Introduction:

Good morning! Thank you to all of you for waking up this morning to attend my senior
project. Unfortunately, I was unable to host a live event but I think zoom will have to do. My
name is Tucker Pincus and I am a current senior in the Legal Studies Academy at first colonial
high school. Each year, students in the academy are tasked with a senior project. For mine, I
chose a topic that really hit close to home for me. Plastic surgery. More specifically, cosmetic
surgery in teenagers under the age of 18. Adolescents living in such a social media driven world
are influenced by celebrities and brands to try new and improved products, including but not
limited to Botox and fillers, as a preventative approach. Yet, many surgeons disagree with the
“preventative” approach and state that “if you can’t see the wrinkles already, it can be difficult to
determine where they will appear.” Plastic surgery in teenagers has become popular in the past
decade because of an increase in self-awareness and desire to fit in with their peers. Nonetheless,
there is minimal evidence and research data to prove that these procedures are effective, safe,
and appropriate for this age group. With that being said, many individuals who seek treatments
that are under the age of 18 are required to have their parent or guardian there in order to sign
consent forms, making the process slightly more complicated but nowhere near as advanced as it
should be. The media has a strong impact on society's thoughts about body image, namely, what
body-type one should have, particularly by transmitting messages about the "ideal body" in
magazines, journals and television. Over the years, personal appearance management has
become a contemporary art form for younger adolescents, and an analysis of the number of
teenagers receiving cosmetic surgery reveals a major concern regarding societal standards. With
influence from the alluring and voluptuous individuals on the screens of tennagers social media
accounts, how is one not supposed to think that they too can have their dream image?

Table of contents:
Here you will find a list of the topics I will be further discussing this morning.
- What is cosmetic surgery?
- Why teenagers?
- The legal realm surrounding teenagers under the age of 18 wishing to recite each
cosmetic surgery
 - And to answer any questions that you all have at any moment, my consultant Dr.
Galumbeck has taken the time to join us this morning as well.
- Dr. Matthew Galumbeck, MD is a Cosmetic, Plastic & Reconstructive Surgery Specialist
in Virginia Beach, VA and has over 30 years of experience in the medical field. He
graduated high school from First Colonial and made his way to William & Mary where
he obtained his undergraduate degree and then graduated from Duke University School
Of Medicine medical school in 1987. I met Dr. Galumbeck when I was 12 years old and
have yet to have a conversation that didn’t;t relate to medicine or my future goals and
how to obtain them. I am extremely grateful for all of his advice and his appreciation and
love for medicine. Dr. Galumbeck has allowed me opportunities to scrub into surgeries
with him and never left me out of the process, always teaching and describing to me what
exactly he was doing and why he was doing it. Thank you Dr. Galumbeck for being here
with us this morning!

What is Cosmetic Surgery?

Cosmetic surgery, once only used by older patients, is a popular alternative for teens who
want to glam-up their body image. There's a greater emphasis between the ages of 13 and 19 on
friends and what individuals think of them. It's also a time period in which concerns like not
being part of the mainstream crowd, financial shifts, and divorce can have a negative effect on
the self-esteem of a youth. It is indeed important to determine whether or not these patients are
seeking surgery to meet their own needs or to fulfill someone else's wishes, such as a parent or
partner.

The spectrum of adolescents is considered between the ages of thirteen and eighteen, as
older teens approach the age of consent. It is necessary to differentiate between teens under the
age of sixteen and those seventeen and older. There are developmental and psychological issues
that vary greatly among these age groups, the issues have nothing to do with this division. They
have two kinds of problems: conforming to their peer group, and apparent cosmetic problems.
Most often, both age groups believe they need cosmetic surgery for two main reasons,
dissatisfaction with their social appearance and the desire for acceptance.
 Furthermore, according to Dr. Kuldeep Singh, it is important that the teenage patient
thoroughly knows the treatment, potential risks, and risk of further surgery. Reasonable informed
consent will be required, as with all surgical procedures. The informed consent-related education
process should assist the patient and the parent/guardian to consider the complications,
advantages and possible risks involved with the operation. It has also been shown that even in
late adolescents above the legal age of consent, particularly rhinoplasty patients, emotional
difficulties, trouble adjusting to their new appearance and impatience in the recovery period are
more common. It is also prudent, for reasons mentioned above, to delay cosmetic surgery until
they are twenty or above, if not completely required, and may also need parental support in their
decision-making (Singh, Jan-Mar 2015, p. 4).

