Medical Aesthetics for Young People: Under 18, Which Treatments Are Medical and Which Can Wait?

Why is medical aesthetics for young people a separate subject?

Adolescence is a period in which the body and face change rapidly and a person's view of themselves fluctuates just as fast. At these ages, worry about appearance is common and is most often a normal part of development. During the same period, young people spend time in an online environment dense with filtered faces and promotion of aesthetic procedures.

A recent commentary published in the field of dermatology draws attention to the increase in appearance-altering procedures in adolescents, and notes that steps such as psychological assessment, structured information-giving and a cooling-off period are often not made mandatory in the guidance of professional bodies. The authors propose a shared ethical framework that includes assessment of medical need, strengthened parental consent and psychological screening. These data come largely from other countries; as far as we know, similar figures have not been published for Turkey.

This article does not aim to stop a young person from seeing a physician. Quite the opposite: having an examination for a treatable skin problem is the right step. The aim is to separate treatment from cosmetic wish and to help ensure that the decision is not rushed.

What is the difference between medical need and cosmetic wish?

Medical need is the treatment of a disease or a loss of function: there is pain, scarring, infection, a symptom that restricts daily life or a marked psychological burden linked to a condition. Cosmetic wish, on the other hand, is the desire to change the appearance of a healthy, normal structure. The line is not always sharp; this is why the distinction is made by the examining physician.

This table is a general framework; it is not an individual diagnosis or treatment recommendation. The same procedure may be treatment in one person and cosmetic in another. For example, botulinum toxin can be used as a treatment for excessive sweating, whereas its use for wrinkles is cosmetic. Age limits and conditions of approval vary with the product and the country.

In which situations may treatment at a young age really be necessary?

Acne is the most common skin problem in this age group and is not merely a matter of appearance. It can leave scars; it can lead to anxiety, low mood and loss of self-confidence. If there are many, deep, painful or scarring spots, and if acne is affecting mood, seeing a physician is recommended. The basis of treatment is mostly medicines applied to the skin or taken by mouth. If scars have been left, you can find the options in our article “Acne Scars”.

Primary excessive sweating often begins in childhood or adolescence; it can lead to avoiding shaking hands, writing on paper or wearing light colours. We have explained the steps of treatment in our article “Treatment of Excessive Sweating (Hyperhidrosis)”. Birthmarks, prominent scars and keloids are also conditions that may need treatment at a young age; our article “Scars and Keloids” may offer guidance on this. Stretch marks that appear during rapid growth, on the other hand, are common and fade over time; the details are in our article “Stretch Marks (Striae)”.

What these situations have in common is that the consultation begins with a diagnosis. The physician first names the problem, then explains the options that have evidence, the expected benefit and the risks. This is the difference between a conversation that begins with the question 'What do you want to have done?' and an examination that begins with the question 'What is bothering you?'

Why are filler and botulinum toxin held back in a face that is still developing?

• The face has not yet taken its final form. The bone structure and soft tissues change throughout adolescence and, in some people, into the early twenties. An area that looks 'thin' or 'small' today may change on its own within a few years.
• There is no evidence of benefit. There is no strong evidence that botulinum toxin in a young face without wrinkles prevents lines from forming later; we have covered this in our article “Rumour: Starting botulinum toxin (commonly called botox) at a young age prevents wrinkles — What does the science say?”.
• The risk does not decrease with age. Complications such as vascular occlusion, infection and asymmetry can also occur at a young age. When the benefit is uncertain, every treatment means taking on these risks.
• The effects are temporary, but the habit may persist. Treatments started early can pave the way for ordinary facial features to be seen as 'flaws that need correcting' and for procedures to become more frequent.
• Tastes change. A look that is very much wanted at sixteen may feel alien to the same person at twenty-five.

In young adulthood, that is, after the age of 18, the decision passes legally to the person themselves; however, most of the points above also apply in the early twenties. We have explained what is necessary and what is not during this period in our article “Skin Care and Medical Aesthetics in Your 20s”.

How is consent obtained under the age of 18, and what are the legal limits?

For medical procedures in minors, the consent of a parent or legal representative is generally required. However, a parent's signature should not be regarded as sufficient on its own: the young person also needs to want the procedure themselves, to understand in age-appropriate language what will be done, the possible risks and the options, and to be able to ask questions. The reverse also holds; carrying out a cosmetic procedure that the young person does not want, at the parent's wish, is unacceptable.

