Adults over a certain age who opt for facial or other plastic surgery for aesthetic reasons are rarely questioned about their rationale. If it’s about low self-esteem, they are generally supported, be it by friends, family or the medical establishment. They are rarely prevented from taking their chosen course of action. If it’s about standing out from the crowd, then that’s acceptable too.

For children and low- to mid-teens, the opposite is true, although the motivation of a child feeling victimised over his/her appearance to the point of seeking appearance-altering cosmetic surgery is the same as for adults. And probably felt with greater urgency. This is not about the powder keg argument surrounding too‑young girls seeking breast augmentation, but the distinct debate as to whether aesthetic plastic surgery should ever be for children.

Hitting the headlines

The issue hit the news in the US again in autumn 2012, when New York non-profit group Little Baby Face Foundation agreed to pay the otoplasty surgery costs of one 14-year-old girl who had suffered taunts from classmates for a number of years.

Otoplasty adjusts the shape of the cartilage within the ear to create the missing folds and to allow the ear to lie closer to the side of the head. It can be carried out under local anaesthetic, and the procedure leaves a small scar close to the groove between the ear and the side of the head.

For some, the procedure is clearly preferable to looking ‘too different’ from the crowd. The story about the US teen received large media coverage in the UK and Australia, as well as the US. It portrayed a young girl victimised at school by fellow pupils. She believed her facial features had marked her out for torment (although a subjective view might consider them not at all extreme, see: .

On examining her, the surgeons decided to also carry out mento- and rhinoplasty during the same operating procedure, which cost $40000 in total.

While bullying at school is sadly not uncommon, undertaking cosmetic plastic surgery to avoid it is. This recent US episode, however, threw the doors open once again on the debate over whether aesthetic plastic surgery is ever justified in those under, say, 16 or 18 years of age.

Otoplasty a major procedure in the US

The American Society of Aesthetic Plastic Surgeons (ASAPS) noted in 2010 that otoplasty is the most popular surgical procedure for US teens. Such surgery is often recommended for children as they near total ear development, at the age 5 or 6 years — prior to the child entering school — which may obviate potential teasing from classmates.

[pull_quote align=”right” ]Almost 219 000 cosmetic plastic surgery procedures (including non‑invasive procedures) were performed on US 13–19-year-olds in 2010.[/pull_quote] The next most common procedure, says ASAPS, is rhinoplasty (the most requested aesthetic surgical procedure by teens), which can be performed in girls aged 13–14 years and boys aged 15–16 years (i.e. when the nose is 90% grown).

Thereafter come breast reduction, usually delayed until the breasts have reached full development; corrective breast asymmetry surgery (US federal regulations prohibit breast implants for under 18s, except in cases of asymmetry and postoperative reconstruction); and treatment of gynaecomastia for teenage boys.

Almost 219 000 cosmetic plastic surgery procedures (including non‑invasive procedures) were performed on US 13–19-year-olds in 2010.

US health insurance does not pay for cosmetic plastic surgery, but coverage is often provided when a procedure alleviates physical symptoms or improves a body function (e.g. breast reduction to eliminate severe back and neck pain).