Whether children can undergo plastic surgery depends entirely on the procedure’s purpose and the patient’s age. Plastic surgery is a medical specialty focused on the repair, reconstruction, or replacement of physical defects. While many associate the field only with aesthetic changes, a significant portion involves medically necessary interventions. The decision to perform surgery on a minor is governed by strict medical and ethical guidelines that prioritize the child’s physical development and psychological well-being.
Reconstructive Versus Cosmetic Procedures
The field of plastic surgery is divided into two categories: reconstructive and cosmetic. Reconstructive surgery restores function or corrects deformities resulting from congenital defects, trauma, or disease. The aim is to rebuild a part of the body to regain normal form and function, such as repairing a cleft lip. In contrast, cosmetic surgery, also known as aesthetic surgery, is elective and enhances the appearance of normal structures purely for aesthetic reasons. Reconstructive procedures are typically covered by insurance due to their medical necessity, while cosmetic procedures generally are not.
Medical Necessity: Reconstructive Surgery for Minors
When plastic surgery is medically necessary to correct a defect or injury, it is routinely performed on children, often beginning in infancy, to ensure proper development. The timing of these interventions is guided by the child’s developmental milestones.
A common example is the repair of a cleft lip and palate, a congenital defect that affects feeding, speech, and hearing. Cleft lip repair is typically performed within the first few months of life, while palate repair often occurs before the child’s first birthday to facilitate proper speech development.
Similarly, microtia, a birth defect where the external ear is underdeveloped, is often corrected through ear reconstruction. Since the ear reaches nearly full adult size by age five or six, surgery is planned around that time to minimize psychological distress as the child enters school.
Plastic surgeons also treat children who have suffered severe burns or trauma, requiring skin grafts and tissue rearrangement to restore function. Congenital hand defects, such as webbed fingers or missing digits, are corrected early to maximize the child’s ability to grasp and manipulate objects. These procedures correct a physical impairment that would otherwise hinder the child’s long-term physical and psychological growth.
Elective Procedures: Cosmetic Surgery and Age Restrictions
Elective cosmetic surgery for minors is highly restricted and generally discouraged for those under 18, though exceptions exist. The primary concern is that the body is still growing, and early procedures could require revision surgery or lead to an unnatural appearance. For most aesthetic procedures, such as breast augmentation or liposuction, surgeons will not operate on a minor.
One frequent cosmetic procedure performed on younger patients is otoplasty, or ear pinning, which corrects prominent ears. Since the ears are nearly fully grown by age five or six, this procedure can be performed early to prevent potential bullying and self-esteem issues.
Rhinoplasty, or nose reshaping, is another common request from teenagers. Surgeons typically wait until the nose has completed its growth, which occurs around age 14 or 15 for girls and 16 or 17 for boys.
Breast reduction surgery for girls with macromastia is often performed between ages 15 and 18. This procedure is often medically justified because the excess weight can cause chronic pain and severely limit physical activity. For boys suffering from persistent gynecomastia, surgery may be considered in mid-to-late adolescence to address significant emotional distress. Before any elective surgery, a psychological screening may be required to ensure the minor has realistic expectations and is pursuing the change for their own benefit, not due to external pressure.
Ethical Considerations and Parental Consent Requirements
All surgical procedures on minors are governed by strict ethical guidelines and legal requirements regarding consent. In the United States, any patient under the age of 18 must have parental or legal guardian consent. The surgeon must ensure that the parents understand the risks, benefits, and expected outcomes of the procedure.
For older children and adolescents, many medical bodies require the minor’s assent, meaning they must agree to the procedure if they are mature enough to understand the implications. This requirement ensures the patient is not being coerced into surgery.
A surgeon has the professional authority and ethical responsibility to refuse a procedure, even if the parents consent. This discretion is exercised if the surgeon believes the procedure is not in the minor’s best interest, is psychologically detrimental, or is being sought for unrealistic reasons. Guidelines emphasize patient safety and long-term psychological well-being as the highest priorities.