Dr. Oakley Smith shares his views on cosmetic enhancement for young patients.

14 04 15 tooyoung cosmetic enhancement

With a media maelstrom over accusations that 16-year-old starlet Kendall Jenner may have had lip injections to Germany recently planning a ban on plastic surgery for minors, one cannot help but wonder, how young is too young? The issue is less concerned with the legality of age and more focused on the relationship between parents, children and surgeons. We spoke with Dr. Oakley Smith, MD, FRCSC, otolaryngologist-head and neck surgeon and a facial plastic surgeon based in Toronto, to explore this issue further.

Age of consent

Technically, there is no legal age in Canadian law that a child can or can’t have elective plastic surgery. For Dr. Smith, the age of his patients is a rough guideline for whether he should operate or not. “It’s more of an assessment that I make when I meet the patient, as to how mature they are.”

In addition to assessing whether a young patient can handle the physical and emotional demands of surgery, Dr. Smith looks for family support. “The younger they are, the more they need parental support. If parents aren’t on board, it makes surgeons hesitant.” Even when older patients, in their late teens and early 20s, lack the approval of their families, it makes him hesitant to operate. All surgeons want positive outcomes for patients, and help from friends and family is critical to the process: “I try to get to know patients over several appointments so [I] feel confident going through with the surgery.” Age really is just a number when it comes to performing plastic surgery on children and teens.

A Parent’s wishes

Dr. Smith has never personally seen a child under the age of 12 come in alone looking for a cosmetic treatment—nearly all surgeons would consider this a red flag. The most common plastic surgery procedure for young children is otoplasty, the costs of which are covered by OHIP until the age of 18. In an otoplasty, the protruding ears are made to lie flatter against the head. “Most of the time this is, in fact, being promoted and put forward by the parents because they are concerned about the impact of it in the schoolyard,” says Dr. Smith.

In the case of otoplasty, the younger the child, the better. “The best time is around age five,” says Dr. Smith, because the ear has reached 85 per cent of its full growth and the child is most likely not in school or being teased. This makes the procedure a pre-emptive way to stop emotional scars from forming.

While some may admonish parents for purporting beauty stereotypes rather than teaching their children to turn the other cheek, Dr. Smith finds that when children have unattractive features altered, the changes tend to be overwhelmingly positive—and a much better alternative to telling kids to ignore hurtful comments.  

A Child’s recovery

Dr. Smith performed a rhinoplasty on a 12-year-old girl with an incredibly deformed nose that prevented her from breathing properly. Dr. Smith described her as an extreme “wallflower,” with an incredibly shy demeanour due to bullying. Consequently, Dr. Smith suggested reshaping her nose while he was correcting the breathing issue to her parents. They were on board, and the transformation post-surgery went more than skin deep. “After the surgery, she was a different girl— very talkative and [would] actually look you in the eye. It influenced her character and growth, and that can happen when we’re young. It doesn’t happen when we’re in our 30s.”

Plastic surgery on teens can also positively impact the mental and social development of the patient—more so than it can for adults. However, Dr. Smith warns that if the surgery doesn’t go as planned or needs a revision, it “has the potential to negatively affect that individual’s character” or cause depression. A good surgeon should spend more time with a young patient to understand his or her motivations, and determine if he or she is a good candidate for surgery. “The surgeon has to be a bit of a psychiatrist,” he explains.

While some may feel children have little autonomy when it comes to cosmetic enhancement, if a child is vehemently against surgery, this would likely cause a surgeon to question operating. If parents are unsure whether their child is ready for such a change, they can get a child psychologist involved to assess the probability of a positive outcome. Children or teens with tendencies toward perfectionism or those with the potential to have body dysmorphic disorder, should avoid plastic surgery.