Nicole Casto was unhappy with the way she looked and determined to do something about it. A year of breast-feeding had taken a toll, she said, so after her tax refund check arrived in June, the 19-year-old single mother underwent breast implant surgery performed by plastic surgeon Barry J. Cohen in his Rockville office.
"My family was upset that I was so young," said Casto, who lives in Woodstock, Va., and works as a waitress. "But I explained to them that it was about being confident," said Casto, who said she is "very pleased" with the surgery.
Kacey Long, 22, of Ennis, Tex., holds one of the implants she had removed after they caused severe complications, including intense pain and fatigue.
(Joseph Victor Stefanchik For The Washington Post)
Live, 3:30 p.m. ET: Michael Olding, M.D., chief of plastic surgery and director of the Cosmetic Surgery and Laser Center at George Washington University Medical, will be online to discuss the rise in cosmetic surgery among teens.
For decades, plastic surgery for teenage girls meant one thing -- a nose job, frequently performed during the summer between high school and college. While rhinoplasty remains the most common cosmetic operation for teenagers, doctors are performing an increasing number of procedures such as breast implants, liposuction and tummy tucks on young women like Casto and even girls as young as 14.
The enormous popularity of reality TV shows such as "Extreme Makeover," "The Swan" and MTV's "I Want a Famous Face," as well as an explosion of Web sites that extol the virtues of cosmetic medicine, has fueled the desire of adolescent girls to alter their bodies permanently, and they are finding more surgeons willing to oblige them. Breast implants and liposuction are now bestowed by parents as graduation or birthday gifts. Some doctors say they have performed breast augmentations on baby-boomer mothers and their teenage daughters.
Critics say that teenage girls, who tend to be both obsessed and dissatisfied with their looks, are too young and shortsighted to understand the implications of surgery, particularly the risks that implants may pose and the long-term maintenance they require. Among them are the possibility of rupture or permanent scarring, the need for periodic operations to replace or remove the devices, potential interference with breast-feeding and mammography, and unresolved questions about their long-term safety.
"Having cleavage may be the most important thing when you're 18, but it's not when you're 25," said Diana Zuckerman, president of the National Research Center for Women and Families, a nonprofit Washington think tank.
A Recent Boom
In the past few months, several physicians groups have warned teenagers and their parents against resorting to major surgery as a quick fix for popularity or self-esteem.
From 2002 to 2003, according to the American Society for Aesthetic Plastic Surgery, the number of girls 18 and younger who got breast implants nearly tripled, from 3,872 to 11,326. Among all age groups, cosmetic implants have skyrocketed in popularity, according to the American Society of Plastic Surgeons. Last year, according to the ASPS, about 247,000 women got implants for augmentation, compared with 32,000 in 1992.
Although cosmetic surgery remains most popular in other cities -- especially Miami, Dallas, Los Angeles and New York -- eight plastic surgeons who practice in the medically conservative Washington area say they are seeing more teenagers than ever.
"I've seen a huge rise in the number of girls" seeking implants, said McLean plastic surgeon Csaba L. Magassy, who has been in practice for 30 years. In the past year, Magassy estimates, he has given breast implants to about 25 teenagers, most of them 18 or 19, a fourfold increase over a few years ago.
Despite the growing popularity of implants, most teenagers who undergo the surgery are reluctant to talk about a procedure that is easily stigmatized as self-indulgent. A few teenagers who have talked about their decision to get implants have received wide attention.
Several teenage girls who had cosmetic surgery in the past year requested that their names be withheld from this story. One of Magassy's recent patients, a 19-year-old student at Salisbury University in Maryland, said she had been seriously considering implants since she was 15. Unhappy with her 34A bra size, she said she did not like the way her clothes fit.
"My mother and I talked about it, I had money saved, and I just wanted to do it," said the student, whose family lives near Annapolis. She said her parents paid part of the $6,700 fee as a reward because she received college scholarships. "I'm just a lot happier" wearing a 36C bra, she added. "I think a lot of girls think about plastic surgery."
Some of Magassy's patients undergo multiple operations, acquiring smaller noses and bigger breasts at the same time. "That's a popular combination," he said. Stephen Greenberg, a New York surgeon, said that of the 100 teenage girls to whom he has given implants in the past year, about 20 had an accompanying tummy tuck or liposuction.