By Madilyn Moeller, Editorial Assistant, and Patrick O'Brien, J.D., Legal Coordinator for the American Med Spa Association

When a young patient, one who has not yet reached the age of majority, comes into your practice seeking treatment, how do you decide whether to take them on as a patient? What special considerations should you have? A lot of this comes down to the individual motivations and goals of the patient, and your professional judgment.

Medical spas should treat their minor patients as any other health care practice would: with parental informed consent, sound professional judgment, and a demonstrated understanding and attention to their development.

Following the guidelines of plastic surgery may serve as a guide when it comes to elective procedures for minors.

Regulations

Internationally, cosmetic procedures for minors have enhanced restrictions. Plastic surgery is limited to minors with compelling medical or psychological reasons for having these procedures. Physicians risk imprisonment for operating without good reason.

The U.S. Food and Drug Administration (FDA) restricts the use of breast implants to people age 18 and older. Saline breast implants are used for women age 18 to 22, with silicone implants limited to women over 22. There are a few reasons why breast augmentation is not approved for patients younger than 18: Teens may not understand the risks associated with the procedure, teen bodies may not be finished developing and the teen may not be psychologically ready to handle the outcome of the surgery.

Plastic Surgery Perspective

How do you know when a patient is a good candidate for a cosmetic procedure? Once you have assessed that the patient has reached appropriate milestones in both physical growth and emotional maturity, they can be considered for treatment. The teen must not only have the maturity to understand the realistic outcomes and limitations of the procedure, but they also need to be ready for possible discomfort or complications when recovering from treatment.

The American Society of Plastic Surgeons (ASPS) advises providers to look for the following before considering treatment:

• The teen initiates the request;
• The teen has realistic goals; and
• The teen is sufficiently mature.

Because minors lack the legal capacity to consent to treatments, obtaining parental consent is of paramount importance. Parental support is equally important to overall patient success. It may indicate the patient will have realistic expectations for the procedure. A mature patient will be able to handle the aftermath and recovery from treatment, but a supportive home environment will make it considerably easier.

Studies have shown that teens who undergo cosmetic surgery may experience an ease in physical, psychological and emotional burden associated with the improved conditions they achieve with their procedures. Ideally, aesthetic procedures can give patients similar relief whether it is addressing a perceived issue with facial features or helping to heal scars.

Young Patients

When it comes to medical aesthetics for young people, their motivation to change their appearance becomes an area of concern. Ideally, the patient should be requesting the treatment to satisfy their own reasons instead of to meet someone else's expectations. Teens may be hoping to better fit in with their peer group or to correct cosmetic problems that may be causing insecurities. But it is important to assess if treatment can realistically address these issues or if the insecurities have a different cause.

When you are asked to treat a minor patient, there are a few suggestions you wish to employ before treatment.

• Consultation: The patient consultation and examination are still the core of medical and medical aesthetic practice, whether the patient is a minor or an adult. It is necessary to have one or more parent or guardian present for the consultation. Not only does this allow you to educate and assess both patient and adult at the same time, but the parent(s) is the one who must give informed consent, so they must be provided the information anyway. Inquire about the teen's motivations and goals for the procedure's outcomes. Educate the patient and parent/guardian about the risks, realistic results and possible complications with the procedure. Not only is this an opportunity to answer all of their questions, it is also the best chance to assess the patient's emotional maturity, motivations and expectations.
• Cooling off: Give the patient time to consider the new information about the treatment. They may see their desire for the treatment in a different light and will need to determine if it is still the best choice for them. You can do this by asking them to call back in a few days to schedule the procedure or by setting their appointment a week or two away. In New South Wales, for example, minors who want plastic surgery wait through a three-month cooling off period.
• Treatment: If, after consideration, they are still interested in moving forward with treatment and you believe the patient and their parent share realistic expectations and motivations then it is time to bring them in. As with other medical practices involving minors, the parent or guardian must be the one to give the informed consent for the patient. Prior to treatment, it is critical to review information and ask if any new questions or concerns have arisen. Properly documenting the patient's medical record is critical here.

Conclusion

Individual cases merit careful evaluation. As with any treatment, you need to consider all the medical aspects of the procedure and the patient. When a minor is involved, emotions and motivations become an important issue as well. Ultimately, as with all medical practice, the best interests of the patient are paramount.