Rhinoplasty is a surgical procedure to reshape the nose. Many young patients may arrive at the office to learn about the procedure. The age range of the patients seeking this procedure is trending lower. This is a function of our society and the age in which patients begin to take great care in their personal appearance.
From a surgical standpoint two important considerations determine when a rhinoplasty should be performed. The first consideration is the physiology, growth and development of the nose. The second is the psychological maturity of the patient undergoing the procedure.
The nose completes most of its growth generally by age 15 in women and age 17 in men. To operate on the nose at an earlier age may affect growth and development. However, not all patients are equal, and it is best to look at other characteristics of puberty and maturity to correlate with the nasal growth to estimate when the maximal growth is complete.
The psychological maturity is a much more difficult factor to assess. We all know that our thinking as a 17 year old is much different than our thinking as a 30 year old. In most places consent can be legally obtained from a 16 year old. However, a surgeon is ethically bound to a much higher standard. It is best to take a careful history and make sure that the client fully understands the surgery, along with the risks and benefits. Consultation with the parent and also alone may be beneficial. The history should also carefully rule out Body Dysmorphic disorder (abnormal preoccupation with body image), early onset depression or schizophrenia or any other emerging psychological condition. If this is suspected in the history, a prompt referral to a psychiatrist for further evaluation may be beneficial prior to considering any surgical procedure. The surgeon must assess how the patient will tolerate the immediate post operative procedure with a potential for pain and discomfort.
In general, the best approach is to carefully assess the patient and the family. No surgeon can give a definitive age as to when to perform a rhinoplasty on a younger patient. Performing a procedure at 18 or 21 or even later can be the best approach in many cases. The surgeon never regrets the patient he has not operated on. The goal of the surgery is to provide benefit for the patient and avoid any psychological or physical adversity.