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Join Babak Azizzadeh, a facial plastic surgeon, in discussing the sensitive topic of getting a nose job, or rhinoplasty, particularly for teenagers. We delve into the importance of thorough research, honest communication with parents, and understanding the risks and long-term effects of the procedure. Babak shares valuable insights on finding a qualified doctor, addressing parents’ concerns, and involving them in the decision-making process. Join us as we explore the crucial aspects of this life-changing decision and empower teenagers and their parents to make informed choices for their health and well-being.

Babak Azizzadeh is a facial plastic surgeon.

He discusses his KevinMD article, “How to approach teen nose jobs with parents.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Babak Azizzadeh. He’s a facial plastic surgeon. His KevinMD article is titled “How to approach teen nose jobs with parents.” Babak, welcome to the show.

Babak Azizzadeh: Thank you so much for having me, Kevin.

Kevin Pho: We’ll get into the article a little bit, but first off, briefly share your story and journey to where you are today.

Babak Azizzadeh: Yeah, so I’m based in Los Angeles. I did my undergrad, med school, and residency training at UCLA, and then I did my facial plastic surgery fellowship at Harvard in Boston, not so close to you but near where you are.

Kevin Pho: And your KevinMD article was about teen nose jobs. Give us some context. How often does this come up in your practice?

Babak Azizzadeh: I would say rhinoplasty in young adults and teenagers is very, very common. It’s probably, I would say, the number-one group of individuals who obtain or want to get rhinoplasty. So managing teenagers with their parents, who are typically paying for the service, is complicated and at the same time actually rewarding, because you’re navigating a complex relationship and a complex surgery. So it comes up often in my practice. That’s the number-one group of patients that I operate on, younger adult rhinoplasty.

Kevin Pho: And when you say younger adult, what is the general age range of these young adults?

Babak Azizzadeh: I would say in girls between 16 and 22, and boys 17 and 23. That’s generally when teenagers, college and high school students, are thinking about their appearance and want to do something about it if they’re being bothered by their nasal appearance.

Kevin Pho: So you wrote some great advice in your KevinMD article, “How to approach teen nose jobs with parents.” Now tell us, how did your article come together? What were some essential messages that you wanted to share?

Babak Azizzadeh: So the number-one thing is that I approach teenagers with a very serious and impactful approach. They are very well researched when they come in. They are much more researched than when I was a teenager or you were a teenager. They know a lot about the information. The information is typically coming to them through TikTok and Instagram, but they’re knowledgeable. They’re very knowledgeable, and you have to speak to them with a lot of expertise and details and approach them very seriously. That’s really the most important thing.

The next most important thing is navigating the relationship between the parents and the teenagers. Are the parents on board with this? Did they actually drive this or push this, or is it the teenager? Ideally, you want both the parents and the teenagers to be on the same page. Both are in agreement, both have done their homework, both have done their research, and now they’re here to get more information. So that is the most important aspect.

The other thing is it’s always OK to wait, right? They’re young, and they’re going to go through some changes. If they’re not on the same page, or there’s hesitance, or there are unreasonable expectations, wait it out. Do it next summer; you could wait. So I try to really calm down the families in terms of the urgency, because sometimes they’ll come and say, “Oh my God, I want to have this over Christmas break.” I’m like, “No, I don’t like doing rhinoplasty over Christmas break. There’s not enough time for recovery. You’re rushing things through.” So it’s really calming down, educating, and treating the young adults with the really detailed information that they’re looking for.

Kevin Pho: So you mentioned that a lot of these teenagers get these ideas and information from social media, like TikTok. Do you find that the information they’re coming with from social media is accurate? Do you have to spend a lot of time dispelling what they see online?

Babak Azizzadeh: So it’s interesting. The way that I do my consultations has changed so much over, I would say, even the last five years. I actually start out my consultation saying, “Look, throw everything you know out for a second. I’m going to educate you on anatomy, aesthetics, what’s realistic, and what’s not realistic, and then we’ll get into what you have heard about this.”

And once you educate them, and again, they’re knowledge-based, they’ve seen surgeries, many of them have actually seen live surgeries online and so forth, they get it. They understand it, and they understand that there are pitfalls to the information that they’re getting on social media. But sometimes you need to re-educate them, just like adults. Adults come in with the same exact problem, so it’s not just teenagers. But they do tend to get their information more from social media than from, let’s say, websites or word of mouth, which, you know, we were traditionally used to.

Kevin Pho: So for those who aren’t familiar with the procedure, walk us through it from beginning to end. Talk about some of the common indications that you see, the procedure itself, the recovery period, and I guess the expectations of what the final look would be like. Walk us through from beginning to end what would be a typical case that you would see.