- Thoughts from Dr. Galumbeck?

Why Teenagers:
- I have broken this section down into two key components - influence from social media
and injectable/filler companies specifically directing their promotion and marketing
towards younger adolescents.
(Social Media)
As social media influencers continue to significantly gain an immense amount of
followers, these teens begin to question their own unique appearances. With this comes an even
larger problem, cyber bullying. Bullying over the internet has additionally become an even larger
reoccurrence that happens daily. This dilemma has led to an outstanding rise in the amount of
teens requesting plastic surgery because of the negative opinions they receive on social media.
What the surgeons are saying is that cosmetic procedures should not technically be performed on
teenagers because most do not have the maturity level to comprehend all of the risks and
benefits.

“Social media pressure has encouraged teens as young as 13 to get bigger lips, smaller
noses, lifted breasts and other procedures” (Powell, 2019). It’s an addictive look. Teenagers and
young adults are seeking validation from how many likes they receive on a post. There has been
a significant increase in adolescents wishing to receive Botox, Dermal fillers, and other cosmetic
procedures such as lip-plumping, breast augmentations, and rhinoplasties (Powell, 2019). The
International Society of Aesthetic Plastic Surgery (2019) reported that social media is the largest
platform for influencers, physicians, and surgeons to advertise their specialties and work
previously performed. Many of these practitioners also utilize what is called a “live-stream” to
broadcast their procedures to their followers, with patient consent of course.

(Targeting the Youth)

Injectable brands and companies have significantly redirected their marketing and
advertising effort to target younger audiences in efforts to promote “preventive” skin care
regimes. Dr. Siun Murphy is a profound and highly recognized plastic surgeon in Ireland. He
believes that dermal fillers and Botox should be banned until the individual has reached the age
of twenty-five. His reasoning is because these teenagers come in and want significant work done
rather than a simple, minimal filler. They want to look exactly and as perfect as those they follow
on social media. However, Dr. Murphy is correct; their bodies have not fully developed and their
faces are still growing, meaning that these procedures, even though many are non-invasive, can
negatively affect their natural body development (Estrada, 2019, p. 3).

Additionally, these products are not inexpensive, and the best ones come with a heavy
price tag, keeping in mind that they need to be replenished if the individual wishes for the look to
stay. With that being said, many adolescents seek more affordable options; nonetheless, these
come with many unforeseen results due to either improper administration or inhibiting products,
making the risk not worth the reward. Members of the ASPS need to hold brands, marketers, and
practitioners accountable for the idea they are instilling within teenagers minds that these
regimes are beauty ideals. Many are unable to make an informed decision regarding their wishes
to receive treatments and can severely endanger their bodies, worsen their self esteem, or cost an
immense amount of money to try and correct (M. Galumbeck, personal communication, Mar. 26,
2021).

(Have Dr. Galumbeck quickly explain what Botox/dermal fillers are.)

Legal Realm:
As I previously stated, there are no United States laws prohibiting individuals under the
legal age from obtaining cosmetic surgery as long as they have consent from a parent or
guardian.

The question of cosmetic surgery in teens can be a vexatious topic. In the United States,
there are no specific laws to prohibit cosmetic surgery for adolescents, however; parental consent
for patients under the age of eighteen is required. Therefore, parents/legal guardians are
responsible for directing their children towards making the right decision (M. Galumbeck,
personal communication, Mar. 26, 2021).

According to the American Society of Plastic Surgeons (ASPC), nearly twenty-one

thousand botox and dermal fillers were injected into patients ranging from as young as thirteen to
nineteen years old. That number is only going to continue to rise in the era of social media
individuals are consumed by today. Plastic surgeons worldwide are seeking the vigilance and
intervention of adults, in particular, lawmakers to take action on an issue heavily weighing down
adolescents (Brown, 2019).

