For More Teenage Girls, Adult Plastic 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)

To Cohen, Casto's surgeon, the dramatic increase in adolescent patients reflects cultural changes that have normalized plastic surgery.

"There's a generational difference," said Cohen, who estimates he has performed breast augmentations on 20 older teenagers. Teenagers, he said, tend to be more open about, and accepting of, cosmetic procedures than their parents are.

Other procedures that have become more popular among teenagers are liposuction and chin implants, which are sometimes performed at the same time as nose jobs. Although some surgeons say they perform liposuction on girls who have lost a lot of weight, others, including Magassy, are reluctant. "They think it's a quick fix and then they're back where they started within a year," he said.

Questions of Maturity

Although there is no prohibition against performing implant surgery on patients younger than 18, some surgeons say they are reluctant to do so in part because girls may still be growing. Sometimes doctors will perform the surgery in cases where one breast is markedly larger than the other or in an older teenager who has no breast development.

"At 18, girls really don't know what they're doing," said Scott L. Spear, president of the ASPS and the chief of plastic surgery at Georgetown University Hospital. Many do not "realize it's more than just having your ears pierced."

Surgeons say they make decisions about whether to operate on an individual basis and try to ensure that teenagers, like their adult counterparts, are appropriate candidates who have realistic expectations. That means weeding out a girl who wants surgery to please someone else, who is counting on surgery to change her life, or who has a deep-seated psychological problem, such as an eating disorder. Surgeons say they tend to subject adults to similar but less intense scrutiny, assuming they are independent and less naive.

Greenberg said he tries to assess how mature teenagers are. He said he turns away those whom he considers too young or those "who say 'I want to look like Britney Spears' or 'I want to be a D cup so I can go out with more boys.' "

Zuckerman said she believes many surgeons tend to gloss over the risks -- which most teenagers do not want to hear about anyway. "Some teenagers sound mature when they're not," she said, "or know the right things to say. You basically have a young girl being reassured by her doctor."

Many doctors say they are reassured when a teenager is accompanied by her mother because it allows them to assess the degree of parental support -- or opposition. Frequently, surgeons say, parents seem unenthused but resigned. "In some ways, it's no different than any other entitlement," said Spear, the father of a teenage daughter and two college-age sons.

Crystal Mast said she told her mother, a nurse, that she was "determined" to get implants after she graduated from high school in June. Mast, 18, who lives in East Islip, N.Y., said she decided the surgery was safe after searching the Internet and booked a consultation with Greenberg, who had been recommended by customers at the Victoria's Secret lingerie store where she worked. After accompanying her to the appointment, Mast said, her mother agreed to loan her about half of the nearly $7,000 surgical fee as a graduation present.

Now that surgery has increased her breast size from an A to a C cup, Mast said, she no longer feels self-conscious about how her clothes fit or in comparison to her more developed younger sister.

Medical Issues

Maturity is only part of the equation, experts say, because of persistent, unresolved questions about the long-term effect of breast implants. In the past 15 years, the devices have been the subject of furious controversy over their safety, mostly involving silicone-gel-filled implants. The Food and Drug Administration has banned the widespread use of silicone-gel implants because of unanswered questions about their safety, but permits the use of saline-filled implants, which have a silicone shell. Both types are the subject of ongoing FDA studies.

Three years ago as a 19-year-old student at Baylor University in Texas, Kacey Long got implants because she wanted to look like Julia Roberts playing Erin Brockovich in the hit movie. Many of her classmates, Long said, had received implants as high school graduation presents.

Her parents strenuously opposed surgery, but Long told them she was going to have it done anyway. Her surgeon agreed to take half his $4,500 fee in installments, and a friend's mother, who worked for the doctor, reassured her that none of his patients had ever complained of problems.