HIGH LIFE : A WEEKLY FORUM FOR HIGH SCHOOL STUDENTS : Teen-Agers Turn to Cosmetic Surgery to Get Right Look
Cathy hated sitting at the front of the classroom. She just knew that everyone was looking at her nose, staring at the bump on it and seeing how crooked it was.
Smiling made it turn down at the end, and pictures of her never turned out quite right. Insecurity plagued her. Finally, this past Christmas, she decided to see a plastic surgeon.
Cathy (not her real name) is not alone. Blessed with their parents’ healthy discretionary incomes, Southern California teen-agers are turning to cosmetic surgery at younger ages and in greater numbers than ever, says Dr. Burr von Maur, a plastic surgeon in Mission Viejo. He estimates that he sees about 200 teen-agers a year. They come to have noses straightened, chins strengthened, ears flattened, eyelids lifted, acne scars removed and breasts reduced or enlarged.
Nose jobs--or rhinoplasties--are the most popular form of aesthetic surgery for teen-agers. Of the 732,250 rhinoplasties performed in 1988 by surgeons belonging to the American Society of Plastic and Reconstructive Surgeons, 16% were for patients under 18.
Cathy, 16, decided to have her nose changed last year. Most cosmetic surgeons will not perform rhinoplasties on patients younger than 13 or 14 because the face is not fully developed. Some surgeons even prefer to wait until their patients reach 15 or 16.
Cathy had been born with a less-than-perfect nose--both her mother and sister had rhinoplasties before her--and had also damaged it playing soccer. An asthma problem that complicated breathing also persuaded her to go ahead with the surgery.
Before the operation, Cathy was asked to read about rhinoplasties and consult with Von Maur and his nurses. The consultation, during which the doctor takes pictures of the part of the body being considered for change and discusses the operation, usually costs between $50 and $150.
One of the most important parts of the consultation is a discussion of the motivation for surgery.
“I had always hated my nose,” Cathy said. “I really could not stand it. I was really insecure about it and about people looking at me, especially from the side.”
Sandra Cericola, a registered nurse in Von Maur’s office and chairman of the Western District of the American Society of Plastic and Reconstructive Surgical Nurses, said cosmetic surgeons often will not work on a person who has unrealistic expectations.
“We did see a young woman who thought (a rhinoplasty) would make her more popular in school,” Cericola said. “(Her nose) wasn’t bad at all, but she had it in her mind that that was her problem. She needed to work on some social adaptation rather than major cosmetic surgery.”
The pre-operative consultations also gave Cathy a chance to learn about the surgery. No skin is cut in a rhinoplasty; surgery is performed entirely by working through the nostrils. Inside the nose, cartilage can be either scraped away or restructured. If extra contouring is needed, cartilage grafts can be taken from behind the ear.
“When you say ‘a nose job,’ you think it’s just one procedure. It’s not; it’s usually a series of them, anywhere from three or four to seven,” Cericola explained.
Each of these procedures is priced separately, and in Orange County the final bill can range from $2,200 to $4,500, according to 58 plastic surgeons surveyed by the Orange County Society of Plastic Surgeons last fall. Prices vary depending on the doctor and whether the surgery is done in a hospital or on an outpatient basis. Insurance will usually pay for any part of the operation that is needed for medical reasons.
Cathy also had to understand a basic tenet by which cosmetic surgeons live: There are no guarantees. While a doctor will try to correct what most bothers the patient about the body part to be altered, he will not promise perfection.
The surgeon’s craft is by no means haphazard, though. “We don’t just guess and gauge,” Cericola said. “There are mathematical formulas that (the doctor) uses. It’s all figured according to angle of degree for the noses.” The angle between the nose and the upper lip for the female nose that gives the prettiest, most feminine form is from 100 to 105 degrees.
More than anything, the aim is to keep the end result looking natural.
“Most of these changes are very subtle changes,” Cericola said. “We don’t try to go for a major change in anyone’s countenance. For one, that can cause psychological problems for them. We don’t want people going away looking like a freak.”
Within two weeks of Cathy’s pre-operative consultation, she had her new nose. Von Maur raised the tip, straightened the bridge, thinned the sides slightly, and fixed the nostrils.
