Teens and Plastic Surgery

One morning during winter break from school in February,

Lauren Genzale headed to a Woodbury plastic surgeon's office for a 10:30

appointment.

An anesthesiologist met with her. Someone else took her blood pressure. An

hour and a half later, Genzale, 18, had a new $7,000 nose.

"I wasn't really nervous," she said. "I wasn't worried about it coming out

bad."

When the Port Jefferson Station teenager was 14, her sister threw a water

jug at her, Genzale said, breaking her nose and leaving behind an unsightly

bump.

"I always took good pictures," she said. "I'm really photogenic. I just

hated my profile. If I turned a certain way, you could see it. I wasn't really

that self-conscious about it. I just would rather not have it there."

Paying thousands of dollars to change a feature that's merely an annoyance

is part of growing up for some teenage girls on Long Island, Genzale and other

teens said.

Statistics from the American Society for Aesthetic Plastic Surgery show

that in 2007 there were about 205,000 cosmetic surgeries on youths 18 and

younger, compared with about 60,000 in 1997. The number peaked in 2001, at

almost 300,000 procedures. In recent years it has held steady, said Dr. Alan

Gold, the society's president-elect and a Great Neck plastic surgeon. Gold said

he knows of no region-specific statistics.

Teenage cosmetic plastic surgery moved into the media spotlight when

18-year-old Stephanie Kuleba of Florida died last month after surgery

reportedly to correct asymmetrical breasts and inverted nipples. Her family has

said the teen was diagnosed with malignant hyperthermia, a hereditary

condition triggered by anesthetics.

Her death highlighted risks involved in any surgery, said Dr. Lloyd D.

Landsman, a Smithtown plastic surgeon.

"It's almost like flying in an airplane," he said. "We all know the risk is

minimal, but if something happens, it can be disastrous."

The risk is even lower for younger patients because they tend to be

healthier and free from such issues as heart disease and circulation problems,

plastic surgeons say.

Landsman said older patients who undergo multiple procedures have the

greatest risk for complications. He cited the November death of rapper Kanye

West's 58-year-old mother after undergoing plastic surgery. Autopsy results

found that she most likely died of heart disease combined with post-surgical

complications, according to published reports.

One of Landsman's patients, Jaclyn Perrotta, 18, of Syosset, got breast

implants and liposuction on her thighs in January.

Perrotta said recently she hadn't heard about the Florida death and it

didn't change her feelings toward plastic surgery.

"Those things rarely happen," she said. "I still would have done it." She

stressed the importance of researching doctors and the procedure. "I would have

gotten it done when I was 15 or 16," she said. "I wish."

The FDA doesn't recommend breast implants for those younger than 18 unless

there's congenital deformity, Gold said.

Dr. Stephen Greenberg, Genzale's plastic surgeon, said he frequently has to

turn away teens, some as young as 16, who want breast implants. He said he

recently told a 17-year-old and her mother to wait until September, when the

girl turns 18. "She wasn't happy about it," he said. "I think it's appropriate

to wait."

There are some psychological aspects doctors try to weigh when deciding

whether a teen is ready for plastic surgery. Gold said he looks to see whether

the patient believes a new nose or bigger breasts will solve all life's

problems.

"I probably turn away about 15 percent of the patients I see," he said, for

that reason and others. He added that emotional maturity isn't always linked

to age: "I frequently see young teens who come in who are more mature, better

prepared ... than many adults."

Gold said he has seen no significant increase recently in teens getting

cosmetic surgery, and downplayed media reports of suburban youths getting the

gift of plastic surgery for graduations and birthdays. "Several patients don't

make a trend," he said.

But he added that it's common for plastic surgery to be done "during

periods of transition," such as going from high school to college.

"I frequently will book students for their procedures around school

vacations," said Greenberg, who has been practicing for 11 years. He said he

reserves school vacation days for students, and those days are often booked a

year in advance. In an average week he performs a rhinoplasty, or nose job, on

about four teenagers, he said.

"My mom promised me that before I went to college she would let me get

rhinoplasty," Genzale said. The procedure cost about $7,750, Genzale said, and

was paid for by her mother, a secretary, and her father, a wholesale car dealer.

It used to be that most Long Island girls who underwent plastic surgery

were from wealthy North Shore families, doctors said. "There was a time when it

was a badge of privilege to get your nose done," said Dr. Jon Turk, a Woodbury

plastic surgeon.

With nose jobs typically ranging from about $6,000 to $9,000 and breast

implants costing around $7,000, "a lot of the North Shore prevalence still

exists," Greenberg said. Still, he noted, plastic surgery is "equalizing

throughout the Island."

One reason, he said, is the stigma seems to be easing. Young women who

undergo plastic surgery or are contemplating it no longer keep it a secret, he

said.

Karen Mendoza, 18, a graduate of H. Frank Carey High School in Franklin

Square, isn't shy about sharing that she's working at Arden B. in Roosevelt

Field Mall to save up enough money for breast implants.

"I want them done eventually," she said. "I don't think it's a big deal."

A perky Brittney Criscuolo greets customers where she works at Bebe Sport

at Roosevelt Field. Asked whether she knows any teenagers who got plastic

surgery, Criscuolo, 21, said nonchalantly, "I did it. Rhinoplasty."

Criscuolo was a senior at East Meadow High when she got plastic surgery

after years of hating her nose - its shape, size, especially the profile it

cast. "It just made me feel ugly," she said.

When her cousin had nose surgery more than a decade ago, Criscuolo said,

her cousin didn't even tell her boyfriend about it. "Now it's like nothing,"

Criscuolo said. "I know girls who for their Sweet 16 got breast implants. ...

