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As others have said, the answer to this question varies by State. In Georgia, I know the arresting officer (not the suspect) is the one who chooses whether the suspect’s blood, breath, or urine will be tested for the possible presence of alcohol and/or drugs.It is certainly possible for test results to be suppressed, though this does not happen very often. There are a myriad of reasons why results may be suppressed, and these reasons vary from State to State. In Georgia, if the officer reads the Informed Consent card incorrectly, a motion to suppress may be granted. This kind of motion might be granted if the Defendant can prove that he or she did not understand the Informed Consent. Believe it or not, In Georgia, more than a few attorneys have successfully convinced Judges that the Informed Consent laws were not followed, because their clients were too drunk to understand the Informed Consent card that the officer read to them! (refer to this article.) Another common argument used by defense attorneys is that chain of custody procedures were not correctly followed. If these procedures are not followed, it can be hard for the prosecution to prove that the specimen that was tested actually come form the defendant’s body. Although attorneys have used dozens of augments to suppress blood, breath, and urine tests, the fact is that most officers are well trained, and very careful when handling evidence, and when addressing informed consent issues. As a result, many defense attorneys decide not to file motions to suppress, knowing that such a motion would be futile.

“For complex surgical procedures, you’re generally better off at teaching hospitals, which usually stay at the forefront of health research. Medical students and residents ask questions, providing more eyes and ears to pay attention and prevent errors. Teaching hospitals have lower complication rates and better outcomes.” —Evan Levine, MD, a cardiologist and the author of What Your Doctor Can’t (or Won’t) Tell You.“Those freestanding ERs popping up all over? They typically don’t have anywhere near the resources of hospital ERs, yet they cost just as much. Go there for small bumps and bruises. For something serious (chest pain, a badly broken bone), get to a trauma center where specialists and surgeons work.” —James Pinckney, MD, an ER doctor, founder of Diamond Physicians in Dallas, Texas. Check out these other 50 secrets an ER staff won’t tell you.Epidural steroid injections for back pain has risky potential complications like neurological problems or paralysis. “Generally, epidural steroid injection isn’t very useful for treatment of chronic back or neck pain,” says Steven Severyn, MD, an anesthesiologist at the Ohio State University Wexner Medical Center.No unnecessary scans. Studies have shown that radiation from CT scans could be responsible for as many as two percent of all cancers in the U.S. “CT scans are much quicker and tend to be less costly than an MRI, but does have the added radiation that MRI’s lack,” says Todd Sontag, DO, a family medicine physician with Orlando Health.Practically all surgeons have an inherent financial conflict of interest. That’s because they are paid approximately ten times more money to perform surgery than to manage your problem conservatively.” —James Rickert, MD, an orthopedic surgeon in Bedford, Indiana.No-certified specialty. If an airline told you that their pilot is the best but he’s not FAA-certified, would you get on the plane? "For the same reason, always check if your surgeon is board-certified in his specialty. Many are not.” Tomas A. Salerno, MD, chief of cardiothoracic surgery at the University of Miami Miller School of MedicineSome surgeons won’t mention procedures they don’t know how to do. "I’ll see patients who were told they needed an open hysterectomy, even though it could be handled laparoscopically. That’s one reason it’s good to get a second opinion.” —Arnold Advincula, MDYears ago, a patient sent his slides to three different pathologists and got three different answers. "I got very upset on hearing that. Now I never rely on just one pathology exam. If your doctor finds something, ask him to send your slides to a nationally recognized reference lab—not just one or two slides but the whole lot—and get a second interpretation.” —Bert Vorstman, MD, a prostate cancer specialist in Coral Springs, FloridaIn medicine, you can get a DUI, go to jail for a couple of hours, and walk out at 7 a.m. the next morning and do a surgery. "You can be accused of sexual misconduct and drug and alcohol abuse in one state and pop over to the next one and get a license. Some state medical boards don’t even thoroughly