The general anesthesia made her sick, and her neck was stiff from having to sleep sitting up, but pain pills kept her face from hurting. Within a week, most of the swelling and bruising around her eyes and nose had subsided.
“I like my nose so much better now. My whole face looks different. It looks like I’m proportioned.”
Most often when rhinoplasty patients return to school or work after the operation, they face friends who notice that something is different but who cannot quite place the change.
Bita Boini, 17, a senior at El Toro High School, underwent a rhinoplasty performed by a surgeon in Beverly Hills when she was 15, the summer before her sophomore year. When she returned to school in the fall, many friends who noticed the change could not tell that she had her nose fixed. “Around the same time, I also had my braces off,” Boini said. “So everyone thought, ‘Oh my gosh, you got your braces off!’ ”
To Boini, though, the change is clear. Her new nose is shorter and, unlike the old one, bump-free. Since the operation was also done to clear her sinuses, her breathing has improved.
Lynda Cardinale, who graduated from Trabuco Hills High School in Mission Viejo in 1988, also had a bump removed from her nose. Unlike Cathy or Boini, her problem was caused by a car accident that broke her nose.
“It wasn’t grotesque or anything,” said Cardinale, 19. “But there was a bump, and I had trouble breathing.”
She looked into plastic surgery this year and decided to go ahead with it in May, after she graduated from the Fashion Institute and received money from the settlement of her car accident.
Rhinoplasties often go hand-in-hand with a chin augmentation to help balance the facial proportions.
Pam Rasmussen, director of communications for the ASPRS, explained: “You see the kids with the real bad underbites, you’re born with that, and chin augmentation can help put the face back in balance.”
Cosmetic surgery has also allowed many girls to reduce or enlarge their breasts. While breast reductions can be done on patients as young as 16, breast enlargements are usually not performed until age 18 or 19. About 9% of the 35,500 breast reductions performed in 1988 were on girls under 18. Only 2% of the 71,720 breast enlargements were for girls under 18.
“There are quite a few girls 16 to 18 with very over-enlarged breasts,” Cericola said. “And, believe it or not, that’s a detriment in our society, especially here in Southern California. (Breast reduction patients) are some of our happiest, most satisfied patients.”
Said Rasmussen: “Breast reduction is done mostly for medical reasons. They’re having problems with back pain, the bra straps are chafing their shoulders, they’re having trouble breathing.
“With breast augmentation, you definitely want to wait because, again, growth may not have stopped yet.”
Older teen-agers who suffer from acne scars sometimes choose a surgical procedure known as dermabrasion that helps to smooth the skin. The skin is scraped away by an instrument that resembles a miniature sander. A scab forms, but it falls off within a week or two. Dermabrasion is done only after acne has stopped forming to reduce the chance of infection.
Another form of plastic surgery, liposuction, has been touted by some as a solution to nagging fat deposits, but Rasmussen warns against it for teen-agers. “With liposuction, they often want it to remove baby fat from their face, but if you don’t wait until they stop growing, then, if they lose the fat later, they might end up looking too gaunt.”
Tiffany White, 17, a June graduate of El Toro High School, decided to have liposuction on her face when she spoke with her cosmetic surgeon about a rhinoplasty to straighten the bump on her nose.
“I’ve always had real chubby cheeks,” White said. “A lot of people said I looked like Bette Midler, and that really bothered me.” Her surgeon told White that her face could be thinned by removing fat from her cheeks and from under her chin.
White had both the nose job and liposuction done in May, and her cheeks and chin are still swollen from the surgery. The swelling from liposuction may last six months to a year.
Rasmussen is quick to warn teen-agers against undergoing any type of plastic surgery merely for aesthetic purposes--unless the teen is entirely sure. She also stresses that the surgery should be the teen-ager’s own choice, not the result of pressure from well-meaning friends and family.
Even after meeting with a plastic surgeon, having pictures taken and spending hours in consultation, many potential patients decide against cosmetic surgery.
“Either they didn’t feel comfortable with us,” Cericola explained, “or, possibly, they found their insurance doesn’t pay for it. Or maybe they’re just not ready to have it done yet.”
