to agree on what constitutes a normal appearance and the desire to improve one's appearance is questionable or even crosses the line to psychopathology” (Zuckerman). What a teenager sees or watches in today’s media can leave a lasting impact on their -image and lead them to make a hasty decision to get cosmetic surgery. 

The final reason why teenagers are increasingly seeking cosmetic surgery is the rise in the popularity of pornography. By college, a third of women and about 90 percent of men have viewed pornography (Simmons). Experts say that porn has actually become the main source of sex-ed for most teenagers (Simmons). Teenagers watch pornography and naturally assume that is how their bodies should look and work. Simmons quotes “Between 2014 and 2015, there was an 80 percent increase in the number of girls eighteen and younger receiving genital plastic surgery” (Simmons). Teenage girls should not feel the need to get genital plastic surgery in order to feel confident in themselves or in their bodies. These procedures do not even have proven effectiveness according to medical reports. Labiaplasty, a procedure done to alter the folds of the vagina, can cause loss of sexual sensation, numbness, pain, and scaring (Simmons). If a sixteen year-old girl wants genital cosmetic surgery to “improve her sexual abilities”, then there is clearly an inner issue that needs to be considered. 

The risks and possible negative impacts of cosmetic surgery in teenagers are numerous and teenagers often don’t have the cognitive abilities to fully understand these risks. For example, teenage bodies are still developing and cosmetic surgery may inhibit some of the essential stages of physical development. In 2015 alone 7,840 young girls underwent breast augmentation surgery with an additional 1,797 teenagers getting breast lifts (Zuckerman). Some teenage girls grow and develop later than others and having this type of surgery before they are fully grown can stunt normal breast growth or alter the overall look of the cosmetic procedure. 

More than physically, cosmetic surgery can have a large impact in a developing teen mentally and emotionally. If a teenager is already psychologically imbalanced, having cosmetic surgery is no guarantee that things will improve. “Psychological counseling is recommended to inform women that surgery is not a definitive solution to treat psychologically based pain or dysfunction” (Giussy et. al). Also, there is no clear evidence that these surgeries are effective in boosting self-esteem or making a teenager feel better about themselves. Why would a teenager make such an important decision without knowing how they will feel about themselves afterward? In some cases, the teenager can become more depressed or feel even worse about themselves after the surgery because their lives don’t improve as much as they thought they would.  For example, the popular crowd at school still doesn’t include them or they don’t get asked to the prom by the boy they like. 

There are also medical risks and complications resulting from cosmetic surgery. Deadly reactions to anesthesia and actual medical mishaps, such as severely misshapen noses can occur. Many women who get breast augmentation can also experience complications within the first three years such as infection, pain and tenderness at the surgical site, and hematomas. In addition, since breast implants last only ten years, a teenager would have to undergo multiple surgeries throughout her lifetime (Zuckerman).  Breast implants can also hinder a woman’s ability to breast feed later in life as well as lead to Body Dysmorphic Disorder (BDD). Body Dysmorphic Disorder is when, after surgery, patients notice a very slight defect and blow it way out of proportion leading to impairment in functioning (Zuckerman). Not only should we consider the physical and emotional factors of teenagers undergoing cosmetic surgery, we should also look at the serious economic impacts to having cosmetic surgery. Cosmetic surgery is rarely covered by insurance, so the costs are very expensive for patients (Zuckerman). A breast lift or breast augmentation can cost nearly $10,000. Teenagers can possibly go into major debt just to pay for their surgery or their parents have to pay and then the burden is shifted onto them. 

Although most research and studies agree that plastic surgery in teenagers should be strictly monitored and in some cases forbidden, there are certain circumstances in which some people believe it’s acceptable. For example, Macromastia in teenage girls is the massive enlargement of the female breast disproportionate to the growth of the remainder of the body. This growth dysfunction is and should be treated with reduction mammaplasty (Sharma et. al). Macromastia can lead teenage girls to clinical depression and social isolation (Sharma et. al). A teenage girl’s peer group and their opinions mean the most to them and if there is something about the teen that makes her stand out in a negative way, she will feel the need to change it.  Reduction mammaplasty surgery would be able to make a girl feel confident in herself again and maybe she would be able to thrive in her new life. In addition to the psychological issues associated with very large breasts, they can also cause physical ailments, such as serious back problems. So, if some part of a teen’s body were so prominent that it impacted daily life activities, surgery would help that issue immensely (Coila). Although there may be certain cases where plastic surgery in young teenagers is acceptable or even medically necessary, the risks associated with the surgery need to be seriously considered.   It is also essential to have a medical recommendation or actual parental consent for a teen to proceed with the surgery. Dr. Steven L. Davis says to use a risk-benefit ratio when determining to go through with cosmetic surgery (Hilton). The risk-benefit ratio is a way of figuring out if the pros outweigh the cons of surgery and vise versa (Hilton).

With so many teenagers resorting to cosmetic surgery to boost their self-confidence, fit in with their peer group, or to become more like the images they see in the media, what can be done to reduce this trend? Teenagers, and their parents, must find other ways to increase their self-confidence and improve their body image without resorting to surgery. Teenagers can participate in team sports, try out for a school play, or join a club. They can also focus more on academics and achieving their goals, such as getting into their dream college or winning an academic scholarship.  The key is surrounding themselves with positive people who all have a common interest and boosting their self-esteem from within. Also, the impact that healthy eating and daily exercise can have on a person’s self-image is astounding. According to Benna Crawford, “Regular exercise makes your heart and bones stronger, lowers your risk for chronic disease right along with your blood pressure, keeps your weight under control and reduces feelings of anxiety and depression” (Crawford). Having a healthy body means having a healthy brain and mentality. Even food can boost the way someone feels about themselves. Carbohydrates make the brain receive more serotonin, which makes you feel more positive, more relaxed, and therefore, more confident (Merryfield). 

A teenager’s parents or even older siblings can also help a teenager have a positive body image.  Parents need to constantly tell their children how much they are loved just the way they are and how proud they are of them. Older siblings can take an active interest in their younger brother’s or sister’s life and be a source of guidance for them. Sometimes a teenager just needs an older person to help them get through this awkward stage by giving them advice on how to be their own person and be confident in themselves.  There are many ways for teens to stay confident in themselves without resorting to cosmetic surgery. 

Cosmetic surgery in teenagers will continue to be a controversial topic. The possible medical risks associated with these surgeries, the psychological trauma they can cause, and the economic stress they put on the teenager and their family should make the teenager (or at least their parents) extremely cautious. Even though most teenagers struggle with their self-confidence and poor body image at some point, the answer is not to go under the knife. Building up a teen’s self-esteem can be done in other, less risky ways. As a society, getting teenagers to think about the future can be very difficult. Their brains are not fully developed and therefore they cannot understand that their actions could possibly be detrimental to them later in life. Having surgery to enhance a body part or to make a facial feature less prominent when they’re 16 might not be the same decision they would make when they’re 35. Making teens realize that there are ways to boost their self-confidence other than permanently changing their bodies will help them in the short run and in the long run.  Participating in team sports, surrounding oneself with a good group of friends, exercising, working hard in school, setting goals, and eating well can all improve a teenager’s self-image.  Having a healthy self-image will then make it more likely teenagers will be confident and happy adults. Finally, having a positive older influence in their lives is imperative to a teen’s self-esteem. A teenager who looks up to an older sibling or has a parent who radiates self-confidence, will become more confident themselves. Identity formation is difficult for teenagers and they need people who they respect to help them become a strong and happy individual. Gaining confidence from within and learning to truly love oneself is harder than undergoing plastic surgery, but in the end more rewarding.  
