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Let’s get into it! (12 yrs old to 18 yrs old)CLOTHING:you may wear mostly anything you want, except for clothes that show your private parts (including cleavage and bottom) and clothes that have sexism, racism, s*xual stuff, curse words, gang affiliation etc.you may wear crop tops when you’re thirteen, but please don’t have it cut off above your ribcageyou can wear whatever swimsuit you want. skimpy bikini, idc.we will go shopping together once a year before school starts, and you may pick out whatever you need, as long as it isn’t too expensive — BUT you must donate some of your old clothes to a good home.if you need new clothes or want to go shopping with friends, i will give you a set amount of money (or you may use your own).you may have six pairs of shoes. you may have more if there are special occasions or circumstances like sports.MAKEUP + HYGEINEyou may wear makeup when you turn thirteen. you don’t have to be a girl. i don’t recommend it, though, because you will feel ugly without it at times. i will buy you the essential makeup if you want it, but any extras you will have to buy yourself. i will also only let you use vegan makeup.i will buy you a skincare set if you’d like :) but i’ve kept my skin clear for years by just using sunscreen, lotion, and soap.you must take a bath everyday. if you are significantly sweating, you will have to take more.i will buy you shampoo, conditioner, and hair products.depending on your hair type, you can wash your hair as many times as needed.TATTOOS + PIERCINGS + HAIR DYE:you can get your lobes pierced whenever you want. however, all other ear piercings must be approved and 15+. i also will not allow you to pierce your belly button, nose, or face until you are 17.you will not get tattoos until you are 18. and even if you do, talk it through with me. please understand it is irreversible.you can dye your hair, but not your roots until you’re 18 because i don’t want you to damage your hair. coloring your hair is a form of self-expression! i will pay for the first time but you must pay for any other time.HOME LIFE:you can close your door from ages 12+. but you will need to join your family for dinner. i understand if you are not feeling well or aren’t hungry.you will need to learn the languages your parents speak. i will teach them to you from a young age so you can be fluent!you can decorate your room however you want, as long as it is approved by me. i’ll give you 100 dollars to start off, and you will fund the rest. talk to me! i’d love to help you. edit: i’ll still pay for the bed frame, mattress, and dresser. i should have clarified sorryif you want to diet, let’s talk it through with the doctor first.i will make you your lunch for school if you’d like, or you can buy at the cafeteria.you will get an allowance of 25 dollars a month. i think that’s rather fair, as you can earn the rest by baby-sitting. i never got allowance.every member in the household will have a chores list. you need to do this, or some privileges will be revoked, like allowance.you can have any pet you want except bugs because i’m really scared of them. you’ll have to take care of your pets. and we will have pets unless someone is allergic. we will also foster animals.you can take any classes you want, like theater, arts, writing, dance, whatever you’d like! i’ll put you in a few classes when you are 4 so you can pick out exactly what classes you like.our family will go walking everyday together. join if you feel up to it!i will help you with period products and all.we will watch movies on friday nights. it’s family time, so join in!keep your room clean.if you live with me past 18, you better pay rent.DRUGS + ALCOHOL:no drugs. not now, not ever. i can’t stop you if you are old enough, but i never want you to smoke. please. it’s ruined families. and mine.you can have alcohol when you’re 21. you can try a little when you’re 16 though.DATING:you can date when you’re 16, but i really feel like you should focus on school as well. i will only stop you if you’re not paying attention to your friends, family, or academics.do NOT date a douchebag. or someone who touches you without consent or is a bad person in general. let me meet them! i won’t bother you otherwise.please only date someone who is up to 1.5 years older or younger than you. make sure not to be in a relationship with an adult if you are a minor.no s*x until you’re 17 and even then, be on the pill and know the consequences of doing it. also. USE. PROTECTION.if you need birth control or condoms, let me know! i’d be happy to get them for you. don’t be afraid.you can date a boy or girl or non-binary or whoever. it doesn’t matter to me.also, you can m*sturb@te. i think it’s totally okay. and you don’t have to talk to me about it cause that’s… your business idc. just stay clean, k?SEXUALITY:my child, i will accept you no matter what. if you’re figuring out yourself, talk to me! i’d be happy to help you through it. you will never have a homophobic parent. i myself am bi :)RELIGION:you may practice any religion except cult or satanic religions.you don’t have to be religious.don’t think you’re better than people of a different religion and make sure there is equality for all.MENTAL HEALTH:talk to me if you’re feeling any way. i will never ignore you.you’ll never be in trouble if you self-harm or anything.i will get you anything you need, be it therapy or medicine.ELECTRONICS + SOCIAL MEDIA:you can have a phone at 12.you may have gmail at 10.there will never be any limits as long as you can control yourself.online friends are fine as they are my favorite people. but if you want online friends, MAKE SURE you talk to me first so i can teach you cyber-safety!social media at 12 is fine, as i will monitor what you post, and until age 15, you need to have a private account. unless you are a model/influencer/actor/actress etc!you can have a fan account for social media.you can watch any rating for any show or game.just uh, don’t let me find out if you watch p*rn. at least do it on private browsing mode.do not send n*des. sweetheart, they have the worst consequences. remember, what you post online stays online forever.i will not go through your devices unless i think you’re doing something wrong and i fear for your safety.SPORTS:you will be playing sports from a