Legal regulations vary by country. The rules of the country you are in determine which procedure can be carried out at what age, with whose consent and by whom; ask your physician about this.

To give one example: in England, since 1 October 2021 it has been an offence to inject botulinum toxin or filler into people under 18 for cosmetic purposes and to make arrangements for this. According to the official guidance, parental permission does not lift this ban. Treatment for a medical reason, on the other hand, can only be carried out with the approval of a doctor and by specified healthcare professionals. The stated aim of the regulation is to protect children from the possible health risks of these treatments. This is an example from a single country; the rules in other countries are different.

A good consent process does not fit into a single appointment. Being given time to think after receiving information, making the decision on another day and being clearly told that the young person has the right to change their mind are especially important in this age group.

How do social media and filters affect the wish?

Filters smooth the skin, slim the nose and enlarge the lips and eyes; what is more, they do this in live video, so fluidly that it goes unnoticed. For someone who looks at these images for a long time, the unfiltered face in the mirror may begin to look 'lacking'. Yet no procedure can do exactly what a filter does; a face with pores, shadows and expressions is normal.

In a survey study of young adults aged 18–25, the intention to have an aesthetic procedure was reported to be higher among those who followed content creators who had had aesthetic procedures and among those who edited their photographs with filters more often. The same study also found that young people overestimated how often others have aesthetic procedures. The study is cross-sectional; that is, it shows an association and does not prove cause and effect.

• Check whether the content you are seeing is an advertisement or a paid partnership.
• The impression that 'everyone is having it done' most often does not reflect reality; those who have it done are simply more visible.
• Videos show the result; they mostly do not show the swelling, the bruising, the regret or the complication.
• Offers that hurry you, such as 'today only', 'special for students' or a benefit for coming with a friend, are a warning sign.
• Treatments carried out on oneself at home can spread among young people; we have explained the risks in our article “Needle-Free Filler Pens and At-Home Treatments”.

When should mental health support be considered?

Worry about appearance is normal in adolescence. In some young people, however, this worry becomes focused on a 'flaw' that others do not notice or see as very minor, takes up hours of the day and narrows their life. This condition, called body dysmorphic disorder, mostly begins in adolescence and often goes unrecognised. One review reports that it affects about two per cent of adolescents; however, this figure varies from study to study.

In this situation aesthetic procedures generally do not bring the expected relief; the worry may shift to another area or increase. The treatments shown to be effective are in the field of mental health: cognitive behavioural therapy and, where necessary, medication recommended by a physician. For this reason, if the following signs are present, a mental health assessment is recommended before any aesthetic procedure:

• Looking in the mirror very often, or avoiding mirrors altogether
• Constantly comparing oneself with others, and asking for reassurance again and again
• Constantly trying to hide an area with make-up, hair, clothing or posture
• Plucking, squeezing or picking in order to smooth the skin
• Avoiding school, friends or having photographs taken
• Insistently asking for a procedure for a detail that others do not notice, or asking for another procedure straight after one
• A marked change in eating pattern, excessive exercise or marked low mood

Suggesting mental health support does not mean blaming the young person or belittling their wish. The aim is to get them to the help that will truly bring relief. We have covered this subject in more detail in our article “Body Image and Aesthetic Treatments”.

What can parents do, and what should they ask the physician?

When a young person says 'I want to have this done', it is most often the start of a conversation. Saying 'no' straight away does not end the wish, it only ends the conversation; the young person looks for information, and sometimes for the treatment, elsewhere. What is more helpful is to ask with curiosity.

• What bothers you most? How long have you felt like this?
• Where did this idea start: did someone say something, or did you see something?
• What do you hope will change in your life after the procedure?
• What do you know about the risks and limits of this procedure?
• If we waited a year, what would we lose and what would we gain?

If the worry points to a real skin problem, going to a physician together is the right step. The questions you can ask the physician at the consultation are listed below.

A physician who inspires trust speaks directly to the young patient, involves the parent in the process as well, is able to say 'not now' or 'there is no need for this' when necessary, and allows time for the decision. A place that recommends a procedure without an examination, without asking the young person any questions or without querying their age, on the other hand, is a sign that you should stop and think again.