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In this episode of the Plastic Surgery Practice podcast, host Alison Werner interviews Babak Azizzadeh, MD, FACS, a double board-certified facial plastic and reconstructive surgeon and director of the Facial Paralysis Institute in Los Angeles. They discuss the nuances of plastic surgery and aesthetic procedures for younger patients, focusing on rhinoplasty and lip fillers.

Overview of Topic

Azizzadeh elaborates on the increasing demand for aesthetic procedures among younger individuals. He provides insights into the physical and social factors influencing the decision to undergo procedures like rhinoplasty and lip fillers, emphasizing the importance of timing and psychological readiness.

Key Takeaway 1: Considerations for Rhinoplasty in Young Patients

Azizzadeh highlights that rhinoplasty is most popular among teenagers and young adults, typically between the ages of 16 and 24. The physical readiness for surgery depends on the individual’s growth and development, with girls often being ready around 15 or 16, and boys a bit later. He stresses the importance of ensuring that the septum and facial growth are complete to avoid stunting facial development.

Key Takeaway 2: The Social Dynamics of Surgery

The social aspects of plastic surgery for minors are complex. Azizzadeh points out that both the patient and their parents must be aligned in their decision-making. Effective communication and mutual agreement are crucial. He also addresses the significant psychosocial impact of nasal deformities, noting that timely intervention can prevent bullying and improve social interactions.

Key Takeaway 3: The Psychological Evaluation Process

Azizzadeh explains that the initial consultation with young patients and their parents is thorough, often lasting up to an hour. During this time, he assesses the psychological readiness and maturity of the patient, as well as the family dynamics. He emphasizes the importance of realistic expectations and continuous evaluation to ensure the suitability of the procedure.

Key Takeaway 4: Timing and Recovery for Surgery

Timing the surgery is critical, with Azizzadeh preferring to schedule procedures early in the summer to allow for ample recovery time. He explains that while the initial recuperation from rhinoplasty is quick, the final results can take longer to manifest, necessitating a more extended recovery period to achieve optimal outcomes.

Key Takeaway 5: Lip Fillers in Younger Patients

Lip fillers are increasingly popular among young adults, particularly those in their 20s, driven by social media influence. Azizzadeh advises a conservative approach, starting with small amounts of filler to achieve a natural look. He warns against overdoing lip fillers, which can result in unnatural appearances and necessitate correction.

Key Takeaway 6: The Impact of Social Media

Social media has profoundly changed the landscape of plastic surgery, making younger patients more informed and opinionated about their desired procedures. Azizzadeh acknowledges the challenge of managing expectations but finds that younger patients are generally open-minded and receptive to professional advice.


Azizzadeh appreciates the enthusiasm and satisfaction of younger patients when procedures are done correctly and conservatively. He emphasizes the importance of education and realistic expectations, ensuring that both physical and psychological factors are considered before proceeding with any aesthetic procedure. PSP

Podcast Transcript

Alison Werner 0:04
Hello and welcome to the plastic surgery practice podcast. I’m your host. Alison Werner, for this episode, I talked to Dr Babak Azizzadeh about plastic surgery and aesthetic procedures with younger patients. Dr Azizzadeh is double board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology, Head and Neck Surgery. He is the director of the Facial Paralysis Institute in Los Angeles, and an associate clinical professor at the David Geffen School of Medicine at UCLA. Here’s our conversation. Dr Azizzadeh, thank you for joining me today.

Dr Babak Azizzadeh 0:35
Thank you so much for having me. Alison, I’m really excited.

Alison Werner 0:39
So, we’re going to now talk about plastic surgery and younger patients, but we’re also going to talk about aesthetic procedures. So to get started, we were going to talk about rhinoplasty. Can you talk to me about that younger population? What ages are we dealing with here?