young age, as i find that has a better consequence than not playing at all.body positivity is important, but i also care for your health. i also understand that you may look fuller even though you are healthy. don’t let anyone bully you for that.i will teach you how to swim, ride a horse, and ride a bike. you don’t have to do these when you’re older, but these are good skills to have, in my opinion.you must have some sort of physical exercise when you’re older. you can choose :)SCHOOL:please try to keep your grade b- and up! if you need help, i will get you a tutor. and i just want to know that you’ve tried your hardest.i will go through your grades every week, so we can catch up on any missing assignments or tests.when we’re young, we do dumb stuff. i get that. but there will be consequences if you do something major.please join a club/sport/team in school! at least one.be a nice kid and don’t be a bully. if you’re being bullied, let me know asap.please go to college~ it’ll help you in the future immensely. you can still have a gap year, though. i totally support you if you want to join the military or smth, but you should still go to college.all school field trips and stuff are allowed.you can go to public, private, or boarding school. there’s pros and cons of all.your bedtime on school nights is 11:30 pm. but you can stay up as long as you want on other nights.BEHAVIOR:listen, talking back is okay as long as you have sufficient reasoning and evidence as to why. prove it to me.please be respectful to everyone in the house.cussing is fine within limits, but no cussing at school. but if you cuss near your (hypothetic) younger siblings, i charge you a dollar.do not be a douchebag or bully.be polite.FRIENDS:honestly you can sleepover at friends’ houses, and they can sleep over at our house.let me know who your friends are! i promise i won’t be a helicopter mom.if you sleep over with someone of the opposite sex, know your limits, kid.TRADITIONS:you are going to have to listen to me blasting blackpink, stray kids, exo, (g)i-dle, nct, and pretty much all k-pop music every day. you don’t have to like it though… but there’ll be a lot of music hahaon the plus side, this means you’ll get to to go to any concerts if you like any artists. and get merch.also, our family is going to be very immersed in music.we will still celebrate christmas traditions. i’m not christian, i just like christmas haha. if you don’t want to, that’s okay! i’m totally fine with that.i’m a huge collector of music albums, so if you’d like, you can help out <3 you don’t have to though.we’ll go to an amusement park at least once a year. you can bring your friends along!i’ll recommend you my fav books. i’m an avid reader and i’d love to see my child using my books.And that’s it! Let me know if you disagree with any points of mine (respectfully).<3 Cassiey’all are so nice though ily

Why Siberian Huskies Have Brilliant Blue EyesResearchers have found genetic clues to the dogs' unusual eye colour.Wednesday, 10 October 2018By Kitson JazynkaScientists have found a genetic mutation thought to cause blue eyes in Siberian huskies.Photograph by Olivier Morin, AFP/GettyElegant and expressive, blue-eyed dogs have some of the most unforgettable furry faces around. Scientists have thrown dog-lovers a bone: clues as to what causes this eye-catching trait.Scientists know that blue eyes are related to the coat colour of some dogs, like merle (or splotchy-coated) Australian shepherds. But what about other dogs that sometimes have piercing baby blues, like the striking and popular Siberian husky? (Related: What Makes a Great Sled Dog? Breed, Ambition, Tough Feet.)Scientists at a DNA testing start-up set out to explore the question by looking into other variations—besides coat colour—that might cause blue eye colour in dogs.In the largest study ever to compare dogs’ complete genetic profiles, researchers found a genetic tweak that can cause blue-eyed dogs. The study was published last week in the journal PLOS Genetics by Adam Boyko and Aaron Sams of Embark Veterinary, Inc.Researchers tested the DNA of more than 6,000 dogs whose owners had purchased DNA test kits to confirm or identify their dogs’ breeds and explore their potential risk of health conditions. The size of the study was possible because of the scientists’ access to vast data thanks to the test kits purchased and owners’ willingness to participate in an online survey where they could also share photos of their dogs.Researchers found that a genetic change, or mutation, near a gene known as ALX4 on canine chromosome 18 is strongly associated with blue eyes in Siberian huskies.Genes are all about cause and effect, like dominoes toppling over, says geneticist Kristopher Irizarry of the College of Veterinary Medicine at Western University of Health Sciences. “One gene will turn on another, or turn off another, or turn off 10 and turn on others,” he says. “Genetics is this very complex spider web of pushes and pulls—and order and time are critical.”Paths to Baby BlueBlue eyes are found in a number of dog breeds, including Old English sheepdogs, border collies, and Welsh and Pembroke corgis, Irizarry points out. But for these breeds the blue-eyed trait is inherited as a recessive trait, meaning that two mutated copies of the gene are required for the blue eyes to occur.In humans, he says, blue eyes are caused by a genetic variation between a pair of genes called HERC2 and OCA2 in the human genome.According to Irizarry, the mutation of the ALX4 gene in Siberian huskies seems to result in decreased pigment production in the eye. The lack of pigment causes the eye to appear blue.