According to the ASPS survey, 38,136 teens had rhinoplasty during ‘08.

Like most surgeons, I prefer to wait until a patient is at least 18, when the nose is fully developed, before performing cosmetic nose surgery.

Of course, there are some exceptions, like when the condition of the patient’s nose is affecting his or her daily life or if the patient is unable to function in public due to the appearance or condition of the nose.

The youngest rhinoplasty patient I’ve had was 17.

I’m sure many of those 38,000 nose surgeries on teens under 18 are due to a functional problem inside the nose that restricts normal breathing. Many others are probably related to accidents and other injuries.

But, even with older teens, the plastic surgeon wants to know a few things before going ahead with the procedure.

For instance, does the teen:

• Want surgery for him-or-herself alone?

During the initial consultation, I carefully watch to make sure the desire for surgery is coming entirely from the patient, and not parents or friends. Plastic surgeons also watch for young people who unrealistically want the features of rock or movie stars. And is the desire for rhinoplasty a fad? Was it breast augmentation last week and liposuction the week before that?

• Understand the after care involved?

Having nose surgery is not the end of the process. The teen must be mature enough to realize that certain after care must be taken for a freshly rejuvenated nose.

I also want to see that the patient appreciates and understands the small risks that exist with any surgical procedure.

• Have realistic expectations?

Even if the procedure is cosmetic, is the teen mature enough to understand that a more attractive nose won’t solve all of life’s problems?

A better looking nose does give a person more self-confidence but it won’t make a young person a rock star, captain of the football team or the head cheerleader.

• Have allergies?

Plastic surgeons need to know if the patient has allergies because pollen, dust, pet dander and other substances can be breathed in through the nose to swell passageways and close off the nostrils.