Babak Azizzadeh: Yeah, so a typical case is a patient who comes in unhappy with the appearance of the nose. It could be that they have a big bump, it could be that they have a bulbous tip, it could be that they have a shallow bridge, a variety of different things. And because the nose is really central to our face, we actually don’t want a beautiful, perfect nose. We just want a nose that’s not distracting, so that people can focus on one’s eyes. That’s really the most important aspect.

So typically, people come in if they’re unhappy with the bridge or the tip. I would say those two things are the most common reasons they come in. Also, some people have breathing issues, breathing issues related to either allergies or a deviated septum or something in that sense. So we always want to manage those holistically and together.

As far as the surgery goes, it’s a very complex surgery. It’s not a simple surgery, even though it’s like, “Oh, it’s a little bump or tip.” It’s complex because, obviously, the anatomy is very three-dimensional. There is an artistic aspect to the results in addition to the technical aspects, and the healing process is unconventional, unlike almost any other body part. The healing process takes years to finalize, and depending on the techniques used, the individual’s anatomy, their skin type, and so forth, you can get a phenomenal healing process or you could get a not-so-great healing process.

But typically speaking, most kids go back to their social activity within a week to 10 days. In three weeks, the nose looks really good, but the final results take about two to three years to realize the refinements and so forth. When it’s done well, the satisfaction rate is actually very good, but not many surgeons do it well or do it often enough. It’s kind of like robotic surgery: You’ve got to do a lot of it to be good at it. Anyone can do robotic surgery if they’ve been trained, but the people who are great at it are the ones who do hundreds and hundreds and have done it over and over again. It’s the same thing. It not only requires that technical gift that some surgeons have, but also the artistic sense of what looks good and what doesn’t look good.

Kevin Pho: Any long-term complications that teens have to be aware of when considering it?

Babak Azizzadeh: Yeah, I mean, I think if the surgery is not performed technically correctly, structurally, the nose, the skin is so overpowering that if the nose is not structurally strong, things will change 10 years later, 15 years later. Cartilages can collapse, breathing issues can develop, and the nose can get what we call warps and change over time. So that’s why the surgeon is very important.

The conversation with the surgeon about what you’re looking for is very important, because you can’t just let the surgeon tell you what to do, and you also have to have reasonable expectations of what the surgeon’s artistic goals are. That’s where before-and-afters come in, and the surgeon’s experience and expertise come in. So all of that needs to go into getting a great outcome with this.

Kevin Pho: So for teenage patients looking for this, and you mentioned that the surgeon’s expertise, and artistic expertise for that matter, is so important, what kind of questions should they ask the doctor in order to find the right surgeon for them?

Babak Azizzadeh: Yeah, I mean, I think the number of rhinoplasties that the physician does on an annual basis, that’s important. Looking at their before-and-afters, because surgeons, we try to put really good before-and-afters on, but it shows off our artistic approach. If you don’t like someone’s before-and-afters, then you know that’s not going to be the right surgeon.

And then also, there are several techniques that surgeons use. Traditionally, it’s like, “Oh, do you do rhinoplasty with the open approach or a closed approach?” which are some technical aspects. If you try to push a doctor to do something they’re not used to, you are going to get a bad outcome. So you have to let the doctor say, “Look, this is what I’m comfortable with,” and if you’re comfortable with that, then go for it. If you’re not comfortable with that, find another surgeon.

Kevin Pho: You mentioned earlier that the best cases are when the teens and the parents are on the same page, right? So for those parents out there, let’s say a teen sees something on Instagram or TikTok and they’re interested in rhinoplasty. Now, from a parent perspective, what kind of questions should they be asking their teen to make sure that this is indeed the right step for them?

Babak Azizzadeh: I mean, I think the number-one thing is don’t dismiss the research that your children have done. Very few kids come in just not thinking about this, like, “Oh, I just want to get a nose job.” They’ve done a lot of homework, so don’t dismiss that. They’re getting their information in a different way, but they are getting some information, some good, some bad. But the same is true with word of mouth, right? We could get information from somebody who thinks they know everything, but they don’t.

But really, make sure that the motivation of the teen is the correct motivation, and that it’s not because some other problem or some other issue is happening and they think that by getting a rhinoplasty, or nose job, they will change that. So that is the most important thing I would say, that communication.

The other thing is some parents force their children to have this surgery, and I really believe that’s wrong. I’m not saying it doesn’t happen, and maybe we think, “Oh my God, I wish my kid had this or that,” but I think that’s putting a lot of pressure on them. This is a lifelong surgery. It’s OK to bring it up and say, “Hey, if you’re not happy with the appearance of your nose, you can have surgery.” But pushing your kid or making them feel bad about themselves because of a physical feature that you don’t like is really creating lifelong trauma and problems, and children who’ll become very insecure adults.