Dr Babak Azizzadeh 0:56
So rhinoplasty, obviously, are commonly known as nose job, and the lay public is is a procedure that’s really probably one of the most popular, if not the most common, procedure that’s done from an aesthetic perspective, and a large portion of the patients who do undergo rhinoplasty are teenagers and young adults, typically speaking, between the ages of 16 to 24 I would say that’s the largest portion of patients, at least in my practice. And obviously, when we’re dealing with individuals who are minors, we really need to be considering a lot of different factors, because we have to take into consideration their physical ability to undergo surgery, and then the social factors that go into undergoing surgery. So on the physical side, you know, boys and girls age differently, their bone structure is different. They undergo puberty at different times, and because of that, there is some variation in terms of the timing of when you want to do rhinoplasty from a physical perspective. In young girls, typically, we want to look at when they had their first period and wait at least a year or two after that. That typically falls anywhere between 15 and 16, and we want to make sure that they’re finished with their growth. A lot of times, one of the questions we ask is, have they changed their height? Have they had any changes other than the typical standard physical changes, and that gives you a guidance of when physically they are ready. With boys, it’s a little bit later, because boys tend to undergo puberty a little bit later they can and they continue to grow. So I know this is long winded, but the reason, physically, we don’t want to do it earlier is because the septum, which is this kind of the internal cartilage inside the nose, that’s often addressed, in addition to the external aspect, is the growth center of the cheeks and the mid face. So touching the septum can impact the actual facial growth, and the mid face facial growth is really important to our attractiveness and beauty, so we don’t want to stunt that. We don’t want to impact that. So that’s kind of a summary of the physical aspects of undergoing rhinoplasty.

Alison Werner 3:40
Okay, so what about the social aspects you mentioned?

Dr Babak Azizzadeh 3:43
So the social aspects are much more complicated, because most of the time, obviously all the time, minors come in with their parents. The parents are involved, generally speaking, in the decision making process. So you want to make sure you have really two stakeholders, the patients and the parents in this process. So number one, we don’t want it, we want to make sure that the patients really want to have this. We want to make sure that they physically need to have it before jumping into needing it. And we want to make sure that the communication between the patients and their parents is really, really solid. They need to be mature. The discussions need to be mature. There can’t be bickering. You can’t have the parents forcing their kids to have rhinoplasty and vice versa. Some kids are driving their parents in and making them pay for this procedure. So it needs to be, all of this needs to be really all happening together at the same time. There can’t be any question marks. If there are question marks, I always suggest waiting an additional year or two and revisiting. The procedure. The other factor that goes into it that’s not talked about almost ever, which I’ve published on, is nose and nasal deformities can have a tremendous amount of social impact on kids. Major nasal deformities, very large noses, very no just like kids who have like loppy or kids can get teased, kids can really have a significant psychosocial impact in school. So sometimes we wait, actually, too long to address issues related to major nasal deformities. So I’ve published on this extensively. I think we need to think about a nasal deformity, kind of like what we do with ears and other factors, and address those a little bit earlier than later.

Alison Werner 5:51
When you have a patient come in, a younger patient come in, how many appointments are you doing to kind of feel out them and the parents and figure out some of these social issues.

Dr Babak Azizzadeh 6:02
Yeah, so plastic surgeons are really good at psychology. So it’s, it’s a lot of what we do involves psychology, analysis, sociology and so forth. So typically, our first discussion is a pretty lengthy one. It’s between 30 minutes to an hour, closer to an hour we, you know, have, you know, obviously, listen to our patients and the parents what their goals are. Make sure those goals are realistic. Make sure they’re valid. If they’re coming in for a little thing, you know, don’t do anything. You’re going to wait. But if it’s like kind of a, more of a, I would say, major issue, or moderate to major issue. You then continue the discussion. We go through an educational process of what you know, the anatomy is, what the before and afters can look like, and that, you know, really give them a view of like this isn’t going to change your life for the most part. There are certain cases that it does change our life, but for the most part. And then lastly, we do a morphing, three dimensional morphing. Throughout this hour, I am listening for cues. I am hearing body language. I’m looking at the body language and the interaction between the parents and the kids to make sure that there isn’t any red flags. If the kids are mature, their issues are valid, the parents are supportive, and vice versa. They’re a good candidate. If any red flags and these factors come in, I generally tell them to wait an additional year. Let’s revisit. So that’s really our first evaluation, and then if they decide to proceed with surgery, and I agree with it, we have a second evaluation closer to the surgery date. I have canceled many patients during that time because if I see any red flags popping up, any of the issues that I’ve outlined. So that second preoperative consultation is another touch point where we want to make sure that everyone’s on board, everyone’s really looking at this in the correct way.

