As shown by TV series' like The Swan and Extreme Makeover, cosmetic surgery is all the rage. And that's true even for children and teens.
   In 2004, according to the American Society of Plastic Surgeons (ASPS), doctors performed nearly 81,000 cosmetic surgeries on those 18 and younger. Those surgeries included:

• Nose reshaping for about 52,000 teens as young as 13.
• Protruding ear tucks for more than 13,000 children as young as 6.
• Breast implants for more than 3,900 teen girls.
• Breast reduction for more than 3,600 teen boys. 

   "Teens tend to have plastic surgery to fit in with peers - to look similar - while adults tend to have plastic surgery to stand out from others," says Dr. H. Steve Byrd, chief of Plastic and Craniofacial Surgery at Children's and professor, Plastics and Craniofacial, UT Southwestern. "Teens can gain self-esteem and confidence when what they view as physical problems are fixed."
   But plastic surgery is not for every youth. For some procedures, the child must reach milestones in age, growth and physical maturity. Also, most reputable surgeons won't operate unless the child shows emotional maturity and sensible expectations.
   "Sometimes it's the parents who want the surgery," says Dr. Byrd. "To hear honestly what the patient wants, it may be necessary to separate them from their parents."
   An 18-year-old girl with enlarged or uneven breasts can be a suitable candidate for surgery. Similarly, a teenager whose breasts have failed to develop may be a candidate for breast implants but she and her parents need to be made aware of the fact that they are starting a lifetime of surgery to maintain her breast size and shape.

A Plastic Surgery Primer
Finding a surgeon: Talk to your doctor and hospital. Seek an American Board of Plastic Surgery-certified surgeon who does the procedure often. When surgery is done outside a hospital, ask if the surgeon has admitting privileges if something goes wrong.
Counseling: You or your surgeon might first want your child to speak with a psychologist or psychiatrist if there is any indication of immaturity or emotional instability.
Physical health: Insist your child first get a complete physical from your family doctor to ensure he or she is fit for surgery.
Complications: Swelling, bleeding and infection can take place. The end result might not be what you and your child expect.
Insurance: In most cases, cosmetic surgery is not covered. Check to see if your policy covers subsequent treatment if complications crop up. Many insurers don't, Dr. Byrd says.