The trend of surgeons being asked to perform cosmetic surgery procedures on children* in Australia appears to be on the rise. It is important for parents to understand that there is difference in the terms 'cosmetic surgery' and 'reconstructive surgery.'
(*For the purpose of this discussion, 'children' are defined as persons under the age of 18 years old).
Cosmetic surgery is surgery performed solely for the purpose of improving one's appearance for non-medical reasons. Reconstructive surgery is performed to restore proper function to an area of the body that has been damaged or disfigured due to injury/accident or improper development as in the case of a cleft palate.
It is critical that parents fully understand, and address, both the reasons why children seek cosmetic surgery and the ensuing ethical and legal issues surrounding performing cosmetic surgery on children in Australia.
The Main Reason Young Australians Seek Cosmetic Surgery
Children in Australia often suffer from the same Body Image Dissatisfaction (BID) issues as their global peers. Whether this is because they are unduly influenced to seek an ideal body often presented by unrealistic media images or if it is due, in part, to a sense of competition for acceptance among their peers, remains unclear. What is known is that there is a rising trend of children seeking to have their bodies surgically altered because they are unhappy with their physical appearance.
Common Cosmetic Surgery Procedures Sought by Children
- Liposuction - cosmetic surgery to address fat reduction or distribution concerns.
- Breast Augmentation or Reduction - cosmetic surgery to address dissatisfaction with breast size or shape
- Rhinoplasty - cosmetic surgery to address dissatisfaction with nose shape or size
- Genioplasty - cosmetic surgery to address dissatisfaction with chin shape or size
- Otoplasty - cosmetic surgery to address dissatisfaction with ear shape or
Important Aspects to Keep in Mind When Considering Cosmetic Surgery for Children
The Physical Aspects - Children's bodies continue to develop until well into their mid-20's. The body image dissatisfaction issues a child has at 13-years-old may naturally correct themselves through the natural development process by the time the child is 17-years-old.
The Emotional Aspects - Children are emotionally vulnerable to peer pressure to look a certain way. Children have a strong desire to "fit in" with their peers.
The Social Aspects - Due to mental and emotional immaturity, children tend to view societal conformity as a desired level of normalcy. They have not reached a developmental age where they can appreciate that everyone has something that makes them different from the next person. They aren't yet capable of understanding that being different is not necessarily a bad thing.
Ethical and Legal Considerations of Performing Cosmetic Surgery on Children
From the standpoint of ethical considerations, it is of critical importance that parents keep in mind that the way children view themselves as individuals today will change as they mature and grow older. A cosmetic procedure performed on a child at age 14 can have effects that can last a lifetime. Most young adults under the age of 18 are not mature enough to fully understand that the decisions they make as children can have unexpected repercussions as they age.
In addition to the ethical aspects, there are several legal aspects to take into consideration when it comes to children and cosmetic surgery. The Public Health Act of 1999 was created in order to protect the health and safety of Australian citizens. In 2008, amendments were introduced for the purposes of specifically addressing the regulations needed when performing cosmetic surgery on children. These amendments strongly suggest the following criteria SHOULD BE MET before performing cosmetic surgery on a child in Australia:
1. It is strongly recommended that the child is found to be sufficiently mentally competent enough to fully comprehend any risks associated with undergoing a cosmetic surgery procedure. A mental health assessment test should be administered to the child for the purpose of determining competency. Suggested factors to take into consideration when administering the competency assessment include the child's age, any emotional and/or mental health issues or concerns, and any other issues or concerns that may have detrimental long-term effects on the child.
2. If the child is found to be incompetent to make decisions of a surgical nature for themselves, a parent may act on the behalf of their child, providing that they are truly acting in the child's best interests. Acting in a child's best interests is generally recognized as acting in a way that benefits or improves a child's physical, mental, and emotional health.
Guidelines for registered medical practitioners who perform cosmetic medical and surgical procedures were published by the Medical board of Australia on the 1st October 2016.
With specific regards to cosmetic medical and surgical procedures for patients under the age of 18:
- the medical practitioner must assess and be satisfied by the patient’s capacity to consent to the procedure.
- the medical practitioner should have regard for the views of a parent of the patient under 18, including whether the parent supports the procedure being performed.
- before any major procedure, patients under the age of 18 must be referred for evaluation to a psychologist, psychiatrist or general practitioner, who works independently of the medical practitioner who will perform the procedure, to identify any significant underlying psychological problems which may make them an unsuitable candidate for the procedure.
- there must be a cooling off period between the informed consent and the procedure being performed. For minor procedures – minimum 7 days. For major procedures – minimum 3 months.
Understanding The Difference Between The Age of Majority and The Age of Consent to Medical Treatment in Australia
Throughout all of Australia, a child legally reaches the age of majority when they become 18 years old. This means they are a legal adult, with all of the rights and responsibilities afforded to adulthood. Reaching the age of majority is not the same thing as reaching the age of consent for medical treatment and procedures. In some Australian states, the age of consent can vary between the ages of 14 and 16 years old. This can be a confusing area to navigate for parents. The legal age of consent in one state or territory may differ from that of another state. The subject of the legal age of consent or refusal to medical treatment and procedure by a child is best addressed by consulting with state or territory local legal statutes.
It is important to note that in areas where the age of consent is less than 18 years old, the courts may intervene to countermand a child's decision if it is found to be in the best interest of the child, in order to protect their health or life.
Parents have an obligation, and a right, to receive information concerning any medical procedure to be performed on a child they have the legal authority to make medical decisions for. Parents have the right to have the information explained to them in a manner that is easy for them to comprehend so that they can make informed medical decisions for their child. This information should include (but aren't limited to):
1. What the procedure is for?
2. The expected outcome of the procedure.
3. Any known risks or complications the procedure may carry or cause.
4. Any alternative treatment options that may be available.
It has been estimated that up to 30% of Australian children will seek some form of cosmetic procedure to alter their physical appearance at some point in their childhood. Traditionally, children are hyper-aware of differences between themselves and their peers. It is essential for parents to educate themselves about the kinds of body image issues their children may be struggling with. Keeping an open line of communication with your child and your child's physician will help your child address and hopefully resolve any issues they may be experiencing.
Cosmetic Rhinoplasty in Children – Dr Ha’s personal perspectives:
I regularly see patients under the age of 18 with regards to changing the appearance of their nose. This can sometimes be part of a breathing or other functional problem or for purely cosmetic reasons.
When performed for the right reasons, having a successful cosmetic rhinoplasty can have profound positive benefits to the childs or young adults confidence and mental state.
It is important to bear in mind that the facial skeleton continues to change and mature throughout adolescence. The age in which facial growth ceases can vary between 16 until the early 20s. Ideally, cosmetic rhinoplasty should be delayed until the surgeon is confident that facial growth has ceased. Operating before this time may affect nasal skeletal maturation, or the nose may continue to change following surgery; leading to an undesirable result.
There are however a few exceptions when considering Rhinoplasty in a child/ young teenager. If a significant nasal bony or cartilage deformity is identified early, correcting this may then allow for normal nasal growth. If surgery is postponed until the child is older, it may result in a greater cosmetic deformity, make surgery much more difficult and you may never be able to achieve an acceptable result.