When Clara Conrad ’25 was 14 years old, she began thinking about how she would want her nose to look if she was to get a nose job. She thought about who she would want to do it. She thought about whether or not she even wanted to do it. Conrad said she considered getting a nose job because of beauty standards propagated by the media.
“I remember thinking that being pretty was only for women with small, button noses, and a lot of that came from the fact that there aren’t a lot of it girls with my facial structure,” Conrad said.
Conrad’s parents, who were supportive of their daughter whatever her choice might have been, offered to fund the procedure as a birthday present. However, Conrad said she chose not to alter her nose.
“I ultimately decided against it because it’s my grandmother’s nose, it’s my father’s nose and it’s something that’s really representative of my family,” Conrad said. “ I think it’s really messed up societally to push teenage girls down the route of getting plastics.”
The pressure to improve one’s appearance has existed for a very long time. With the rise of social media and selfie culture, the effects of comparison and negative body image have only been augmented, according to the Dove Self-Esteem Project.
Additionally, the pandemic made plastic surgery a more popular treatment for perceived physical flaws, because people wanted to feel more satisfied with their appearances before going back to in-person activities, felt the stress of the pandemic had aged their features and had extra money that they would have used had they been going about their normal activities, according to a report by the American Society of Plastic Surgeons.
Of the 87,966 cosmetic surgical procedures performed on patients aged 13-19, over half were rhinoplasties in 2020, according to the American Society of Plastic Surgeons.
In medical ethics, there is a principle called the Child’s Right to an Open Future, first coined in 1980 by political philosopher Joel Feinberg. The principle states that parents should not make choices for their children that would prevent them from having opportunities in the future and should instead wait for their child to become mature enough to make choices autonomously.Clinical Ethicist Joseph Raho said, depending on the circumstances, cosmetic surgery performed on a teenager could violate the principle.
“When you start talking about modifying a part of the body, you might worry that the intervention is irreversible,” Raho said. “When the minor becomes an adult, he or she might regret the earlier decision. Parents, as decision-makers for minors, ought to consider delaying the decision until the child reaches the age of majority.”
Raho said a surgeon needs to consider the minor’s motives as well as the benefits and risks of the intervention before agreeing to offer a minor the surgery.
“Why does the minor wish to have this cosmetic procedure?” Raho said. “Why [do] they think it will help them? What do they think the benefits are? And I think parents need to carefully determine whether or not the child’s request [is] a legitimate request, or if it’s being unduly influenced by perhaps peers at school.”
For minors, whose brains and senses of self are not fully developed, surgeons have to take additional steps to make sure that their patients are psychologically and physically mature enough to handle a surgery. Facial Plastic Surgeon Manish Shah said he evaluates his teenage patients’ mental state to ensure that the surgery will have a positive effect on their futures.
“We interview [minor patients] pretty extensively to make sure that something like this would help push them in the right direction from a personal and a psychological development standpoint, because you don’t want to do anything that is frivolous on somebody so young, whose brain is maturing and whose sense of themselves in the world is a very immature version of itself,” Shah said.
Facial Plastic Surgeon Behrad Aynehchi said the anatomical and chemical differences between teenagers and adults are another factor that he takes into account before performing a cosmetic surgery.
“The soft tissue and healing of a teenager is different than [that of] an adult, ” Aynehchi said. “Teenagers typically tend to have more hormones, and they may have more sebaceous skin, [and] they may have [a higher] likelihood of inflammation afterwards. So sometimes they swell longer afterwards than an adult rhinoplasty.”
Shah said he performs rhinoplasties on males and females starting at different ages because of sex-dependent rates of facial maturation.
“If [the surgery is] done too early, it can restrict development,” Shah said. “[If] I’m doing a rhinoplasty, for young women, we wait until they’re at least 14 years old, [when] they don’t look like they’re growing extensively. For boys, because they can have a secondary growth spurt pretty late in life, we usually wait until they are late 17, early 18 years old before we would do surgical procedures.”
