Which cosmetic procedures are appropriate for young patients?

Key Points

The question, according to one expert, becomes whether dermatologists and others should perform cosmetic procedures on patients who are still growing - physically and mentally.

"I am very selective about procedures I perform in pediatric patients. It is important to have an extensive consultation with the patient - ideally with both parents present - before determining whether a requested procedure is appropriate for the patient," says dermatologist Hema Sundaram, M.D., who has a cosmetic and laser surgery practice in Washington.

Some young patients also seek liposuction, onabotulinumtoxinA, laser hair removal, laser skin resurfacing and microdermabrasion, according to 2008 statistics by the American Society of Plastic Surgeons.

Less commonly, young patients seek fillers. More than 4,000 patients from age 13 to 19 had soft tissue augmentation, with fillers such as calcium hydroxylapatite, collagen and fat.

Appropriate procedures

Dr. Sundaram says she will perform noninvasive procedures on pediatric patients, but on a case-by-case basis.

"(I will do) laser hair removal, for teenage female patients whose self-esteem is being severely impacted by significant facial hair. I do not perform bikini area hair removal or other procedures I consider sexualizing in patients under 18," she says.

Dr. Sundaram says she may perform microdermabrasion and chemical peels on young patients for significant acne or scarring.

"I use DermaSweep (CosMedic R&D) crystal-free microdermabrasion with epi-infusion of glycolic and salicylic acid; Vitalize peel, which is a modified Jessner's peel with retinoic acid; (and) Illuminize peel (SkinMedica), which is a combined alpha and beta hydroxy acid light peel," Dr. Sundaram says.

She may also agree to perform intense pulsed light procedures for vascular or pigmented congenital lesions that severely impact patients' self-esteem.

Age inappropriate

Dr. Sundaram says she will stop short of performing minimally invasive procedures, such as tissue fillers and neurotoxins, for aesthetic purposes on pediatric patients.

While she does not perform breast augmentation, rhinoplasty and other surgical procedures, Dr. Sundaram says pediatric patients are, for the most part, too young for those, too.

Undergoing cosmetic procedures at a young age could adversely impact body image and self-esteem. Often, these patients lack the physical maturity needed for successful outcomes from cosmetic procedures, she says.

"Also, I believe some procedures, such as lip (and) breast augmentation, (and) bikini area laser hair removal, are inappropriately sexualizing for a pediatric patient," she says.

Pediatric considerations

Dermatologists should ask important questions before performing cosmetic procedures on patients 18 and younger, Dr. Sundaram says.

Dermatologists should feel certain that the benefits greatly outweigh the risks (both physical and psychological). They should also ensure that parents are not pressuring their children - even subliminally - into having cosmetic enhancement.

There are special considerations when working with these young patients, Dr. Sundaram says.

"Compliance may be a greater issue. (It is) essential to have full support and understanding of both patient and parents in this regard," she says. "(The) procedure should not be performed unless full compliance with post-treatment care and follow-up will occur."

She adds that adolescents may not respond as well as their older counterparts to laser hair removal and acne therapy, and should be counseled prior to treatment that they may require multiple treatment sessions.