Assessing adolescents and young girls for plastic surgical intervention: pre-surgical appearance ratings and appearance-related burdens as reported by adolescents and young adults, parents and surgeons

Safety of Cosmetic Surgery in Adolescent Patients

Background

Limited surgical literature currently exists that evaluates postoperative complications after cosmetic surgery in adolescents.

Objectives

The purpose of this study was to determine the incidence of major postoperative complications in adolescent patients undergoing cosmetic surgery and compare their complication rates to older patients.

Methods

A prospective cohort of patients undergoing cosmetic surgical procedures between 2008 and 2013 was identified from the CosmetAssure database. Demographics, clinical characteristics, surgical procedures, and major complications in adolescent patients (age 10-19 years) and older patients (≥20 years old) were compared. Risk factors analyzed included age, gender, body mass index, smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures.

Results

Overall, 3519 adolescents and 124,409 older patients underwent cosmetic surgical procedures. The adolescent cohort contained more men (20.0% vs 6.0%, P < 0.01), lower mean body mass index (22.6 ± 4.1 vs 24.4 ± 4.6, P < 0.01), lower prevalence of diabetes (0.8% vs 1.9%, P <0.01), and fewer smokers (5.9% vs 8.3%, P < 0.01) compared to the older patient cohort. Most commonly adolescent patients underwent breast followed by face and body procedures. Overall adolescent patients demonstrated a lower incidence of major postoperative complications compared to older patients after single (0.6% vs 1.5%, P < 0.01) and combined (1.2% vs 3%, P = 0.03) cosmetic procedures. Adolescent patients had lower complications rates after face, breast, and body procedures compared to the older cohort. The most common postoperative complications in adolescent patients were hematoma (0.34%) and infection (0.28%).

Conclusions

Cosmetic surgical procedures in adolescent patients are safe with a lower rate of major postoperative complications compared to older patients.

Level of Evidence

2.

Scoliosis brace design: influence of visual aesthetics on user acceptance and compliance

Adolescent idiopathic scoliosis is a common condition found in adolescents. A rigid brace is often prescribed as the treatment for this spinal deformity, which negatively affects user compliance due to the discomfort caused by the brace, and the psychological distress resulting from its appearance. However, the latter, which is the impact of visual aesthetics, has not been thoroughly studied for scoliosis braces. Therefore, a qualitative study with in-depth interviews has been carried out with 10 participants who have a Cobb angle of 20°-30° to determine the impact of visual aesthetics on user acceptance and compliance towards the brace. It is found that co-designing with patients on the aesthetic aspects of the surface design of the brace increases the level of user compliance and induces positive user perception. Therefore, aesthetic preferences need to be taken into consideration in the design process of braces. Practitioner Summary: The impact of visual aesthetics on user acceptance and compliance towards a rigid brace for scoliosis is investigated. The findings indicate that an aesthetically pleasing brace and the involvement of patients in the design process of the brace are important for increasing user compliance and addressing psychological issues during treatment.

Considerations in breast augmentation in the adolescent patient

Nearly 320,000 breast augmentations were performed in 2011, with adolescents under 18 years of age accounting for 4,830 procedures (1.5%). Breast development typically starts at 11 years (range, 8-13 years) and is complete at 15 years (range, 11-18 years). This wide age range for physical maturity matches the equally wide range of emotional maturity in this patient population. Developmental, psychological, and regulatory aspects unique to adolescent breast augmentation are reviewed. Self-image and societal influences must be considered, including both internal and external motivations for seeking breast augmentation. Preoperative assessment and counseling of these patients are discussed. Both parental consent and adolescent assent must be considered. Ideal conditions for adolescent assent are described. Breast augmentation for purely aesthetic purposes should be undertaken with extreme caution as ideal conditions for complete assent are rare. Augmentation as a technique for breast balancing in cases of significant asymmetry can be helpful.