It's like tanning or getting a new outfit."

Long Island's affluence and proximity to New York City also play a role in

how plastic surgery is viewed here. "I know a lot of people who had plastic

surgery," Criscuolo said. "Maybe if I were upstate or from a smaller town it

would be a big deal."

Perrotta said she talks freely about her surgery with her friends. "But my

parents," she said, "don't want anybody to know."

When Genzale returned to Comsewogue High School, where she's a senior,

classmates showered her with compliments, she said, as though she simply had

changed her hairstyle. "People were like, 'Oh my gosh, you look so good,'" she

said. "People weren't giving me negative feedback or anything."

The problem with a casual attitude toward cosmetic surgery is that it can

lead to never feeling satisfied with one's physical appearance, said Fugen

Neziroglu, clinical director of the Bio-Behavioral Institute in Great Neck and

a psychology professor at Hofstra University.

A preoccupation with a slight defect, or an imagined one, Neziroglu said,

is known as body dysmorphic disorder. "I'm asked more and more to go into the

school districts and identify girls who are at risk," she said.

Neziroglu described one 16- year-old girl who is obsessed with her nose,

constantly pushing it up, taping it and using concealer cosmetics to make it

appear slimmer. "Her parents can't afford the surgery, and truthfully, she

doesn't need it," Neziroglu said.

To help the girl, Neziroglu said she took her to a department store twice -

once while wearing the nose makeup and once without. Neziroglu asked the girl

to note how clerks treated her when trying on sunglasses or jewelry and

shoppers' reactions while walking through the store.

The experience, Neziroglu said, helped the girl understand that others

don't fixate on her nose the way she does.

Today's youths are different from past generations, Neziroglu said:

"There's more of an acceptance of plastic surgery. The parents also put a lot

of emphasis on appearance. The children are learning different values."

That change began about 10 years ago, she said, when going to the gym and

working out became popular. Though exercise was promoted as having health

benefits, it sparked an emphasis on physical appearance, she said.

The girls who had cosmetic work done said there is indeed pressure to look

a certain way.

"As a girl living on Long Island, I'd say there is a lot of pressure,"

Genzale said. "Schools are really cliquey. We all dress pretty well. Everybody

has Coach bags and everything."

Perrotta, a freshman at the University of Rochester, said there was

pressure at Syosset High School to wear expensive brands and look like a model.

"In Syosset, everyone there is pretty wealthy," said Perrotta, who had

saved up for her procedures since she was 16 and got some help from her

parents, whom she plans to pay back. "Most of the girls were really skinny, and

if you weren't, you stood out."

Neziroglu agrees that the Long Island high school environment is

competitive when it comes to body image. "A lot of social comparison is going

on in the high schools," she said.

Nicole Cordella, 18, a senior at North Babylon High School, said she always

felt self-conscious about her large breasts. She felt sometimes people were

staring at her chest.

"By ninth grade I was already like a D," she said. "My friends had

nicknames for me."

So in February she underwent a breast reduction, going from a 32 DDD to a

32 C. Part of the reason for the surgery was that she was starting to have back

problems. "I did it for cosmetic reasons also," said Cordella, who is petite

and wears size 2 jeans. "I just felt they were a bit too big for the size of my

body."

Now she's looking forward to being able to buy bras at Victoria's Secret,

which doesn't normally carry her old size. She even recently bought a black

checker-trimmed Burberry bikini, a symbolic moment after years of dreading

swimwear.

Cordella's mother, Denise Cordella, said if not for her daughter's back

problems, she would have preferred that Nicole wait until she was older. But

she said she also sees value in plastic surgery. "If it's going to help their

self-esteem, I think it's worth it," she said.

Siobhan O'Connor, 21, of Wantagh, said increased self-esteem was an added

benefit of undergoing rhinoplasty after an sport utility vehicle door slammed

into her face during her junior year in high school and broke her nose, leaving

it a bit crooked. But the bigger impact was that surgery allowed her to

breathe out of her nose for the first time. Still, O'Connor said she

appreciates her improved appearance.

"It really shot down my confidence," she said of her crooked nose. "Now

whenever I see a camera, I jump in front of it."

It's been about two months since Genzale's surgery, and she said her

classmates are telling her they want rhinoplasty, too.

She said she doesn't mind talking about it and doesn't understand why

others keep it a secret. "Famous people and stuff, they deny it when it's so

obvious," she said. "I don't see what the point is."

When she's a freshman this fall at Wagner College on Staten Island, Genzale

said, she won't pretend as if her old nose never existed. "You can see it on

my Facebook," she said. "I'm not going to, like, delete all my old pictures."

The price of looking good

In 2007, the top five cosmetic procedures undergone by people 18 and under.

1. Laer hair removal

(75,457 procedures)

Cost varies. An upper lip costs about $350; both legs are about $700

2. Microdemermabrasion

(41,009 procedures)

Removes dead outermost surface of skin. Used to remove sun-damaged skin and to

lessen scars and dark spots.

Cost: $150-$250

3. Chemical peel

(13,790 procedures)

Improves facial skin using solution, causes blistering and peel off. Cost:

$1,500-$2,500 for deep full-face peel; $100-$200 for superficial glycolic acid

peel.

4. Cosmetic ear surgery

(12,419 procedures)

Cost: $5,000-$6,000.

5. Rhinoplasty (nose reshaping surgery)

(10,709 procedures)

Cost: $5,000-$9,000

SOURCE: American Society for Aesthetic Plastic Surgery