Alison Werner 8:15
So then once you’ve gotten to that point of it’s right for this patient, what are we talking next in terms of procedure and timing?

Dr Babak Azizzadeh 8:24
Yeah, so that’s a good question. I generally like, from a procedure perspective, to do these in the summer, early in the summer, so that the kids have plenty of time for recovery. Rhinoplasty, unlike many other surgeries, healing process a little bit takes a little bit longer. You know, the recuperation is very fast, but the healing process of the nose, the final results are a little bit slower than other plastic surgery procedures. So I don’t want to rush the patients in terms of that recovery. When I was training, it was a very, very, very and still today, like it was like spring break, Christmas break, a lot of people, but it was like one or two weeks, very, very quick. So now I try to kind of put everyone in the May, June area time period, so that they have plenty of time during the summer to recover. And you know, preoperatively and postoperatively, obviously, the parents are very involved in the post operative process with the kids. We’re very involved in the post operative process with the kids. Kids do really well. I mean, the and to be honest with you, probably they are the happiest plastic surgery patients we have, if you choose correctly, because it really it’s important to them. It’s really important, and it’s something that, for the most part, when they come in, they’ve really thought about it, and they’re well researched, because now they have, you know, the internet, they have social media. Sometimes some unrealistic expectations exist, but we can kind of manage that.

Alison Werner 9:58
Okay, so I want to switch gears just a little bit to talk about lip fillers, because that is another procedure, non surgical, that you’re seeing in your practice with younger patients. So what age range are we talking here?

Dr Babak Azizzadeh 10:13
Yeah, I mean lip filler, lips are tremendous, tremendous area of interest in in young adults, 20 and up, and older adults too. But really, I would say age 20 and up, you just see, you know, over the last five to 10 years, because of social media influencers, there has been a tremendous increase in interest in utilizing lip fillers. So it’s a common procedure that I would say we see in all age groups, especially in young adults, in, you know, in the age range above 20. And it’s a satisfying procedure, if it’s done correctly, judiciously and safely, because sometimes you get almost like lip dysphoria, where you don’t know, the patient doesn’t know how much to augment and what looks natural and what doesn’t. So you just have to, as the practitioner, you just have to take it one step at a time and really, really go slowly, go conservatively, so you get an authentic, you know, kind of, you know, a result that people don’t know. That individual has had lip fillers. And over the past year, I would say, I’ve seen more people come back to erase the lip fillers than ever built before because they were overdone. They got duck lips, they got these weird look, and people are no longer looking at their eyes, and that’s the focus, right? When we do no surgery, when we do face surgery, when we do lip augmentation, we don’t want that area to be the area that the casual observer is looking at, right? We want them to look into their eyes. And so when the lips is the only thing that when you’re out on a date or you’re socializing, people are looking at that’s not a great look. So lip fillers just need to be done very, very judiciously.

Alison Werner 12:27
Is there a difference between a lip filler candidate or a patient at 20 versus 35, 40?

Dr Babak Azizzadeh 12:37
Yeah, I think the results, believe it or not, are better in a 20 year old because their lip volume, the elasticity of the lips, the mass of the lips, the muscles of the lips are firmer and have less looseness to it. So a little bit of filler can go a long way, whereas let’s kind of like really separate it out to someone who’s 60, right? They have a lot of atrophy. The elasticity is really poor. The lip have really kind of, you know, involuted. So the difference between a 20 and a 60 year old is tremendous and definitely more satisfying in a 20 year old than a 60 year old, because it’s really hard to get in a 60 year old, we have to go more towards lip lifts rather than surgical Yeah, so that we can kind of shorten the upper lip, naturally avert the lip so and there are some younger patients that we like doing lip lifts for as well. And some people don’t need lip fillers. They need lip lifts. But for the most part, the more with fillers in general, the better the tissue elasticity, the better the results, because the filler has a place where it can kind of expand itself, so you don’t need as much filler, and you could get a more natural result.

Alison Werner 14:02
What do you consider kind of best practice when it comes to lip fillers in a younger patient?

