Q&A: Dermatologist weighs in on ethics of cosmetic enhancements in adolescents
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Key takeaways:
- Adolescents have ongoing cognitive development and are more prone to high-risk behaviors.
- It is recommended that practitioners generally decline requests to perform these procedures.
The demand for cosmetic enhancement procedures is on the rise among adolescents, with 229,740 performed among this population in 2020 alone, according to a study published in the Journal of the American Academy of Dermatology.
Ethical issues surrounding the administration of cosmetic enhancement procedures (CEP) to adolescents remains a polarizing topic among organizations and practitioners. While the Nuffield Council on Bioethics recommends that CEP be limited to patients aged 18 years and older, the American Society of Plastic Surgeons permits the provision of CEP in adolescents provided the adolescent initiated the request, has realistic goals and “demonstrates sufficient maturity.”
The lack of consistency among these recommendations may leave practitioners wondering what to do when an adolescent does ask them to perform a CEP.
Sami K. Saikaly, MD, a clinical assistant professor in the department of dermatology and director of cosmetics clinics at the University of Florida College of Medicine, as well as an investigator in the aforementioned study, spoke with Healio about the practitioner-recommended guidelines for administering CEP to adolescents.
Healio: Why are so many adolescents asking for CEP?
Saikaly: External influences such as peers, advertising and social media are commonly cited as motivators for pursuing CEP.
Healio: What are the physical and emotional risks associated with CEP?
Saikaly: All CEPs have risks. Physical risks vary depending on the type of procedure being offered. While most of the physical risks are temporary (such as redness, infection, pigmentation changes, swelling, blistering and others), some are permanent (such as scarring). Fillers, for example, are associated with the rare risk for vascular occlusion, which can result in skin necrosis or even permanent vision loss.
As for emotional risks of CEP in adolescents, their bodies and body image are still evolving and may change significantly over time. In addition, as they are more prone to high-risk behaviors and external influences, they may try to conform to pressures for often unrealistic beauty standards. If CEP is performed, depending on the patient’s developmental readiness and expected outcomes, there is the risk for post-procedure regret and dissatisfaction.
Healio: Under what circumstances should a practitioner offer this procedure to an adolescent?
Saikaly: Since adolescents have ongoing cognitive development and are more prone to high-risk behaviors and external influences, we recommend generally declining requests to perform CEP in adolescents unless there are extenuating circumstances (and parental approval).
In addition, there is evidence that body satisfaction may improve and stabilize as adolescents transition to adulthood, thus alleviating the need for CEP.
Healio: What is your recommendation for responding to an adolescent patient that wants CEP?
Saikaly: I would recommend that the physician explore the patient’s motivations for desiring CEP, how the patient expects the procedure would change their life, whether the patient expectation is realistic, and what the patient would do if the expected outcome does not materialize.
Overall, however, unless there are rare and extenuating exceptions, we generally decline requests to perform CEP in adolescents, and explain that there is no harm in delaying CEP until adulthood.
Healio: Is there anything else that you would like to add?
Saikaly: Given that every CEP has risks, it is of crucial importance for patients of all ages to ensure that the practitioners who are offering the procedure are adequately trained in performing the procedure and managing any potential adverse effects.