Kevin Pho: Now take us into your exam room. What were some cases that raised red flags for you, that you personally saw, that made you think, “Hey, this isn’t the right thing for that teen”?

Babak Azizzadeh: Yeah, so whenever someone comes in with a lot of minutiae, “I don’t like this little shadow, I don’t like that,” that’s a major red flag. Rhinoplasty, or any plastic surgery, is really about the global changes: “Look, I don’t like the appearance of my nose. I’d like to improve that appearance.” But when someone says, “Oh, I don’t like this shadow, and I think I need to use a spreader to improve that,” or they’re telling me technical terms, that person will end up having an unsatisfactory result, because they probably have some other issues that need to be dealt with, like body dysmorphic syndrome and other more complicated psychologic issues. So that, I would say, is the most important thing that we want to avoid.

The other thing is some people come in and say, “Look, I don’t like this bump, and I think I’m going to look a hundred times better doing it.” That’s not the case. Generally speaking, we want to give feedback to young adults or teenagers about what impact this is really going to make. It’s probably not going to make as much impact as they’re thinking.

Now, on the other hand, a really great example of when this surgery really helps: I had a teenager, a young 15-year-old girl, and she had a very large, unattractive, masculine nose on a female. She was being bullied from the age of 10. She stopped going to school because of it, and they had searched all around the country, because we have a lot of traditional ways of approaching things with age and so forth, which I’m not a big believer in. I think we have to look at each individual differently. We did a rhinoplasty on her, and after that she started going to school and socializing. Her life changed.

So this is something that, actually, with a lot of children, we have to look at more like how we treat lop ears, which can have a tremendous social, psychosocial impact on them. It’s the same thing with rhinoplasty. When someone has a nose that does not fit their face and is a big, distracting feature, and people are teasing them left and right, that’s something that we can fix and help. So there are times that it’s not so frivolous, that it’s not just a minor, subtle problem, and I think it can be very impactful in those individuals.

Kevin Pho: In general, what percentage of teens who come to your clinic are indeed appropriate candidates for rhinoplasty?

Babak Azizzadeh: Oh, I would say about 75 to 80 percent. It’s actually a high percentage, and it may be skewed because of my practice, but I would say the majority are very knowledgeable. They’ve done their homework, they have a real issue that they’re concerned with, which I think can benefit, and they come in with knowledgeable parents. Twenty percent of the time, they fall into categories, either the parents, the young adult, or the issue, or they have some other psychosocial issues that are not going to be amenable to it.

Kevin Pho: And what is the general price range for this procedure?

Babak Azizzadeh: That’s a great question, and that really varies, I would say, from region to region, as well as with the expertise of the surgeon. The very top-notch experts around the country probably charge in the range of $15,000 to $30,000, but you can probably find a rhinoplasty somewhere for $5,000, $6,000, $10,000. But it is an operation.

Interestingly enough, Kevin, I had this operation myself. That’s one of the reasons I was really attracted to this surgery. I had a crooked nose, and growing up, I was teased all the time. But the doctors that were in my price range when I was a kid, and I didn’t have a very high price range, my parents couldn’t afford it, I hated the results. I didn’t like the results they were producing. So I just waited until I could afford the surgeon that I thought had the best results, and had it.

So you can wait. I mean, this is not something you should rush into. It is something that you should take your time with, and make sure that you find the right surgeon and that you’re doing it at the right time for yourself. And if you’re a young adult or teenager, do it in collaboration with your family, with their blessing, in a way.

Kevin Pho: Would you say there is a correlation between price and expertise?

Babak Azizzadeh: I would say yes, and it’s a very rare thing that I would say that. I would say yes because I know the top doctors in the country, and they’re the ones who have refined their artwork. They have spent years perfecting and learning, and they’re not rushing and doing a hundred of these a week. They’re doing two, three, four surgeries a week, and they’re spending a lot of hours. So they are going to charge more than someone who is maybe fresh out of training, or doesn’t do it that often, or has a mill, a factory, where they’re doing three or four surgeries a day, five days a week. So I would say yes, but with an asterisk.

Kevin Pho: He’s a facial plastic surgeon. His KevinMD article is titled “How to approach teen nose jobs with parents.” Babak, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Babak Azizzadeh: Yeah, I mean, I think, like in any other situation, communication between the teenager and the parents is really important. That’s number one. Doing your basic homework and research. Having reasonable expectations: These surgeries are not going to change people’s lives, with certain exceptions, as I outlined. And seeing a couple of doctors, making sure that the artistic side of it is as important as the technical side. Once those are all brought together, I think this is an amazing operation that can really change and be very impactful in people’s lives.

Kevin Pho: Babak, thank you so much for sharing your time and insight. Thanks again for being on the show.

Babak Azizzadeh: Thank you, Kevin. It’s really an honor.