Postoperative satisfaction and the patient's body image, life satisfaction, and self-esteem: a retrospective study comparing adolescent girls and boys after cosmetic surgery

BACKGROUND

Cosmetic surgery procedures are more complex for adolescents than for adults because there are more factors affecting patient satisfaction, especially psychological factors. This study was designed to find answers to four main questions: (1) whether postoperative satisfaction rates differ statistically between males and females, (2) whether postoperative satisfaction correlates significantly with the self-esteem, body image, life satisfaction trilogy, (3) what the postoperative patient satisfaction and cosmetic procedure rates are among adolescents by years, and (4) whether a statistically significant relationship exists between postoperative satisfaction and a willingness of adolescents to undergo another cosmetic surgery.

METHODS

The study enrolled 86 of 165 patients who underwent surgery between January 2001 and June 2005. A simple poll consisting of 12 simple questions was used to collect data.

RESULTS

No statistically significant difference was found in postoperative satisfaction rates between males and females. The findings show that postoperative satisfaction is significantly related to self-esteem, body image, and life satisfaction. The patient satisfaction rate was 93.83%, and there was no increase in adolescent cosmetic surgery rates over the years.

CONCLUSION

Adolescents are good candidates for cosmetic surgery, but patients must be evaluated carefully. Any suspicion about a patient's psychological status must result in a psychiatric consultation.

Surgeon reliability in rating physical deformity in adolescent idiopathic scoliosis

STUDY DESIGN

Cross sectional survey.

OBJECTIVES

To compare pediatric spine surgeons' relative rankings of the importance of surgical considerations, and their reliability of ratings of the physical deformity of patients with adolescent idiopathic scoliosis (AIS).

SUMMARY OF BACKGROUND DATA

Adolescents' appearance is a factor in surgical decision-making. Although the reliability of the Cobb angle has been extensively studied, less attention has been directed toward the reliability of surgeons' assessment of physical appearance.

METHODS

Five surgeons ranked the relative importance of 13 surgical considerations. While viewing clinical photographs of 40 patients, surgeons rated the following: shoulder blades, shoulders, waist asymmetry, and the "overall appearance" of the back.

RESULTS

"Severity of deformity" was consistently ranked the most important surgical consideration. Surgeons, however, varied widely in their reliability of their ratings of physical appearance: shoulder blades (kappa = 0.34), shoulders (kappa = 0.22), waist (kappa = 0.24), and overall appearance (kappa = 0.40).

CONCLUSION

Because patients' physical appearance is an important element of surgical decision-making, differences among surgeons could be contributing to inconsistent recommendations.

Bilateral Reduction Mammoplasty in an Adolescent Population: Adolescent Bilateral Reduction Mammoplasty

Bilateral reduction mammoplasty in adolescent patients can be a controversial procedure because of the significance of possible long-term complications and the permanence of the results. There are no current criteria specifically for adolescent candidates for reduction surgery, although many of these young women may have severe physical symptoms. Therefore, the demographics and outcomes of these patients are of particular interest in determining the risks and benefits particular to this surgery for younger patients. Seventy-three patients who had undergone bilateral reduction mammoplasty between 1981 and 2000 were identified in the hospital and office records of four midwestern plastic surgeons. Patient ages ranged between 12.5 and 18.9 years, with a mean age of 16.1 years. A two-pronged investigation involved examination of demographics of the adolescent population and short- and long-term outcomes and satisfaction. Demographic survey included age, weight, height, BMI, breast size, and amount of tissue removed. Indications for surgery and postoperative complications were surveyed in office records and via questionnaire. Seventeen patients (23%) were successfully contacted and returned a detailed questionnaire evaluating indications for surgery, preoperative and postoperative complications, and overall satisfaction. Eighty-two percent of patients reported resolution of their physical symptoms, including back, shoulder, and neck pain. Self-esteem, however, was cited most commonly as a reason to recommend this procedure to other adolescent women. Nearly 65% of respondents would repeat their adolescent surgical experience, and 82.4% would recommend this procedure to a teenaged friend in a similar situation. The authors' data suggest that adolescent patients benefit significantly from reduction mammoplasty and that long-term satisfaction remains high, despite the age of the patients at surgery.