Teens' cosmetic dreams don't always come true

		MTV's I Want a Famous Face followed Kacey Long's breast implant removal. Her size D implants meant she couldn't lift her arms.
		Family photo

"I dreamed about working in an office," says Long, 22. "I aligned all of my goals into making that dream a reality."

While studying human resource management at Baylor University, Long decided to change her look. She modeled herself after Julia Roberts in her Oscar-winning 2000 portrayal of a famous office worker — Erin Brockovich.

So at 19, Long decided to get breast implants. "I was all about doing anything I could to improve myself," she says.

With that decision, she joined thousands of young people who are surgically altering their appearance each year. Teenagers even younger than Long was at the time are having breasts enlarged, noses and ears reshaped, and skin peeled and plumped.

Young patients The most-performed cosmetic procedures on patients 18 or younger in 2003: Type of procedure Number of procedures 1. Chemical peel 126, 327 2. Microderm-abrasion 74, 722 3. Nose reshaping 42, 515 4. Ear surgery 15, 973 5. Botox injections 5, 606 6. Collagen injections 4,094 7. Sclerotherapy 4,002 8. Breast augmentation 3,841 9. Male breast reduction* 3,033 10. Liposuction 3,017 * Breast reduction in women is considered reconstructive surgery Source: American Society of Plastic Surgeons

In 2003, almost 336,000 teens 18 or younger had some kind of cosmetic surgery or procedure, a 50% increase over 2002.

Patient-safety advocates believe that many of the teens having surgery are unnecessarily putting themselves at risk of injury or even death. Teens face different obstacles in making a decision like this, experts say. They are often insecure and naive about medical risks. And they literally are not always finished growing up.

Yet the number of girls 18 or younger having breast augmentation surgery is climbing — up 24% from 2002 to 2003. Parental consent is needed for patients under 18. There have been reports of girls getting breast implants as gifts for high school graduation.

Plastic surgery, like any surgery, can go wrong, as it did for Long.

Her decision was easy. A friend vouched for the surgeon. She could picture herself being happier after surgery. She had nearly half of the $4,500 cost, and the doctor agreed to take the rest in installments. So she became one of about 220,000 women who had breast augmentation surgery in 2001.

"I wish I had never done it," says Long, who began feeling sick and weak within months after a plastic surgeon enlarged her breasts to size D. "I couldn't lift my arms. It disabled me within a year."

Although research has not proved that implants can cause serious diseases, Long says she has been diagnosed with systemic silicone poisoning from the shells surrounding the saline implants, rheumatoid arthritis, fibromyalgia and chronic fatigue syndrome.

She had the implants removed in September — a procedure that was documented for MTV's I Want a Famous Face, which follows young plastic surgery patients.

Long says she feels lucky to be alive. "Every time you go under anesthesia, you may not wake up."

Nobody tracks deaths or injuries caused by plastic surgery, but one study found that one in 50,000 liposuction surgery patients die.

From May 2003 to January 2004, five people died in Florida after cosmetic plastic surgery. In New York this year, two women — one the wife of a cardiologist and the other Olivia Goldsmith, author of The First Wives Club — also died after cosmetic procedures.

Understanding motives

"The big problem with adolescents is they are being operated on at the most tumultuous time in their bodies. They may not recognize the permanence of what they're doing," says David Sarwer, a psychologist at the Center for Human Appearance at the University of Pennsylvania medical school.

Dennis Hurwitz, a plastic surgeon and clinical professor at the University of Pittsburgh, agrees.

"Plastic surgeons are operating psychiatrists," he says. Good plastic surgeons talk to prospective patients to get to the root of why they want to change their looks, he says, which is especially important with teens. "It takes a lot of effort."

He says he convinces two-thirds of the teens who come to him seeking plastic surgery that they don't need to be changed. Teens risk making a decision they'll regret, Hurwitz says. "You must recognize their impulsive behavior."

One of his patients, Jennifer, had a bump removed from her nose at 18. Her nose was injured and her breathing impaired after a cheerleading accident. Now 20 and studying to be a pharmacist, she did not want her last name published to protect her privacy.

"It's a very traumatic experience," Jennifer says. "It should not be used for perfection. Society today views surgery as no big deal anymore. But this is not something to do just because you want your body to be perfect."