research your background; they argue that the less-than-$10 fee to access national data is too expensive.” —Marty Makary, MD.Surgeons are control freaks. "When things don’t go our way in the operating room, we can have outbursts. Some of us curse, some throw instruments, others have tantrums.” —Paul Ruggieri, MD, author of Confessions of a Surgeon: The Good, the Bad, and the Complicated ... Life Behind the O.R. DoorsMistakes are probably more common than you would think. "But most of them don’t actually hurt people. I work with residents, and I don’t let them do anything that I can’t fix if they screw it up. If there’s an error that I fix that I’m sure won’t affect the patient at all, I’m not going to say anything about it. That would accomplish nothing except to stress out the patient.” —An orthopedic surgeonSome problems just don’t fix well with surgery, like many cases of back pain. "My advice? Grin and bear it. Some surgeons vehemently disagree. They say, ‘Oh, you have a degenerative disk, and that must be the culprit. Let’s fix it.’ But many people have a degenerative disk with no pain. There isn’t a lot of evidence that we’re helping very many people.” —Kevin B. Jones, MDAlways ask about nonsurgical options and whether there’s anything wrong with waiting a little while. "Surgeons are busy, and they like to operate. A professor from my residency would say, ‘There is nothing more dangerous than a surgeon with an open operating room and a mortgage to pay.’” —Kevin B. Jones, MDTalk to your doctor about donating your blood or asking your family members to donate blood before an elective surgery. "Banked blood is a foreign substance, like an organ, and your body can potentially react adversely. If you can use your own blood or blood from your family, there’s less chance of those reactions." —Kathy Magliato, MD, cardiothoracic surgeon at Saint John’s Health Center in Santa Monica, CaliforniaResidents have to learn how to operate, and it’s required that an attending physician be ‘present'. But ‘present’ doesn’t mean he has to be in the operating room scrubbed in. At an academic institution, ask whether your surgeon will be actively participating in the surgery or just checking in every hour." —Ezriel “Ed” Kornel, MDDuring my six weeks as a surgical intern in the ER, I inadvertently stuck myself twice with contaminated needles...... briefly nodded off in the middle of suturing a leg laceration, accidentally punctured a guy’s femoral artery while trying to draw some blood, and broke up a fight between the family members of a guy who’d come in with a stab wound to the abdomen. I was slugged in the head by a delirious patient in an alcoholic rage, spat upon, coughed on, vomited on, farted on, bled on, and mistaken for an orderly.” —Paul Ruggieri, MDYour doctor should not push you to make a speedy decision about prostate cancer surgery. "Most prostate cancers are extremely slow-growing, and there is so much misleading information out there, so you should take your time.” —Bert Vorstman, MDIf you have pain in your calf after surgery, or if it swells and looks red, call your doctor right away. "Those are the main symptoms of a blood clot, which is a risk of just about every surgery.” —James Rickert, MDThis is what really keeps us up at night. "It’s not making a mistake in the operating room; it’s the noncompliant patients. When patients don’t do what we tell them, bad things can happen.” —Kurian Thott, MD, an ob-gyn in Stafford, VirginiaDon’t ask too many questions. If you ask too many questions, you can be branded as a pain in the neck. "When one extremely hostile relative bombarded me every time I walked in, I developed a tendency not to go in the room. If you have three pages full of questions, show them to the nurse. Say ‘How many of these should I wait to ask the doctor about? How many can you help me with?’” —General surgeon who blogs under the name Skeptical ScalpelAbout 25 percent of operations are unnecessary, but administrators e-mail doctors telling them to do more. "This is not an insurance company putting pressure on doctors; this is not a government regulation. This is private hospitals pushing doctors to generate more money by doing more procedures. It goes on at America’s top hospitals. The Cleveland Clinic has said this system of paying doctors is so ethically immoral that it started paying its doctors a flat salary no matter how many operations they do.” —Marty Makary, MD.Fatigue and impatience have undoubtedly contributed to some mistakes I’ve made in the operating room. "But unless you ask, your surgeon is not going to tell you that he was up all night on call before your procedure and that he may not be in tip-top form.” —Paul Ruggieri, MDI always ask at national conferences of doctors, ‘How many of you know of another doctor who should not be practicing medicine because he is too dangerous?’ "Every hand goes up.” —Marty Makary, MDVery often, plastic surgery patients don’t admit to a previous surgery, and I don’t find out until I’m in there. "I’ll go in on an eyelid or a nose, and it’s just a mess. If you don’t tell us you had lipo, there will be scar tissue, and the fat won’t come out normally. So please be 100 percent honest. There’s no need to be embarrassed. We’ve heard it all, and we don’t judge.” —Andrew Ordon, MD, cohost of the television show The Doctors and a board-certified plastic surgeon.The biggest mistake during recovery is not giving yourself enough of a break. "Give yourself time to heal. If you don’t, you can cause complications and prolong your recovery."—Andrew Ordon, MDIf your doctor wants to give you a stent, always ask: Is this better than medicine? "If you’re not having a heart attack or an unstable angina, you will do equally well with a stent or medicine, studies show. Having something permanently implanted in your body is not a risk-free proposition. There is evidence that thousands of people have had stents they likely did not need." —Marc Gillinov, MD.If I had any kind of serious medical condition, I’d go to a teaching hospital. "You’ll get doctors involved with the latest in medicine. Even for simple cases, if there’s a complication that requires an assist device or a heart transplant, some hospitals may not be able to do it. At a university hospital, you also have the advantage of having a resident or physician bedside 24-7, with a surgeon on call always available." —Tomas A. Salerno, MDBefore any operation, always ask what’s broken and how fixing it will help. "Just because you have a blockage in an artery doesn’t mean you need it fixed, especially if you don’t have symptoms.” —Marc Gillinov, MDSpecialists quietly pad your bill. “Less-well-trained physicians will call in an abundance of consults to help them take care of the patient. If those specialists check on you every day, your bill is being padded and padded. Ask whether those daily visits are necessary.” —Evan Levine, MD.Ask how to recover faster. “Since each day in the hospital costs $4,293 on average, one of the best ways to cut costs is to get out sooner. Find out what criteria you need to meet to be discharged, and then get motivated, whether it’s moving from the bed to a chair or walking two laps around the hospital floor.” —James Pinckney, MD.Second-guess tests. “Fifteen to 30 percent of everything we do—tests, medications, and procedures—is unnecessary, our research has shown. It’s partly because of patient demand; it’s partly to prevent malpractice. When your doctor orders a test, ask why, what he expects to learn, and how your care will change if you don’t have it.” —Marty Makary, MD.“Your surgeon may be doing someone else’s surgery at the same time as yours. We’re talking about complex, long, highly skilled operations that are scheduled completely concurrently, so your surgeon is not present for half of yours or more. Many of us have been concerned about this for decades. Ask about it beforehand.” —Marty Makary, MD.“Hospital toiletries are awful. The lotion is watery. The bars of soap are so harsh that they dry out your skin. There is no conditioner. The toilet paper is not the softest. Come with your own.” —Michele Curtis, MD.Being transferred? Speak up. “If you go to a smaller hospital and it has to transfer you to a different medical center, demand that it ship you to the closest one that can handle your care. What’s happening is that community medical centers are sending patients instead to the big hospital that they’re affiliated with, even if it’s farther away. It happens even when a patient is bleeding to death or having a heart attack that needs emergency care.” —Evan Levine, MD.“Don’t assume the food is what you should be eating. There’s no communication between dietary and pharmacy, and that can be a problem when you’re on certain meds. I’ve had patients on drugs for hypertension or heart failure (which raises potassium levels), and the hospital is delivering (potassium-rich) bananas and orange juice. Then their potassium goes sky high, and I have to stop the meds. Ask your doctor whether there are foods you should avoid.” —Evan Levine, MD.On weekends and holidays, hospitals typically have lighter staffing and less experienced doctors and nurses. Some lab tests and other diagnostic services may be unavailable. If you’re having a major elective surgery, try to schedule it for early in the week so you won’t be in the hospital over the weekend. —Roy Benaroch, MD, a pediatrician and the author of A Guide to Getting the Best Healthcare for Your Child.