“There’s no blue pigment. It’s about the way the light enters and exits the eye, creating the appearance of blue, the same way the sky looks blue but outer space is not blue,” says Irizarry.The type of mutation found in the study—in this case, the duplication of a snippet of genetic information—is also how tri-coloured Australian shepherds sometimes end up with blue eyes, a phenomenon unexplained before this study, says one of its authors,Embark Veterinary, Inc. senior scientist Aaron Sams.Doggie DNA BonanzaOne of the most remarkable aspects of this study, Irizarry says, is that the scientists had so much data to work with. In a study he’s working on to explore neurological disease in German shepherds, collecting DNA from even 40 dogs was a challenge, requiring a lot of driving and carrying around equipment to collect each DNA sample.The blue eye of a white Siberian husky dog, 'Canis lupus familiars'.Photograph by David Liittschwager, Nat Geo Image Collection“With 6,000 people getting DNA samples from their dogs and mailing them to a centralised location and then filling out a website form detailing all the traits of their dog—that’s a game-changer for how genetics is being done in the 21st century,” he says.Bridgett von Holdt, a biologist at Princeton University, agrees. “It’s great that a private company can get owner approval to use samples for two purposes, the intended commercial product and additional research,” she said via email.An added benefit is that pet owners get to contribute to science, says Irizarry. It’s also a big step for citizen science. “Each owner’s pet not only inspired the work, but actually contributed DNA to the study. This is very cool.”Source: Why Siberian Huskies Have Brilliant Blue Eyes

Q. Should children under 16 be allowed to get cosmetic surgery?A. Dr. Michael Kulick gave the perfect answer. The following articles provide more background.Should Teenagers Be Allowed To Have Cosmetic Surgery? (Australia’s well thought out guidelines)Teens Getting Plastic Surgery: Be Cautious (health.usnews.com)Briefing Paper: Plastic Surgery for Teenagers (American Society of Plastic Surgeons position paper)Should cosmetic surgery be banned? (teenagers opposing views SCMP)Cosmetic surgery and teenagers – a disaster waiting to happen (The Guardian)Should Teens Get Plastic Surgery To Boost Their Self-Esteem? (Jezebel)Should Teenagers Be Allowed To Have Cosmetic Surgery?“It seems to us that both sides are right, at least in part. And perhaps, in certain aspects, each side could be wrong.”There are differing opinions and much controversy around the topic. One group says it is best to let teens have cosmetic surgery if they wish. Others believe there should be age restrictions for cosmetic surgery, that allowing teens unlimited access opens them up to exploitation and fosters unhealthy values. Who is right? Should teens themselves have a say? And where does Australian law stand on the matter?Should teens have cosmetic surgery? That depends. If there is a medical reason, or some factor that is clearly affecting the physical, emotional or psychological wellbeing of a child or teen, then cosmetic surgery should clearly be an option on the table.If there is no medical reason or justification that makes the procedure urgent, but the teen expresses the desire for social or self-esteem reasons, some hard thinking needs to be done.Also, should teens themselves have a say? Where does Australian law stand on the matter? These are all important issues to explore in this article.Let’s start with what cosmetic surgical procedures are common among teenagers.What do teenagers want?According to the American Society for Aesthetic Plastic Surgery (ASAPS), the most common cosmetic surgical procedures for teens include ear correction surgery (otoplasty), nose reshaping (rhinoplasty), breast reduction (reduction mammoplasty) in teen girls, correction of breast asymmetry, and male breast reduction surgery in teen boys with excessive breast development or gynaecomastia.You can read more about the ongoing dialogue and justifications concerning breast reduction surgery in our article, should breast reduction be available to teenagers?What if the parents are OK with it?Sure, some parents willingly pay for a cosmetic breast enhancement for their daughter or for their son to have nose-reshaping surgery. Some are even willing to let teenagers have liposuction. But should this be allowed?One camp says that letting teens who want it have cosmetic surgery if their parents see no problem with granting approval and paying for the procedures. Similar thinking exists everywhere in the world, but we are increasingly hearing about cases in the US and the UK.Here are a few stories:Surgeon Gave Teen Daughter Breast Implants - An ABC News story from February 2012.Teenage victim of online bullying resorted to plastic surgery to silence teasing – A story from the U.S. about a 13 year old girl named Nicolette having nose reshaping surgery (MailOnline, October 2011).Two videos from the American Society for Aesthetic Plastic Surgery tell the stories of Allison, a young teen who had nose reshaping surgery (rhinoplasty) and Wills, a teen boy with gynaecomastia who underwent treatment for male breast reduction.Aside from the ‘ick’ factor, the first story received the most publicity and public backlash, possibly because breast augmentation is considered purely cosmetic. The teenagers in the other stories appear to have benefited greatly from their surgery, facing less bullying, less embarrassment and possibly feeling better about themselves after their procedures.The question then is whether these teens’ lives and the lives of numerous others like them should be made difficult by outright bans on cosmetic surgery for teenagers, or whether age restrictions, with some leeway for cases such as these, should be put in place.Age related cosmetic surgery banThose in the opposing camp want a blanket ban on cosmetic surgery for kids and teenagers. They would like to place restrictions on when young people can decide for themselves when they need cosmetic surgery.They rightly claim that the lack of restrictions make children and teenagers vulnerable to manipulation and exploitation by unscrupulous elements. They also say that obsession with physical features and physical beauty at an early age fosters unhealthy values, setting up kids for problems with body image and self esteem.Who is right?It seems to us that both sides are right, at least in part. And perhaps, in certain aspects, each side could be wrong.There are valid points in the argument for an age-related ban, but is a blanket ban justified? Then what happens to teens like Wills, Nicollette and Allison, and to numerous other kids who are bullied for their unusual features? In a perfect world the bullying would be corrected, not the physical features, but we—and our children—live in the world we have.Who decides?When the annual survey of the Cosmetic Physicians Society of Australasia (CPSA), conducted through Costhetics, included a question about age, 