Adolescence refers to the transitional period between puberty and adulthood. The World Health Organization defines an adolescent as a person between 10 and 19 years of age, but commonly it is used to describe individuals typically between ages 13 and 19 [1]. In recent years, there has been a significant surge in social media usage among adolescents, with platforms such as Instagram, TikTok, and YouTube gaining immense popularity. While these platforms were initially intended for communication and entertainment, their excessive use has inadvertently fostered environments for social comparison and negative self-perception, particularly concerning one’s physical appearance.

Today’s adolescents face an unprecedented level of vulnerability to bullying and mockery, both online and offline [2]. Appearance-based teasing has become more pervasive and persistent, leading to a range of psychological issues such as low self-esteem, anxiety, stress, and in extreme cases, suicidal ideation [3].

In response, some adolescents seek cosmetic procedures to address specific concerns that may be sources of bullying. Procedures such as acne scar revision, Botox for hyperhidrosis and its associated complications, and laser hair reduction, when performed by trained experts, are generally low-risk. For example, laser hair reduction is considered safe in patients beginning two years after menarche [4]. When appropriately indicated, such interventions can significantly boost a teen’s confidence and self-esteem, particularly in cases where they are targets of bullying.

Acne scar revision can be done by various procedures such as microdermabrasion, dermaroller, fractional lasers, microneedling, radiofrequency, or chemical peels. Almost all of these procedures are safe and can be recommended to patients aged 16 years and above [4]. Acne scars are one of the more common aesthetic concerns seen in adolescent dermatology. While active acne itself may cause immediate distress, the residual scarring can lead to a long-term negative body image and reinforce social withdrawal. When undertaken by trained professionals, these procedures are not only safe but can have a huge psychosocial impact on the patient’s life.

However, in clinical practice, dermatologists often encounter a common conflict—adolescents requesting relatively safe cosmetic procedures often face resistance from parents or guardians. Legally, minors require guardian consent for any elective procedure. Even if an adolescent demonstrates the proper understanding regarding the procedure, its effects and possible outcomes. and appears capable of informed consent, proceeding without guardian approval can result in medicolegal repercussions.

This scenario raises a tough ethical dilemma that involves bodily autonomy, mental health, and legal guardianship. On one hand, there is a young individual suffering from genuine emotional distress, potentially exacerbated by bullying, social ridicule, and isolation. On the other hand, the law and traditional ethical frameworks state that the decision-making authority lies with parents or a legal guardian. Denying the procedure could prolong the adolescent’s psychological suffering, whereas proceeding without parental consent could be viewed as a breach of medical ethics and legal responsibility.

In such situations, it is crucial to sensitively navigate family dynamics and understand any cultural values that may underlie parental hesitation. A calm, mediated discussion where all parties can voice their concerns often proves helpful. Counseling sessions help to highlight the emotional impact of the issue on the adolescent and demonstrate the safety and benefits of the procedure. In some cases, involving a psychologist or counselor may help assess the adolescent’s psychological readiness and facilitate communication between the teen and their guardian.

From an ethical standpoint, healthcare providers must weigh the principle of beneficence, that is, promoting the patient’s well-being against non-maleficence (do no harm) and respecting the patient’s own bodily autonomy, which in case of minors, is only partially realized through parental influence. The principle of justice may also be applicable as the adolescent faces stigma and isolation due to treatable aesthetic issues [5].

Ultimately, while the clinician is bound by the legal requirement for parental consent, they also play a vital role as an empathetic advocate for the adolescent. By promoting open dialogue, providing accurate information regarding the procedure’s safety and outcome, and by giving priority to the adolescent’s well-being, healthcare providers can help families reach a shared decision that honors the emotional and physical needs of the patient.

In conclusion, elective cosmetic procedures in adolescents, when indicated for psychological or social well-being rather than vanity, should not be dismissed straightaway. With appropriate counseling, assessment of the teen’s readiness, and proper parental engagement, everyone can be part of a holistic care plan. It is imperative that ethics policies evolve in tandem with societal changes to address such nuanced realities in adolescent healthcare.

REFERENCES

1.World Health Organization. 2018. Last accessed on 2025 June 5 Available from:https://www.who.int/southeastasia/health-topics/adolescent-health

2.Gámez-Guadix M, Orue I, Smith PK, Calvete E. Longitudinal and reciprocal relations of cyberbullying with depression, substance use, and problematic internet use among adolescents. J Adolesc Health. 2013;53:446-52.

3.Plexousakis SS, Kourkoutas E, Giovazolias T, Chatira K, Nikolopoulos D. School bullying and post-traumatic stress disorder symptoms:The role of parental bonding. Front Public Health. 2019;7:75.

4.Khunger, Niti;Pant, Hema1. Cosmetic procedures in adolescents:What’s safe and what can wait. Indian J Paediat Dermatol. 2021;22:12-20.

5.Varkey B. Principles of clinical ethics and their application to practice. Med Princ Pract. 2021;30:17-28.