Janice*, a student who had a rhinoplasty at age 17, said her doctor decided she was ready to have the procedure due to her deviated septum, her age and her perspective surrounding the surgery.
“My doctor didn’t ask me questions about my mental health per se, but he did gauge why I wanted it done and got the feel for my mentality through those types of questions,” Janice said. “From there, he kind of figured that I was doing it for myself and he saw that I had a deviated septum, so I would have to get it done eventually.”
Shah said he first and foremost evaluates whether or not his patient’s requests seem feasible and if he can see the deformity that the patient would like to be corrected.
“For a lot of things, it’s very easy to see why a change would be beneficial to them, whether it’s a very large nose or a traumatized nose from playing sports, so making a smaller nose or nose that functions works well,” Shah said.
Unlike the majority of patients undergoing elective cosmetic surgery, minors do not have power to make medical decisions — their parents do. Aynehchi said that each child has a different level of decision- making independence, but he encourages minors who disagree with their guardian’s vision for the reconstruction to wait to have surgery until they are older.
“Even though [minors] may all be accompanied by their parents, some have a more autonomous tone and the parents are confident in what [their children are] requesting,” Aynehchi said. “Others, the parents are completely in charge and are kind of dictating what they think that the teenager would like and the teenager’s trusting of the parent. But there are situations where they’re at odds with each other, and those are the most difficult ones. Those are the ones that I may say, ‘We want to wait a little bit until the teenager is a little bit older,’ when they may be more on the same page with their parents.”
A Google search for celebrities with nose jobs yields mainly results about famous women. In 2020, only 18% of nose reshaping procedures were performed on men, according to a study from the American Society of Plastic Surgeons. Aynehchi said most teenagers who come in for rhinoplasties are female.
“Earlier in my career, it was more of a standard approach where the females came in [because] they wanted to bring down the bump. They wanted [their nose] to be smaller and cuter,” Aynechi said. “It’s kind of trending as social media has been influencing things significantly. They want to go more aggressive, now they want to take down the bump even more, they want to bring the tip up even more [and] they just want to really heighten the effect of whatever they’re doing.”
Aynehchi said that men come in for the surgery with different motives and expectations than women.
“Males typically err on the much more conservative side,” Aynechi said. “The males that come in typically have a very obvious issue where they have a very big nose, a big hump, droopy tip, or they’ve had some kind of trauma from sports and they want their nose more straight and cleaner looking. They’re a lot more conservative, and they’re a lot less influenced by social media than females are.”
Conrad said she thinks a factor in the upward trend of plastic surgery for teenagers can be attributed to the rise of social media and influencers.
“In the age of social media, there’s this very unattainable look that I think really came from the Kardashians and their normalization of plastic surgery,” Conrad said. “It’s just like a really casual thing to do. I’m not sure if that culture existed before, but I think social media and people like influencers and the Kardashians have made it more socially acceptable to [go under] the knife for cosmetic reasons.”
Janice said social media did not influence her decision to get a nose job.
“I had always been insecure with my nose, even before I was on social media,” Janice said. “Also, I was taught at a very young age that social media is not just fake but in no way translated to reality. So social media didn’t alter my perception of myself, especially my nose.”
Janice said the procedure positively affected her image of herself.
“I definitely think that I have a lot more self-confidence,” Janice said. “My nose was definitely a large insecurity of mine. Having it done, I’m a lot more secure.”
Sara Segil ’25 said she knows multiple teenagers who have had nose jobs, and she feels that beauty standards often affect decisions to get the procedure done at a young age.
“I think everybody obsesses over little features so much in this day and age,” Segil said. “There’s a stigma about your nose, and people judge you based on your facial features, but then people judge you again if you decide to change your facial features. It goes both ways.”
Segil said societal pressures both cause people to get cosmetic surgery and create stigmas around surgery.
“I don’t care if people have a nose job, but there are many people who judge other people based on how they do it, but the reason that they’re doing that is because society as a whole, or maybe even just themselves, feels uncomfortable with their own physical feature,” Segil said. “It’s a double-edged sword going both ways.”
*Name has been changed.
