Bridging the generation gap-dilemmas of a cosmetic surgeon.

Body art in the form of tattoos and piercings is increasing in popularity among the young generation. Though ancient art forms, they are now being seen as tools to enhance body image and self-esteem and are mostly done under peer pressure.

Tattooing is the tradition of introduction of permanent colored pigment granules in the skin, being carried out by tribes since ancient times. However, in today's generation, it is considered a fashion statement. Getting a tattoo may seem easy and cool, but getting one removed is a tedious and prolonged procedure. Fortunately, with the advent of the Q-switched lasers, tattoo removal has become less cumbersome. However, complications can arise and erasing the tattoo is not always complete, with ghost images and persistent pigmentation being common, particularly in professional and colored tattoos. This issue highlights the risks of tattooing and also discusses the complexities and newer trends in laser tattoo removal.[1234]

Another traditional art form, body piercing with decorative jewelry, at sites other than the earlobe has grown in popularity in the past decade among teenagers and adults. The eyebrows, nose, tongue, lips, nipples, navel, and genitals may be pierced. Though the exact incidence of complications is not known, body piercing can be a risky procedure, particularly in uncommon sites such as the oral cavity and the genitals. Adverse effects that can arise include local and systemic infections, foreign body and allergic reactions, and tears and lacerations. Hypertrophic scarring and keloid formation are also common in susceptible individuals. At times, the jewelry can get embedded in the tissue as highlighted in a report in this issue.[5] A majority of these procedures are carried out on the roadside, without any regard to proper aseptic precautions. Another worrisome trend is that apart from the risks of tattooing and body piercing, these individuals may at times exhibit other high-risk behaviors, making them prone to sexually transmitted infections and drug addictions. Dermatologists and physicians practicing cosmetology must be aware of the hazards and the treatment of complications arising from these procedures. The symposium in this issue on laser tattoo removal covers all aspects in detail.

Another important ethical issue that can confront an aesthetic surgeon today is cosmetic surgery among teenagers. The article on ethics in this issue discusses this problem.[6] Cultural and social practices as well as the social media are playing a large role in the increasing demand for these procedures in younger and younger patients. According to the American Society of Plastic Surgeons (ASPS) statistics, 63,623 cosmetic surgical procedures and 155,941 cosmetic minimally invasive procedures were performed in the US among teenagers aged 13-19 years.[7] Breast surgery for asymmetry or enhancement, gynecomastia, rhinoplasty for misshapen nose, otoplasty for protruding ears, liposuction, genital surgery, laser treatment, and correction of scars caused by acne or trauma are some of the common procedures sought by teenagers. However, the desire to improve one's appearance can cross the line to psychopathology in the absence of an overt deformity. Adolescents often seek surgery to avoid being teased or bullied. However, the psychological burden on a young impressionable mind unable to resist peer pressure cannot be underestimated. They often have an inflated sense of benefit and a minimized sense of the risks involved. This is the dilemma faced by surgeons; to do or to wait. The surgeon must consider several points before deciding to do a surgery. Is the procedure necessary at this age, are the expectations realistic, and are the teenager and his/her parents aware of the risks involved? A detailed informed consent, effective counseling, and a cooling period to rethink the procedure are recommended.

Counseling this young generation to desist from risky practices and permanent procedures is a difficult task for parents and physicians alike. They are often rebellious and do not think of the long-term effects. The need of the hour is that they must be encouraged to think that what they consider a trendy and cool practice today may be associated with complications, difficult and painful to treat later on in life. To do is easy but to undo or delete is difficult and often incomplete. Jimmy Buffett aptly sings,[8]

“She said a tattoo is a badge of validation,

But the truth of the matter is far more revealing,

It's a permanent reminder of a temporary feeling”.