In 1996, at least 14,000 teens had cosmetic surgery. The actual number is probably much higher - perhaps even twice as high - since these statistics do not include procedures performed by dermatologists, ophthalmologists, otolaryngologists, and other specialists.

Traditionally, the teen who underwent cosmetic surgery probably had a nose reshaped (rhinoplasty) or protruding ears pinned back. While these are still the most common operations, other, more controversial procedures are increasing (see chart below). These include liposuction and breast augmentation, procedures LoVerme, and many other cosmetic surgeons, believe are inappropriate for teenagers. However, breast reduction is another story. "A teenager with very large breasts is self-conscious and takes a lot of teasing," LoVerme says. "When the problem is corrected, it makes a world of difference."

Surgery for teenagers is a relatively small part of LoVerme's practice. Much of his work on children is treatment of injuries caused by sports and auto accidents. "One spring, I repaired a broken nose every week," he recalls. "They were either baseball or softball injuries." He also travels to underdeveloped countries every year with an organization called Healing the Children to repair congenital defects, primarily cleft palates. Last year was his fifth trip to El Salvador as part of a medical team that performed 78 reconstructive procedures in one week.

"With any cosmetic procedure, you need to be sure the patient has realistic expectations about the outcome," he says. "Someone who thinks having a nose straightened will change their life is not a good candidate for surgery." Lauren had no such expectations. She merely wanted to look better. After a few months of discussion, the family decided to have the procedure done in early summer, giving Lauren a few months to recuperate before starting high school in September.

Lauren's surgery took 1 and a half hours and was performed under general anesthesia. To make the nose smaller, LoVerme brought the nasal bones together to form a narrower bridge, and trimmed cartilage to refine and reshape the tip. He also removed a small portion of the muscle that connected Lauren's upper lip to the septum, pulling her lip up when she smiled. All the surgery was done from inside her nose and mouth.