Hurwitz acknowledges, and other experts agree, that most plastic surgeons do not spend much time investigating a patient's motives.

"You're not going to have too many plastic surgeons saying you don't really need this," says Diana Zuckerman, president of the National Center for Policy Research for Women & Families. "Once you get in the door, of course, the doctors are saying everything they can to persuade you to have surgery."

Zuckerman wants rules to protect girls from plastic surgery.

"Breast implants are not approved for anyone under 18, but any doctor can perform the surgery legally," she says. "I'd like to see the American Society of Plastic Surgeons have a policy saying we think our doctors shouldn't do this on anyone under 18."

Experts disagree on whether teens are too young for surgeries such as breast augmentation.

Zuckerman says girls should be encouraged to develop more before having surgery. "A lot of teens gain weight during their freshman year in college," she says. "If they had just waited a few years, they might have been less flat-chested."

Long, who now has breasts that are slightly larger without implants, asks, "Why didn't my doctor tell me I was still growing?"

But Hurwitz says some girls graduating high school should be allowed to have breast implants.

"The transition from high school into college can have the most positive impact," he says. "We should not just disregard this as frivolous. A child with no or little development of the breasts who wants to live the dorm life and have a relationship, let's not deny her because of her age or immaturity. That can be worked through with thoughtful decisions."

Not everyone is 'realistic'

Walter Erhardt, an Albany, Ga., plastic surgeon, says some teens are more prepared than adults. "We look for maturity and realistic expectations," he says. When either is lacking, he says, "that will be the reason I turn down somebody who is 40 or 50."

As an example, he points to Martha, now 19, a patient who got breast implants at age 18.

Martha, who also did not want her last name published, says the thought of breast enhancements crossed her mind early because "breast augmentation runs in the family." Both her mother and her aunt have breast implants.

Her dad is a physician, so when she saw that she hadn't developed noticeable breasts after puberty, which included a bout with an eating disorder, she began researching breast augmentation in medical journals and online. "If I think about something too much, I could freak myself out," she says. "But I considered the risk."

She also considered the misgivings of a girlfriend who had had the surgery two years before.

"She rushed into it," Martha says. "She was talking about regretting it and worrying about how it wasn't natural and how they didn't look right and how she shouldn't have done it."

After periods of doubt and more research, she decided to get the surgery. Her father paid the $3,000 fee, and she awoke sore but pleased. "I look proportional."

Her advice to other teens: "Don't just accept the facts you hear."

And only trust a surgeon certified by the American Board of Plastic Surgery, she says. "That says whether or not they are good enough, safe enough, trustworthy enough to cut you open."

Reality TV shows get some of the credit for America's love affair with plastic surgery. Millions of people have tuned in to Fox's The Swan and ABC's Extreme Makeover to watch what doctors call oversimplified and unrealistic transformations of average people.

Showing the ugly side

But not all shows gloss over the difficulties. The MTV documentary I Want a Famous Face, which showed Long's negative experience with breast implants, unflinchingly shows the downsides of the surgeries in an effort to help teens make the right decision.

"There is often a long, painful recovery," says Dave Sirulnick, executive vice president of MTV News and Production. "There is no guarantee for success. There is no guarantee you are going to look like anything close to what you think you are going to look like. It seemed to us that young MTV viewers were not getting that."

So the documentary team followed people who already had decided on their own to get surgery in hopes of looking like a celebrity, as Long had hoped to look like Julia Roberts, and they told their stories — even the gory parts.

"To most people, it's fairly alarming," Sirulnick says. "Some would say grotesque."

By showing the bad with the good, he says, teens get a more realistic view. "We're not coming out against it or for it; we're just saying this is something that is happening. A lot of young people don't know the real risk. Plastic surgery has taken on cachet, sort of. It just seems so normal. It's so much in the culture."

Long likes telling her story to others, especially young people. "The younger you are, the more you don't know about medicine," she says. "When a doctor says jump, you say, 'How high?' "

Arthur Aaron Levin, director of the Center for Medical Consumers in New York, offers another question for young patients to ask as they enter what he calls medicine's "uncharted waters" of medical errors: "Is it worth your life?"