Dr Babak Azizzadeh 14:07
Yeah, I mean, start slow. Start very slow. Hyaluronic acids, obviously, I think that’s, you know, and everyone has their preference, you know, in terms of what hyaluronic acid gel to use, but go very, slow. And, you know, it’s hard to do that, right? Because people are busy, the patients are busy. You’re busy. You don’t want to put, like, point two CC’s a filler and have them come back in a week or two and use another syringe and so forth, so. But that is the best practice. The best practice is slow, steady, have them come back in a month or two, do more at that time, and that, I feel, is the best practice of getting the best results.

Alison Werner 14:50
When you have younger patients coming into your practice, what are some of the concerns or just issues that you think about with them compared to your older or middle aged patients?

Dr Babak Azizzadeh 15:00
Yeah. I mean, for the most part, younger patients just sticking to maybe fillers and other aesthetic enhancements, or even rhino they’re looking to do plastic surgery to look better. It’s more about the attractiveness factor. Whereas someone who’s in their 50s, they want to look more youthful. It’s two very different factors that you’re looking at. Of course, the 50 year old wants to look better too. Youthfulness and attractiveness go hand in hand and so forth. But the younger adult who is coming in, they’re looking to address flaws, address factors that hopefully they think are going to make them look more attractive. So it’s a little bit different, and it’s actually more difficult, right? Because attractiveness is so individualized, right? It’s in the eye of the beholder, and that’s why I’m, like, very trustworthy with younger adults, to kind of listen to them and tell, you know, like hear them out, because they kind of have their own esthetic eye that you have to work with sometimes. Obviously, you don’t want anyone to look unnatural, but I think you do have to listen. I mean, you listen to everybody but younger patients, they have their own like what they’re looking for, and sometimes you will be guided a little bit more by by the patient.

Alison Werner 16:32
Do you feel like social media has changed the way younger patients talk to you now?

Dr Babak Azizzadeh 16:38
1,000%. 10,000% Yeah. 1,000,000% Yeah, of course. I mean, look, social media has completely turned everything upside down in terms of, comparatively to 20 years ago. 20 years ago, young adults, younger patients, really didn’t know about any of these things other than, you know, rhinoplasty or something, you know, ear clipping or something like that. Now, I think, you know, plastic surgery is just people are bombarded by their, you know, by plastic surgery transformations, by social media influencers, by doctors. I think there’s a lot more information out there. Some good, some not so good. Sometimes overload, information overload, sometimes misinformation. So there is, the interest is tremendous. It’s like on a whole different level compared to 20 years ago. But young adults, they’re great consumers, because they actually just like, you know, 45 year old soccer mom, yeah, they’re great consumers. They’re coming in they they know kind of what they want, but just like anyone else, you gotta educate them, you know, educate them on what’s real, what’s not, you know, kind of more of a fad and so forth.

Alison Werner 18:02
Yeah, I would think that managing expectations are what is real, what’s right for them is a bigger conversation.

Dr Babak Azizzadeh 18:09
Yeah, but they’re very open minded. I think, I think they’re, you know, for the most part. I think when, when you explain why you want to do something or not to do something, I think they’re very open minded. They’re not going to be like, you don’t know, I’m going to go to someone else. I mean, for the most part.

Alison Werner 18:26
Well, what’s your overall kind of take on young girl, younger patients and plastic surgery?

Dr Babak Azizzadeh 18:33
Yeah. I mean, I think sometimes some plastic surgeons and aesthetic practitioners look at young adults or even teenagers as like, okay, maybe they’re not as they don’t understand what’s going on as much they don’t give them. But I think it’s a very, very educated consumer group, and I think they kind of know what they want. They will ask questions, they will do research. And overall, I think there, they have probably the highest rate of satisfaction out of almost any age group with procedures, as long as the procedures are done correctly and conservatively. So I love the age group. I think they’re phenomenal, phenomenal patients. And it’s actually really fun, because they get so excited they have a lot of interest in it. And it’s, it’s, it’s changed a lot over the past 10, 15 years.

Alison Werner 19:34
Well, Dr azizadeh, thank you so much for talking me today.

Dr Babak Azizzadeh 19:37
Thank you, Alison, and I appreciate your invitation again.

Alison Werner 19:40
as always. Thank you for joining us. Be sure to subscribe to the Plastic Surgery Practice podcast to keep up with the latest episodes, and be sure to check out to keep up with the latest industry news. Until next time, take care you.

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