76 percent of the respondents felt that 21 is the most appropriate minimum age to start surgery for aesthetic purposes. Nearly 20 percent of people felt 18 to 21 were appropriate ages. Compare that figure with the 4 percent who felt that ages 16 to 18 was appropriate and to the mere 1 percent who said 16 years or younger was okay.In considering where public opinion stands on this matter, it is important to remember that those who took part in the survey appear to be very open to cosmetic treatments—which is probably what drew them to Costhetics and to the survey in the first place. Yet even they felt that teenagers are not old enough to make their own cosmetic surgery decisions; that age restrictions are appropriate.Surprisingly though, the Australian public appears to be more broadminded on the matter. When a March 2012 survey in the Herald Sun ran a survey asking its readers “Should plastic surgery have an age restriction?” the cumulative results showed that around 84 percent of its readers answered ‘yes’ and only 16 percent said ‘no’.But does that mean Australians welcome a total ban on cosmetic surgery for those under the age of 21 years? Or do they want guidelines, with room for case-by-case evaluation? It will take time to find a balanced answer.Meanwhile, Australian lawmakers seeking to better regulate cosmetic surgery to ensure safe conditions for consumers have recognised the complications of this question.Australian laws on cosmetic surgery for kids and teenagersAt present, laws differ from state to state on how cosmetic surgery is regulated for kids and teens. Queensland has the strictest laws, restricting cosmetic surgery for those below 18 years, subject to a ‘best interest’ requirement.The National Framework on Cosmetic Medical and Surgical Procedures (2011) contains measures meant to safeguard those below the age of 18. The supplementary guidelines in relation to cosmetic medical or surgical procedures recommend measures for adults as well as those below 18. These specific recommendations were directed at the Australian Medical Board.Here are the key features:The first consultation should be with the operating doctor, rather than with an agent or patient advisor.In determining the suitability of a procedure, the doctor is required to undertake an exploration of why the surgery or procedure is requested. The doctor should explore both external reasons—such as a perceived need to please others—and internal reasons—such as strong feelings about appearance. Doctors are also required to look into the person’s expectations of the requested surgery or procedure to ensure they are realistic.The guidelines state that “If there are indications that the person has self-esteem or mental health problems, the person should be referred to a GP or an appropriately qualified health professional” such as a psychiatrist, psychologist or specialist counsellor for review. However, when the Medical Board of Australia invited public comments on the proposed guidelines, the Australasian College of Cosmetic Surgery submission pointed out that “a self-esteem ‘problem’ could imply anything from a normal response to some aesthetic concern, which a cosmetic procedure might ameliorate, to body Dysmorphic Disorder”. Therefore, the College recommended changing that requirement to include a phrase requiring a doctor to refer for evaluation those whom they believe “may have an underlying psychopathology such as Body Dysmorphic Disorder or other mental health condition or concern which may make them an unsuitable candidate for a cosmetic medical or surgical procedure”.A pre-procedure consultation within a reasonable time before the day of the procedure that includes informed written consent from the patient. The informed consent should be reconfirmed on the day of the procedure.Guidelines also encouraged a cooling-off period between the initial consultation and the date of procedure.In addition, there are specific recommendations for those under 18 years of age:A ‘cooling off’ period of 3 months if the requested surgery or procedure has no medical justification. There should be a second consultation at the end of the ‘cooling-off’ period during which the request is further explored. Doctors should not schedule the surgery or procedure at the initial consultation.Doctors are asked to encourage prospective patients to discuss their desire for the surgery or procedure and any concerns they have during the cooling-off period.The requesting person should be assessed by an appropriately qualified health professional such as a psychiatrist, psychologist or specialist counsellor.The Supplementary Guidelines on Cosmetic Medical and Surgical Procedures that will be part of “Good Medical Practice: A code of conduct for doctors in Australia” are yet to be issued in final form. Once they are issued, regardless of state laws, all medical professionals seeking registration in Australia will be obligated to adhere to those guidelines.As things stand, this area is in constant flux. At present, if your teenager wants cosmetic surgery you may be confined by your state laws and the ‘best interest’ clause in the current code of conduct for doctors in Australia.For more informationShould breast reduction be available to teenagers?Mark D. Epstein, M.D., F.A.C.S. Published on Apr 23, 2018Teens Getting Plastic Surgery: Be Cautious (health.usnews.com)Video: Cosmetic Procedures(HEALTHINATION)AS MILLIONS OF teenagers begin their final summer before college, not a few are prepping for cosmetic surgery, to take advantage of the long recovery time and a transition from one peer group to the next. In the aftermath of a $20 million-plus court award in Pennsylvania in May to a family whose 18-year-old daughter died from what was likely a pulmonary embolism after liposuction, some parents may be wondering whether cosmetic treatments in teens are safe.U.S. News & World Report asked Richard D'Amico, president of the American Society of Plastic Surgeons, what families should consider when deciding whether to take the plunge.How do doctors determine if surgery in teens is appropriate?I think it's important to draw a distinction between teenagers who are younger than 18 and those who are older. At 18, these individuals are adults in the eyes of the law and are allowed to make the decision on their own. For those under 18, it