“Many hospitals say no drinking or eating after midnight the day before your surgery because it’s more convenient for them. But that means patients may show up uncomfortable, dehydrated, and starving, especially for afternoon surgery. The latest American Society of Anesthesiologists guidelines are more nuanced: no fried or fatty foods for eight hours before your surgery and no food at all for six hours. Clear liquids, including water, fruit juices without pulp, soda, Gatorade, and black coffee, may be consumed up to two hours beforehand.” —Cynthia Wong, MD, an anesthesiologist at University of Iowa Healthcare“Get copies of your labs, tests, and scans before you leave the hospital, along with your discharge summary and operative report if you had surgery. It can be shockingly difficult for me to get copies of those things. Even though I have a computer and the hospital has a computer, our computers don’t talk to each other.” —Roy Benaroch, MD.“One time, I ran into a patient I had performed a simple appendectomy on. He thanked me for saving his life, then told me it almost ruined him because he couldn’t pay the bill. Four hours in the hospital, and they charged him $12,000, and that didn’t even include my fee. I showed his bill to some other doctors. We took out an ad in the newspaper demanding change.” —Hans Rechsteiner, MD, a general surgeon in northern Wisconsin.We're Impatient. Your doctor generally knows more than a website. I have patients with whom I spend enormous amounts of time, explaining things and coming up with a treatment strategy. Then I get e-mails a few days later, saying they were looking at this website that says something completely different and wacky, and they want to do that. To which I want to say (but I don't), "So why don't you get the website to take over your care?"--James Dillard, MDNinety-four percent of doctors take gifts from drug companies, even though research has shown that these gifts bias our clinical decision making. Internist, Rochester, Minnesota Those so-called free medication samples of the newest and most expensive drugs may not be the best or safest.--Internist, PhiladelphiaDoctors get paid each time they visit their patients in the hospital, so if you're there for seven days rather than five, they can bill for seven visits. The hospital often gets paid only for the diagnosis code, whether you're in there for two days or ten. Evan S. Levine, MDWhen a parent asks me what the cause of her child's fever could be, I just say it's probably a virus. If I told the truth and ran through the long list of all the other possible causes, including cancer, you'd never stop crying. It's just too overwhelming. Pediatrician, Hartsdale, New York60% of doctors don't follow hand-washing guidelines. Source: CDC Morbidity and Mortality Weekly Report96% of doctors agree they should report impaired or incompetent colleagues or those who make serious mistakes, but ...94% of doctors have accepted some kind of freebie from a drug company.Source: New England Journal of Medicine58% doctors would give adolescents contraceptives without parental consent. Source: New England Journal of MedicineYour doctor or nurse may have messed up your meds.Doctors in training look the same as doctors in charge.Your medical records are not confidential. If your charts are an open book, it boosts the odds that sensitive details about your health will slip into the hands of people who could use them against you—employers, ex-spouses, or medical identity thieves, says Deborah Peel, M.D., founder and chairwoman of the nonprofit advocacy group Patient Privacy Rights.Your doctor's hands may be filthy.Toronto doctor reveals secrets of hospital slang. Obese patients are “whales” or “beemers”. Old people are known as FTDs, or “failure to die”ER doctors want you to know ER is just like a horror movie. At first you're excited for every day, then there's lots of blood and screaming and crying and it's terrifying. And there's plenty of riddles, like, 'What exactly did you shove up there?!'" It takes an entire team to make an ER run. They work around the clock with little to no breaks. They care about you and they will fight for you.These are some secrets regarded to doctors including surgeons. They are also human beings and make mistakes. We need to collaborate with them to get the best results for your care. Understand them more.Thanks for reading.Sources:50 Secrets Hospitals Don’t Want to Tell You (But Every Patient Should Know)41 secrets your doctor would never share with you8 Secrets Your Hospital Keeps23 Things ER Employees Want You To KnowToronto doctor reveals secrets of hospital slang

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