The other day a patient of mine asked what I thought about her daughter's desire to get Botox. She told me that they had been to the dermatologist for a routine appointment when a projector screen in the waiting room began showing pictures of various anti-aging procedures. "The video kept looping over and over, with before and after pictures, so you couldn't help but watch it," she said, as if explaining her interest in such matters. That's when she realized her daughter was watching too. Her daughter is 16-years-old.
In light of the recent deaths of two young women undergoing cosmetic procedures -- one a 23 year old receiving her sixth breast implant, the other a 35 year old getting liposuction, along with the recent research showing evidence of potential muscle atrophy with repeated use of botox, it wasn't difficult to answer my patient's question. "Starting Botox at age 16 was not a good idea." In fact, I suggested that interest in anti-aging procedures by girls her age was worth a deeper discussion about what lay behind the request. Self-esteem issues? Concerns about her body? Fear of aging?
My patient's question stayed with me long after she left my office, and I began to think of the challenges facing young girls -- and guys -- today. Why was this teen -- or for that matter any teen -- thinking about facial lines and wrinkles? How early does this all start? And I wondered what exactly these young people were trying to ward off? Were fine lines and slight sags indications of imperfections that needed fixing? Or did these changes foreshadow the inevitable vulnerability that comes with age? Although we know how preoccupied midlife women are with visible changes they see -- and the extremes to which they will go to defy them -- we may not be aware how far this fear has trickled down. More importantly, do we have to wait for another death resulting from optional plastic surgery or witness the unsightly effects from overuse of cosmetic procedures like Botox to know we are a culture in trouble?
What we do know is that young girls (and boys) today live in a society obsessed with youth and beauty. They can't escape the messages that bombard them in the media about the importance of looking younger, thinner, stronger, enhanced and better. There are the reality shows that promote all sorts of transformations; "Extreme Makeover," "The Biggest Loser," "The Swan," and, one of the most offensive, "Bridalplasty." In that show, which I wrote about here, young brides competed for the surgical procedure of their choice and were presented to their grooms on their wedding day. The message was clear; even on one's wedding day, perfection, not love, was the goal. And of course during these shows (surprisingly a favorite of the under 30 demographic) non-stop ads offer their own version of anti-aging solutions. Commercials featuring beautiful, and of course, young looking actresses, endorse makeup, gels, creams, and yes, Botox and Juvederm, products that promise to revitalize, revolutionize and transform. And while the girls hear a little bit of this or that will take years from their faces, the boys hear how years can be added to their sex lives. Have you counted the number of Erectile Dysfunction ads that are aired during one single quarter of one football game? By the fourth quarter, guys must feel exhausted imagining the long lasting, ever-ready potency that will be demanded of them as they age.
If we then turn to the Internet, where the fastest rise in marketing is taking place, (and where young kids spend half their lives), we find there are even more anti-aging messages invading our youth's psyche. Online advertisers allow viewers to remove lines from wrinkled faces by using magic wands and create images of perfection by virtually altering body parts with the touch of a button. How can teens distinguish what is real and what isn't, what is possible or not? With that in mind, what about the amount of online pornography our teens have access to -- in spite of our attempts to disallow it? Whether we recognize it or not, they are exposed to and growing up around digitally (or surgically) enhanced everything, everywhere. Add to that the kind of film clips that my patient saw in places you don't even expect -- and what are we telling our kids?
These are not merely observations. While the number of cosmetic procedures remains highest among midlife women, the steepest increases can be found among women much younger. A quarter of a million teens have undergone cosmetic surgery in 2010 in the US alone (these include procedures to reshape, reconstruct and enhance). According to a recent article in The New York Times, about teen usage of anti-aging injectables, approximately 12,000 between the ages of 13-19 received Botox and Dysport (two brand names for the botulinum toxin) some receiving multiple doses. "Teen Toxing," as it is sometimes called, has increased 2 percent over the past year and 100 percent in the past 15 years. While this rise may be astounding, it is small in comparison to the 509 perncet increase in Botox use by all ages over that same period. It doesn't take a psychologist to recognize that my patient's question and these statistics reflect a larger problem that has to be addressed.
The president of the National Research Center for Women and Families, Diana Zuckerman said to the L.A. Times, "We've made a decision about what beauty looks like in this country, and everybody -- teens in particular -- wants to fit the mold." The article goes on to say, that although cosmetic surgery on teens is concerning, surgeons argue that these procedures aren't just about improving appearances. They can improve self-esteem too. They say, "Because teens take every imperfection (real or perceived) seriously, physical differences, however minor, can influence what they think of themselves and how they behave."
Which brings me back to my patient and her daughter asking about Botox. How are parents to respond to their teens who beg them to "renew" or "reshape" their faces and bodies using cosmetic procedures? Remember, we are not talking magic wands, but requests that can involve general anesthesia and invasive surgery. What are we to make of teens who have been convinced -- sometimes by their own doctors -- that just the right physical alteration might help them not only look better, but be more confident and popular? When we are asked by our kids to help keep them from being left out, or from possibly being bullied, can we stop ourselves? And, if they have been told that they can potentially avoid signs of aging -- and I mean promises they will never ever have a wrinkle -- if they act now rather than later, do we deprive them of what we may have wished for, but never could have achieved?
But, wait. What if your teen suggests throwing some medication into the mix. Ritalin before SATs? Klonopin for Prom anxiety? Zoloft to ease their romantic troubles? And what if your tween wants in on it too? Will we be leading them down a slippery slope never to climb back up? Wasn't adolescence supposed to be about learning to cope and deal with the kinds of struggles that prepare them for the rest of adulthood? To answer, I say again, a 16-year-old's desire for Botox, or for that matter, any cosmetic procedure must be questioned for many reasons. So should all quick-fixes that override the internal angst these desires may represent. That we are even struggling to answer the questions these teens are asking worries me on many levels. Does it worry you?
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Vivian Diller, Ph.D. is a psychologist in private practice in New York City. She has written articles on beauty, aging, media, models and dancers. She serves as a consultant to companies promoting health, beauty and cosmetic products. "Face It: What Women Really Feel As Their Looks Change" (2010), written with Jill Muir-Sukenick, Ph.D. and edited by Michele Willens, is a psychological guide to help women deal with the emotions brought on by their changing appearances. For more information, please visit www.VivianDiller.com