becomes a family and parental matter. We also have to distinguish between procedures that are purely cosmetic and those that are reconstructive. Several factors are important in deciding when and for whom surgery is appropriate: an ability to understand the procedure; that the desire for surgery does not reflect what a parent, friend, or boyfriend desires; and that expectations are realistic. If your expectations aren't realistic and you have low self-esteem or no friends, cosmetic surgery is not the right answer. Rather, I would recommend counseling. But if a young person has good self-esteem and good family support, can understand what's going on, and has realistic expectations, then surgery may be appropriate. The need to know all these things is what makes the consultation so critical.It can be entirely appropriate for teenagers under 18 to undergo reconstructive procedures. This is most often for maldevelopment of the breast in girls [which can include deformities and severe underdevelopment of the breast and nipple] and overdevelopment of the breast in young teenage boys—a condition known as gynecomastia. When girls' breasts are too big for their bodies, a breast reduction is also considered a reconstructive procedure.What about cosmetic or aesthetic procedures?On the cosmetic side for those under 18, we're really talking about rhinoplasty, where the primary endeavor is to improve the appearance of the nose, whether or not there is a problem with the septum. Both the Food and Drug Administration and the American Society of Plastic Surgeons feel that young women under 18 should not get breast implants for purely cosmetic reasons. Once a teenager reaches 18 years of age, we can perform cosmetic enhancements or enlargement of the breast using saline implants. FDA guidelines suggest waiting until 22 years of age before using gel implants.Is it considered OK for teens who are concerned with their weight to get liposuction?It's generally discouraged in teens younger than 18 with weight problems. It's recommended that weight loss is addressed and controlled with diet and exercise. The body contouring technique is not a weight loss tool, and that is true at any age. In fact, if someone is grossly overweight, he or she has to get to a better weight before liposuction is considered. There are a lot of teenagers with psychological issues related to their weight. And while as plastic surgeons we usually don't get involved in counseling, if someone who is 15 or 16 is obsessed with their weight, counseling can be very helpful.And for teens 18 and older?It's a very reasonable and useful tool, but we like to have people with the maturity to be able to manage their weight with diet and exercise. Then contouring improvements can be made.Are teenagers more susceptible to certain complications than adults are?No. But people need to know that cosmetic surgery is still surgery and, though extremely rare, there are risks. Before we even go ahead with surgery, the family and the teenager need to understand the potential risks from both surgery and anesthesia.However, there are instances where the teenage body is still growing and we don't operate on structures if they need time for further growth. With rhinoplasties, the issue is usually that the nose is already too big, so further growth will not be beneficial.Can you describe what happens at a typical consultation?When a teenager who is younger than 18 comes in for the consultation, he or she must be accompanied by a parent or guardian. We first sit down and discuss the patient's request—in this case it would almost always be rhinoplasty—and we make sure it's something the teenager actually wants. You can tell when people want something or if they're simply there because mom has expectations of the teenager's appearance. Those things come out in the discussion. We find out if the teenager's expectations are realistic and ask them point-blank why they want the surgery. They have to be able to talk and communicate their desires and not just parrot what someone else told them. If their reason is just that their boyfriend wants it or because some friends tease them, then that's inappropriate and I wouldn't offer that family the surgery. In that case, I would postpone the discussion until they're really ready. What you want to hear is that the teenager wants the surgery for themselves. And as we talk to them, we determine what their self-esteem is.What then?If I don't think they're ready, I'll tell the parents that yes, there may be an issue with the teen's nose, but I don't think this young person is ready yet. Let's talk again next year. If the teenager believes that if only she got her nose done, she would no longer be ostracized, then I'd refer her for counseling. I also look at the level of parental support. You really have to look at personal maturity and make sure that the expectations are realistic. Certainly parents can seek a second opinion, but they must treat what the surgeon says very seriously.What are the main considerations a parent and teenager should take into account when deciding on plastic surgery?No matter what someone's age is, patients should always choose a plastic surgeon certified by the American Board of Plastic Surgery. The second critical element is to make sure the surgery is carried out in a licensed hospital or accredited facility because complications can happen to people of all ages. Make sure you sit down with the plastic surgeon and have a thorough consultation that goes beyond just the area of concern, particularly with teenagers. This includes a thorough physical exam and all preoperative testing. The doctor should get to know the teenager and make sure he or she is emotionally ready and will be able to deal with complications if they come up. I see all of my patients twice before I do surgery, and I think it's a good idea to have the patient come back after the first discussion. It shows perseverance and drives home the point that this is a serious decision.And if the patient is 18 and older, but still young, I encourage parents or guardians to be involved in the decision making, even though it is the patient's legal choice.Matthew Shulman, ContributorBriefing Paper: Plastic Surgery for TeenagersTeenagers who want to have plastic surgery usually have different motivations and goals than adults. They