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t is very important for plastic surgeons as well as patients seeking aesthetic procedures to be aware that age and anatomical development play a major role in decision making.

During surgery, accidental damage to still-developing or growing anatomical structures may result in deficient growth or even potential deformities.

So, instead of achieving an ideal result, procedures may generate more detrimental effects.

Older patients have other associated medical problems like uncontrolled hypertension, diabetes or chronic heart disease. For them, increased risk must be considered when contemplating complex and long aesthetic procedures. It is very important that plastic surgeons be honest in giving advice and practise wisely. It is also essential that the patients not be impulsive or insistent when deciding on aesthetic procedures.

Generally, women complete anatomical developments after they are 18 and men a little later after 21. During this period, the different parts of the body, such as bones and cartilage, grow at their own natural pace. If we perform a rhinoplasty (nose surgery) and damage still-growing cartilage, then growth may be retarded. If growing cartilage is accidentally displaced then the nose may become asymmetrical. While a prosthesis inserted to augment the height of a nose may initially appear good, when the nose continues to grow, the prosthesis will appear shorter and a gap may develop and make it disproportional. The younger the patient the more obvious this can be.

Meanwhile, if surgery is done on the breasts of a maturing woman, it may distort them or affect their full development. Therefore, for breast surgery, it may be wise to wait till the patient is about 18 years of age before considering aesthetic surgery.

For aesthetic surgery of the ear, particularly the correction of a prominent 'bat's ear', it is better to perform corrective surgery after 6, as the ears would have by then achieved almost full growth. If performed earlier, any accidental damage to the growing parts of the cartilage can cause a retardation of the ear size or shape.

Asians tend to develop more scars and are particularly prone to develop scars at ages associated with puberyy growth spurts.

Therefore, if we are considering any aesthetic surgery during this period, we have to take extra precautions. Gentle handling of tissues, good opposition of tissue and skin and good post-operative wound care are vital to ensure good healing with minimum scarring.

It can be discouraging to cause ugly scars in our genuine pursuit of aesthetic perfections.

Non-structural body anatomy like soft tissue and skin are not so affected by age related aesthetic surgery. Therefore, the aesthetic surgery on the eyelids such as double eyelid surgery can be performed at any age, provided that the patient can tolerate the surgery.

It is vital for plastic surgeons the patients are happy and have satisfactory results and are not marred by undesired deformities or scars after an aesthetic procedure. This requires good understanding of anatomy and the growth patterns of different parts of the body, gentleness, good surgical skills, decisive and gentle surgery and careful post-operative care.

The possible risks must also be considered. Most of all, plastic surgeons must exercise professionalism and honesty in their practice of aesthetic procedures.

Yeap Choong Lieng, a physician, was deputy head of the Department of Plastic Surgery at the Singapore General Hospital until he started private practice at the Mount Elizabeth Medical Center/ Hospital.