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The Right Time for Pediatric Plastic Surgery

Cosmetic or elective treatments in children is a topic not without controversy.  Whether to perform elective treatments and the timing of these are questions that come up frequently in our practice; and we recently asked our plastic surgeon Dr. Inessa Fishman to expand on them.

“The answers to questions about plastic surgery in children are not simple,” says Dr. Fishman. “I treat newborns for congenital ear deformities; 5- and 6-year-olds for misshapen or prominent ears; 12- and 13-year-olds for overweight and obesity; and 15- and 16-year-olds for cosmetic and functional nose and labial concerns. I carefully consider physical age and emotional and intellectual maturity in the timing of treatments, and think that decisions of whether to treat and when to treat should be carefully considered by all parties involved.”

Treatment Timing and Patient Understanding

Newborn Ear CorrectionIdeally, a child is able to understand the details of treatment, and the risks and benefits and recovery involved, but of course this is not always possible, Dr. Fishman notes. In the setting of newborn congenital ear correction, Dr. Fishman must start treatment ideally within the first 2-3 weeks of life, and recommend treatment be started as early as possible for best chance of success. In this setting, she makes treatment recommendations to parents and related healthcare providers like Pediatricians and Audiologists.

In-depth Discussions Before Surgery

In the setting of cosmetic and/ or functional rhinoplasty or labiaplasty, she likes to have a thorough discussion with the patient and caregivers before recommending treatment. “The patient’s autonomy, the drive to do no harm, the desire to improve functional concerns and to take away causes for insecurity–I carefully consider all these factors during my decision-making and treatment,” says Dr. Fishman.

Addressing Peer Ridicule and Aesthetic Concerns

Studies show that children with congenital ear deformity face peer ridicule starting around age 6-8 years, and one of our goals in using the Earwell therapy to treat ear deformity is to decrease the chance of this teasing, in addition to restoring a more “average” appearance to the affected ears.  In the setting of teenagers pondering nose surgery or labiaplasty, we usually discuss a combination of aesthetic and functional goals of treatment, as concerns tend to involve breathing difficulties or addressing results of previous nose trauma; improving comfort from excessive rubbing or irritation of labial tissue; and addressing appearance concerns.

Balancing Benefits and Risks

Benefits must outweigh risks when considering any treatment, including elective surgery or non-surgical therapy, says Dr. Fishman.  In caring for a minor or young child, we consider benefits, risks, health, age, and mental, physical, and emotional maturity carefully when making decisions for young patients.  Every patient–and their family and support system–is considered on an individual basis, with multiple factors weighing in on the decision to pursue elective treatment, and when. 

Dr. Fishman’s Commitment to Patient Care

“It is a privilege to care for people, and I am honored to receive the trust of families in caring for their child,” says Dr. Fishman.  “As a physician, surgeon, and parent, I want to make the best decision for all my patients–including the young patients who are unable to make treatment decisions–and these considerations and my desire to do my best, always, are integral to why I love the practice of medicine.”

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