Protocol for Surgeons:

The American Society of Plastic Surgeons briefing paper on plastic surgery for
steenagers dives into the protocol and precautionary steps surgeons take in order to bring clarity
to aspects of the procedure to ensure that their decision is the one they want to move forward
with. Many surgeons agree that when children wish to obtain a cosmetic procedure, they have a
different motive for doing so compared to adults. Teens appear to have cosmetic surgery to fit in
or look similar to their peers without fewer of constant judgment or bullying. When adults want
cosmetic procedures performed, it is usually to stand out from their crowd of peers, to appear
more youthful. They state in the article that the ASPS (American Society of Plastic Surgeons)
advises parents to really discuss with their child while intuitively taking note of the mental and
physical maturity levels. Many surgeons won’t conduct certain procedures because they do not
feel that the chilled has fully grown/matured in that area. These surgeons are board certified and
follow protocol and lead with the ethical values they practice medicine by as well as their own
intuition (American Society Of Plastic Surgeons, n.d.).

(Input from Dr. Galumbeck)

Case Study:

The family of Emmalyn Nguyen filed a lawsuit against a doctor and nurse anesthetist
located in Greenwood Village, CO, after stating that their daughter suffered from two cardiac
arrests and brain damage during her cosmetic surgery. Emmalyn was 18 years old and had just
graduated from Mountain Range High School and had saved money to undergo the $6,000 breast
augmentation procedure that Dr. Geoffrey Kim would later perform. Many of Emmalyn’s family
members had previously undergone this procedure so her parents thought nothing of it and that
she would be perfectly safe; however, what they didn’t know was that the negligence of the
medical staff to safely complete the procedure would leave their daughter in a state of minimal
conscious awareness. Medical records state that Ms. Nguyen went into cardiac arrest twice in the
span of a few minutes and was stabilized both times, but 911 was never called, even though she
was believed to be “neurologically unresponsive.” The family stated, “What was supposed to be
a two hour procedure went late into the evening.” The family was continuously misled about
what happened during the procedure and the staff failed to provide Emmalyn with the necessary
medical assistance prior to finally calling 911 at 7:35 p.m., due to her “taking longer to wake
up.” Nguyen is now unable to speak, walk, eat, or take care of herself and will likely remain this
way for the rest of her life. Even though there is no such thing as a risk free procedure, this all
could have been prevented. Nurse anesthetist Meeker, was involved in a similar case in 2007
where patient Paula Harty suffered from a low blood pressure as well as heart rate, leading to her
cardiac arrest and eventually death. These things cannot go unrecognized by the medical
professionals we put our lives into the hands of. This negligence is provocative and calls to
question whether certain care providers should be licensed to practice. This lawsuit signifies how
vital it is for parents to consult with not only their teenager wishing to undergo a cosmetic
procedure, but who will be performing it as well. Ask questions and be aware of who the treating
physician is that will be performing the surgery. To make sure the doctor and staff are qualified,
so parents go as far as to look into their background, what institutions they graduated from, who
their medical staff is and what their educational background consists of (Maass, 2019).

(Read quotes)
Where do we stand today?
Many equate their self worth and value to a numeric value; for example, likes, comments,
etc. They see who is getting likes and who is getting followers and they assume that that’s the
right path, but not one for all. Individuals need influencers in their lives to motivate them to live
their own to the fullest. Sadly, too many adolescents get wrapped up in wanting to live this
lifestyle of the rich-and-famous that isn’t readily available to the majority. A great number of
people see these attractive individuals pop-up everywhere and see qualities in them that they
want. They want to have their skin, their features, their beautiful smile. Why? Because they
know it attracts so many others. Beauty standards perpetuated by social media influencers and
pop-stars are highly overrated and most aren’t even factual or evident. There are many plastic
surgeons who will not perform these procedures even with parental consent, they believe that
both emotionally and physically, they just aren’t developed. The bigger question is why are so
many teenagers defining beauty to the standards people hold. Self-esteem and confidence are the
foundation of any healthy existence. As science and medicine evolve the distinction between
elective surgery and other noninvasive procedures are now offered to younger populations
including adolescents. The ethical and legal implications are dynamic and continue to redefine
themselves.