In recent years there has been a noticeable global rise in the number of teenagers under the age of 18 choosing to undergo plastic surgery. This is a complex social phenomenon driven by cultural influences, social pressure and sometimes genuine medical need. Israel is reporting a similar trend: the Israeli Association of Aesthetic Plastic Surgeons notes a dramatic 56 percent increase in demand for plastic surgeries ahead of the long summer break, mainly nose, ear and breast procedures performed under general or local anesthesia.

According to the association, the main reason teenagers opt for plastic surgery during summer vacation is the chance to recover at home away from the curious eyes of classmates. Returning to school in September after the recovery period allows them to start the new academic year with a fresh appearance and greater self-confidence without many people around them knowing about the procedure carried out in July and August.

At the same time, the association stresses that before deciding on surgery it is essential to confirm that the desire for change does not stem from a passing whim, social pressure or temporary peer influence, and that the summer break is not being used simply to undergo a surgical procedure without understanding its long-term implications.

"The war has ended, the sense of uncertainty has decreased and the long summer vacation is beginning," says Dr. Meir Cohen, a specialist in plastic surgery and chairman of the Israeli Association of Aesthetic Plastic Surgeons. "All of these factors have led to a roughly 56 percent rise in inquiries to plastic surgeons' clinics this year for procedures during July and August. These are surgeries performed under general or local anesthesia, of course with written parental consent and only after we verify that the expectations of the teenagers are entirely realistic before carrying out the surgical procedure itself."

He notes that it is important for the family discussion before approaching a surgeon to take place in front of a regular mirror rather than a selfie, which tends to distort facial features and create an optical illusion that makes the nose appear disproportionately large and prominent.

"If a photo is used, it is better to take it from a distance of about one and a half meters from the face," explains Dr. Cohen. "When shooting up close the nose always looks larger than it really is simply because it is closer to the lens." He adds, "Although summer offers a convenient time, it is very important that parents together with the surgeon thoroughly examine the emotional and physical readiness of the adolescents for the surgery itself and for the recovery period in particular."

Alongside other influences, Dr. Cohen says artificial intelligence tools have also recently become an inseparable part of meetings with teenagers. "Today the chat even sits with us in the meeting," he says. "Teenagers arrive with entire conversations they conducted with it, with 'before and after' images the artificial intelligence created for them and with answers they received about the surgery. In many cases the recommendations they bring also include details of risks and complications."

Despite concerns about the impact of technology and social media, he sees advantages as well. "There is no choice, this is part of our new lives and we must address it. Overall artificial intelligence is a positive thing in this field because people arrive much more informed. Usually the answers they receive are balanced and their quality is only improving."

Social media, he says, does not only have negative effects. "There are teenagers who share the surgeries they underwent and also the complications they experienced. This exposure brings information from different directions and I do not think it is a bad thing. People arrive better prepared for the meeting with the doctor, see both successes and failures, and ultimately make more informed decisions."

According to Dr. Cohen, age alone is not enough to decide on surgery. "The first barrier is of course the appropriate age for each procedure, but afterward it is necessary to understand whether the teenager truly grasps what the surgery means - the recovery period, the risks and the possibility of complications," he says.

He notes that a joint conversation with the parents already takes place at the initial stage. "It is important that they bring the mature perspective and connect the adolescent to reality. We show images of the recovery process, explain what bruising is, what a swollen nose looks like after surgery and what to expect in the first weeks. It is necessary to understand that there is a process so that it does not become traumatic."

The patient's emotional state is also examined as an integral part of the process. "We look at the person sitting in front of us. Is he or she introverted? How much hope is pinned on this surgery? If a girl says the surgery will change her entire life - that is already a red flag. Even when someone complains about a nose that looks completely normal and the problem presented is very minor, careful thought is needed about whether it is right to proceed."

He adds, "Nose surgery is the surgery of the summer and this situation must be navigated together - the doctor, the parents and the patient. Personally, with nose surgeries and others as well, I try to postpone as much as possible and tell the adolescents: 'Come back in another year, after the army, and we will discuss it then.' This age is an unstable platform."

Despite the concerns of many parents, Dr. Cohen says cases of regret after procedures such as nose surgery or ear pinning are not common when suitability is assessed correctly. "I have not seen anyone who had a large nose, asked for a proportionate nose and later regretted it. After ear pinning we also hardly ever see regret," he said.

At the same time he warns against overly aggressive surgeries. "There are cases where the nose was made too small, especially among men, and it no longer looks natural. That is very difficult to correct and some people spend their entire lives undergoing revision surgeries."

He says the area that concerns him most is breast augmentation at a young age. "This is not an innocent procedure. It is a decision that may accompany the patient for years to come. That is the central message - this needs to be thought through very carefully. It is not just any surgery but an 'accessory' that you need to be aware is inside your body."

So at what age is plastic surgery already possible? The answer is not uniform and depends on the type of procedure, the pace of physical development and sometimes the emotional maturity of the patient. Standard recommendations set physiological boundaries for each surgery in order to avoid interfering with natural growth processes, yet in certain cases they also allow flexibility according to individual circumstances.

Nose surgery: It is recommended to wait at least until age 17, since the nose completes its anatomical and physiological development around that age. According to the association, intervention too early may adversely affect natural growth processes. The association also notes that before nose surgery it is important to remember that selfies tend to enlarge the appearance of the nose, so parents are advised to conduct the conversation with adolescents in front of a mirror or using a photo taken with a regular camera.

Ear pinning: Since the structure of the ear finishes developing around age six, the surgery can be performed at that age and there is no obligation to wait until adulthood. The decision depends on the severity of the condition and consideration of the child's mental state. If significant distress exists, the procedure may be considered even for young children and teenagers, and there is no reason to wait when the child is suffering socially.

Breast reduction for boys: In cases of breast tissue enlargement in boys, known as gynecomastia, it is recommended to perform the surgery only from age 16 onward even if the condition is noticeable at a younger age. If the boy is overweight the recommendation is to wait and accompany the process with controlled weight loss before surgery.

Breast augmentation or reduction for girls: The clinical recommendation is stricter. The association advises performing breast augmentation only after age 18 and preferably waiting until age 21 because the breasts are still developing. Since the surgical procedure may disrupt natural physical development it is better to wait an additional year or two until growth is complete, even when there is full parental support. There have already been cases in Israel and abroad in which girls who underwent breast reduction at a young age later experienced renewed breast growth to similar dimensions after weight gain several years later.