often have plastic surgery to improve physical characteristics they feel are awkward or flawed, that if left uncorrected, may affect them well into adulthood. Teens tend to have plastic surgery to fit in with peers, to look similar. Adults tend to have plastic surgery to standout from others.2015 Plastic Surgery Statistics: Cosmetic Patients Ages 13-19Common physical characteristics or concerns a teen may wish to correct include a misshapen nose, protruding ears, overly large breasts, asymmetrical breasts, or severe acne and scarring.Teens frequently gain self-esteem and confidence when their physical problems are corrected. In fact, successful plastic surgery may reverse the social withdrawal that so often accompanies teens who feel different. According to American Society of Plastic Surgeons (ASPS) statistics, 64,470 cosmetic surgical procedures were performed on people age 13-19 in 2015, while 161,700 cosmetic minimally-invasive procedures were performed.Not every teenager seeking plastic surgery is well suited for an operation. Teens must demonstrate emotional maturity and an understanding of the limitations of plastic surgery. The ASPS cautions teenagers and parents to keep in mind that plastic surgery is real surgery, with great benefits, but also carries some risks. Teens should have realistic expectations about plastic surgery and what it can do for them. In addition, certain milestones in growth and physical maturity must be achieved before undergoing plastic surgery.Although health insurance does not pay for cosmetic plastic surgery, coverage is often provided when a procedure alleviates physical symptoms or improves a body function. Such is usually the case, for instance, when breast reduction eliminates severe back and neck pain. It should be noted; however, that health insurance coverage varies greatly between health plans.StatementAs with any surgery, parental consent is required for all plastic surgery procedures performed on teens younger than 18 years old. The ASPS advises parents to evaluate the teenager's physical and emotional maturity and believes that individual cases merit careful evaluation under the guidance of a plastic surgeon certified by The American Board of Plastic Surgery. The most rewarding outcomes are expected when the following exist:The teenager initiates the request.While parental support is essential, the teenager's own desire for plastic surgery must be clearly expressed and repeated over a period of time.The teenager has realistic goals.The young person must appreciate both the benefits and limitations of plastic surgery, avoiding unrealistic expectations about life changes that will occur as a result of the procedure.The teenager has sufficient maturity.Teenagers must be able to tolerate the discomfort and temporary disfigurement of a surgical procedure. Plastic surgery is not recommended for teens who are prone to mood swings or erratic behavior, who are abusing drugs and/or alcohol, or who are being treated for clinical depression or other mental illness.Common Plastic Surgery ProceduresRhinoplasty (nose reshaping)Plastic surgery may be performed on the nose to straighten the bridge, remove an unsightly hump, reshape the tip or open breathing passages. Ordinarily this is not performed until the nose reaches its adult size - about age 15 or 16 in girls and a year later in boys. In the event of a prior injury or obstruction to breathing, insurance may cover a portion of the procedure. According to ASPS statistics, 30,246 rhinoplasty procedures were performed on patients age 13-19 in 2015. The procedure accounted for nearly 50 percent of all cosmetic surgical procedures performed on this age group.Zendaya Plastic Surgery / Nose Job / Rhinoplasty New LookOtoplasty (ear surgery)Surgical correction of protruding ears, in which the ears are pinned back, may be performed any time after the age of five. Otoplasty made up 10.1 percent of all cosmetic surgical procedures performed on this age group in 2015, with more than 6,472 procedures. Insurance reimbursement for otoplasty is possible, but typically only occurs in extreme cases.Free plastic surgery for bullied teen stirs controversyCorrection of Breast AsymmetryWhen one breast grows much larger size than the other, an operation may correct the difference by reducing the larger breast, augmenting the smaller, or both. Insurance reimbursement is occasionally possible with this procedure.Breast AugmentationSaline-filled breast implants can be used for breast augmentation in women 18-years or older and for breast reconstruction [U.S. Food and Drug Administration (FDA) approval; May, 2000].In November 2006, the FDA re-approved the use of silicone breast implants for breast augmentation. However, silicone breast implants are only approved for use in women age 22-years or older.Many teenagers who want breast augmentation have one breast that is larger than the other - sometimes a full cup size or more in difference. This condition is called breast asymmetry. Using a saline-filled implant in the smaller breast allows the patient to have breasts of the same size. Although waiting may prolong the physical awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. More than 7,840 breast augmentations were performed on 18-19 year olds in 2015.Breast ReductionSurgical reduction of very large breasts can overcome both physical and psychological burdens for a teenage girl. In fact, many teenagers suffer ongoing back pain due to overly large breasts. Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. Insurance reimbursement is often possible with this procedure. In 2010, more than 4,600 breast reductions were performed on patients age 13-19.Acne and Acne Scar TreatmentAcne eruptions may be controlled by the proper use of modern prescription drugs. In addition to supervising the use of these medications, plastic surgeons may improve acne scars by smoothing or "refinishing" the skin with a laser or with a fine sanding technique called microdermabrasion. In 2015, nearly 7,871 microdermabrasion procedures were performed on patients age 13-19. Other treatments for acne related skin problems include laser skin resurfacing, dermabrasion, and chemical peels. In 2015, 27,954 laser skin resurfacing procedures, 6,119 chemical peels, and 17,978 Botulinum Toxin Type A (Botox, Dysport) were performed on patients 13-19.Male Breast Reduction (Gynecomastia)Teenage boys with large breasts, known as gynecomastia, are often eager to undergo plastic surgery. Surgical correction, accomplished in a variety of ways, is occasionally covered by insurance. Gynecomastia accounted for 10.9 percent of cosmetic surgical procedures for patients age 13-19 in 2015, totaling 7,021 procedures.Male Breast Reduction Guide | American Board of Cosmetic SurgeryTo assist people considering plastic surgery ASPS has developed a brochure, "Make the Right Choice," which offers information on managing expectations and questions to ask before plastic surgery. www.plasticsurgery.orgRecommended ReadingLukash, F. Children's art as a helpful index of anxiety and self-esteem with plastic surgery. Plastic and Reconstructive Surgery 2002. 109:1777-1786.McGrath, M.H. and Mukerji, S. Plastic surgery and the teenage patient. Journal of Pediatric & Adolescent Gynecology 2000; 13:105-118.Pearl, A. and Weston, J. Attitudes of adolescents about cosmetic surgery. Annals of Plastic Surgery 2003; 50:628-630.Rosen, D. Question from the clinician: Adolescent gynecomastia. Pediatrics in Review 2003; 24:317-319.Sarwer, D.B. Plastic surgery in children and adolescents. In: Thompson, J.K., Smolak L. (eds.). Body image, eating disorders and obesity in children and adolescents: Theory, assessment, treatment and prevention. Washington, DC: APA Press, 2001, pp 341-366.Sarwer, D.B., Wadden, T.A. and Whitaker, L.A. An investigation of changes in body image following cosmetic surgery. Plastic and Reconstructive Surgery 2002. 109:363-371.Sheerin, D., Morag, M. and Kusumakar, V. Psychosocial adjustment in children with port-wine stains and prominent ears. Journal of the American Academy of Child & Adolescent Psychiatry 1995. 34:1637-1647.Simis, K.J., Hovius, S.E.R., Beauford, I.D., Verhulst, F.C., Koot, H.M. and the Adolescence Plastic Surgical Research Group. After plastic surgery: Adolescent-reported appearance ratings and appearance-related burdens in patient and general population groups. Plastic and Reconstructive Surgery 2002. 109:9-17.Simis, K.J., Verhulst, F.C. and Koot, H.M. Body image, psychosocial functioning and personality: How different are adolescents and young adults applying for plastic surgery? Journal of Child Psychology & Psychiatry 2000; 42:669-678.Bullied teens have extreme desire for plastic surgery, finds studyShould cosmetic surgery be banned?Elise Choi, 16, Sai Kung Sung Tsun Catholic SchoolHave you noticed that an increasing number of celebrities are having cosmetic surgery? It is because they want a better image to present to the public. But should all of us join in?I think cosmetic surgery should be banned. First of all, people have different definitions of beauty. We have to accept the fact that everyone is unique. True beauty lies in your personality. If a boy or a girl is considered ugly but has a good personality, people will find him or her attractive on the inside. That beauty is everlasting. Good looks fade with age. Character is far more important.The cosmetic surgery trend misleads people into thinking that looks are most important. They might copy their idols' looks so they can feel good about themselves and be accepted by the public. This would be bad for society.Changing our looks is a type of cheating. Our looks are a present from our parents and we should respect that.More importantly, cosmetic surgery involves risks. Some doctors might not even have a licence. If the effect is not what you expected, you wouldn't be able to do anything about it. Once your face is changed, it's changed.There's also the problem of hygiene. If cosmetic equipment is not sterilised properly, it could spread disease.I think cosmetic surgery should be banned as soon as possible, before anyone gets hurt.Matthew Murchie, 15, St Joseph's CollegeCosmetic surgery has gained a bad name in recent years, not only as something against nature but also as a dangerous type of operation that can leave patients with awful, plastic-looking faces.Many patients undergo plastic surgery only because they need it. For example, people who have facial injuries or were born deformed may require surgery to fit in with society.Some may say we should allow only those who really need it to have cosmetic surgery and ban it for those who wish to use it to look good. But where do we draw the line? Is it acceptable for someone to, say, correct a harelip? Would we then allow someone to straighten a crooked nose?More importantly, we are already free to change our appearance in whatever ways we like. We dye our hair, grow beards, pierce our bodies and get tattoos. Just because cosmetic surgery requires a surgeon and pain-killing drugs doesn't mean there is anything wrong about it.Banning cosmetic surgery would have serious consequences. Cosmetic surgery is performed by qualified surgeons. Once it is banned, illegal providers would arise for those who want it, and the operations would be far more risky.It doesn't matter whether those who choose cosmetic surgery are making a good or bad choice. All that matters is that it can help people improve how they see themselves. After all, it is our own choice if we want to change our appearance.Cosmetic surgery and teenagers – a disaster waiting to happenYoung women feeling insecure, media pressure to get the 'perfect body' and an unregulated industry exploiting a growing market all add up to a looming crisis. So why won't the government step in?Jane Martinson @janemartinson Mon 28 Apr 2014 17.00 BSTElla, from Ashurst, near Southampton, has been thinking of having cosmetic surgery since she was 11. She is now 18, and the therapist dealing with her low self-esteem issues has advised counselling before having her breasts enlarged. "She made it very clear that often cosmetic surgery doesn't fix everything," Ella told BBC's Newsbeat, "but I do feel like it would fix the large part of it in that I wouldn't feel ashamed any more."Soon, surgery to address body confidence issues may be more common than therapy, as young women appear to be fuelling the increase in cosmetic procedures in the UK. Hard evidence is limited in a surprisingly unregulated industry but anecdotal evidence is everywhere, so much so that last week the British Association of Aesthetic Plastic Surgeons (Baaps) called for a crackdown.The demand for surgery isn't new. In 2005, a magazine survey of 2,000 teenagers found that 40% of girls had considered plastic surgery. Since then, however, the industry has grown five-fold, an increase unaffected by the 2012 scandal over the PIP breast implants.Born into the sexualised womanhood of Girl Power, the millennials have come of age in a society increasingly inured to the exploits of the surgery-enhanced reality TV stars. Leah Totton, the Apprentice winner who used Alan Sugar's money to set up cosmetic skin care clinics this year, says she has had to put a blanket ban on procedures for under-18s after one 14-year-old girl came into the clinic with her mother and asked for Botox.In April last year, a report by NHS medical director Sir Bruce Keogh found that 41% of girls aged seven to 10 and 63% aged 11 to 16 said they felt some pressure to look the way celebrities do. Suggesting that surgery had become "normalised" in pursuit of a "designer" body, he called for tougher controls over who can offer treatments and how they can be marketed. The government ignored him.Ash Mosahebi, a consultant plastic surgeon and council member of Baaps, calls the lack of regulation in the UK a "big problem". "The government's view is that restrictive practices are counterproductive to the economy. Our view is that they are important for patient safety."So what are the rules about offering children cosmetic surgery? Similar to those for other "permanent" procedures such as tattoos. Any surgery on an under-18 needs parental consent, though there is a grey area after 16 in which parents can't insist on treatment, for example. The lack of regulation in an industry in which anyone can order dermal fillers online and set up shop suggests the grey area is wider than that. Not for nothing does the association call dermal fillers "a crisis waiting to happen". Do cosmetic surgeons demand proof of age? "I do, but there may be some less scrupulous people who don't," admits Mosahebi.Guidelines suggest that teens must have reached certain milestones in growth and physical maturity as well as "emotional maturity", such as an awareness that plastic surgery is not a panacea for all ills, for example.Increased regulation of the industry isn't a panacea either, of course. More rules govern who can perform cosmetic surgery in the US and yet 236,356 cosmetic procedures were performed on 13- to 19-year olds in 2012, according to the American Society of Plastic Surgeons.Campaigners say more should be done to stop the media encouraging unrealistic body types. Lucy-Anne Holmes, founder of No More Page 3, says: "One gender is allowed to be fully clothed, look old and be overweight while the other isn't. The impact this has on girls and young women is sad and unfair."Cosmetic surgery is increasingly the answer for young women, and men, who want to cosmetically "enhance" their bodies. Mosahebi says: "At some stage we will have another disaster and they might change their mind." By then, of course, it'll be too late.• This article was amended on 30 April 2014. The original said anyone with a medical degree can order dermal fillers online. This has been corrected.Should Teens Get Plastic Surgery To Boost Their Self-Esteem?More teenagers are getting plastic surgery in the hope that it will make them look "normal," but can you get self-esteemfrom a scalpel?Today's New York Times reports that the bad economy is having little effect on the number of teens getting plastic surgery, and in fact, the number of people age 18 or younger who had cosmetic surgery more than tripled in the past 10 years, to 205,119 in 2007 from 59,890 in 1997. Liposuctions and breast augmentations are much more popular than they were a decade ago — remember Amanda from an episode of the View last July? — and have increased more than sixfold.Teen Girl Gets Lipo To "Prevent" Eating DisorderToday on The View, we met 15-year-old Amanda, who had a breast reduction and liposuction on her…Teens are often motivated to get plastic surgery because they believe their natural looks are inadequate. “Unlike adults who may elect cosmetic surgery for that ‘wow’ factor to stand out in a crowd, to be rejuvenated and get noticed, kids have a different mantra. They do it to fit in,” said Dr. Frederick Lukash, a New York plastic surgeon who specializes in adolescents. Dr. Lukash is especially familiar with why teens want to change their appearance because he has performed rhinoplasty on two of his three daughters, at the ages of 16 and 17.All teens want to fit in, and the reality is that kids will often be teased for "abnormalities" such as ears that stick out "too far", or a crooked nose. But studies show that today, most kids think there is something wrong with the way they look naturally. 7 in 10 girls said they believed that when it came to beauty and body image they did not measure up, and only 10 percent thought they were "pretty enough," according to a recent survey of 1,000 American girls sponsored by the Dove Self-Esteeem Fund. “Our children are barraged with images of ideal women and men that aren’t even real, but computer composites,” said Jean Kilbourne, co-author of So Sexy, So Soon, a book on adolescents. “These girls and boys can’t compete. The truth is, no one can. And it leaves teens feeling more inadequate than ever and a lot of parents unsure as to the right thing to do.”Often the parents and doctors who allow a child to get plastic surgery just want to spare them pain and increase their self esteem. Some even justify the plastic surgery by saying it will prevent other destructive behaviors like eating disorders, bullying, and self-mutilation. But while most doctors say they can judge how developed a teen's body is and if they are getting a procedure done for the "right" reasons, the long term effects are hard to predict. It's natural for teens to have issues with their looks because their bodies are changing so much and they're trying to figure out how to define themselves as adults. But accepting how you look is part of maturing, and if perceived imperfections are taken care of with a knife, teens may not be learning mentally how to be comfortable with their appearance.Seeking Self-Esteem Through Surgery [The New York Times]A Surgeon Finds Teenage Clients In His Own Family [The New York Times]Earlier: Teen Girl Gets Lipo To "Prevent" Eating Disorder