About face: more and more teen girls are willing to do almost anything to look good, including going under the knife. But with all the possible dangers involved, both physical and emotional, is plastic surgery really such a smart move?

Ask friends of Julie, 17, to describe her, and you get words like "pretty," "athletic" and "smart." But if you'd asked Julie to describe herself a year ago, you'd only hear about her "pudgy" stomach.

"I've had a bad body image my entire life," says Julie. "Even in kindergarten, I remember playing with a friend and thinking, 'Wow! My arm is as big as her leg!' I was just always a chubby little girl. Even my very best guy friend nicknamed me 'Pork Rind' at age 9. That totally crushed me. I think that's what really started my obsession with my looks.

"I felt totally inadequate. I was completely focused on the middle area of my body as being really ugly. No matter how many sit-ups I did, my stomach was never flat. Sometimes, I'd think, 'This is so stupid. Why am I worrying about this? I have so many other things going for me!' But I couldn't stop myself. So when I was 16, I decided to have liposuction to finally put an end to my obsession."

Julie is one of thousands of teens opting for plastic surgery. In 2003, over 74,000 cosmetic surgeries were performed on kids under 18. That's an astounding 14-percent increase in just three years. And if you include all cosmetic procedures, like chemical peels, microdermabrasion and Botox (yes, teens getting Botox!), the number shoots up to 336,000--up over 50 percent in one year.

Last year, 42,515 teens got nose jobs (rhinoplasty) and 15,973 had ear pinnings (otoplasty)--the two most popular surgeries among teens. But there were also 3,841 breast implants--up more than 24 percent in a year--plus thousands like Julie having fat sucked out of them by liposuction.

Startling facts? Not when you consider that hit shows, like The Swan and Extreme Makeover, make plastic surgery look like no biggie. But, as we all know, reality TV is seldom reality. Recovery from surgery is far more painful than what you see on a one-hour show, and the operations involve life-and-death risks--with no "body-back" guarantees! So should plastic surgery, with all its potential consequences, even be an option for teenagers?

Plastic Surgery Nation

"Plastic surgery is available more than ever to the average person, and that's a big motivating factor," explains Dr. Paul Glat, a plastic surgeon practicing in Philadelphia.

"It's a sad fact," says Janice Styer, therapist at the Caron Foundation in Philadelphia, "but getting plastic surgery is almost as accepted as getting braces these days." Unfortunately, surgery is not the quick fix many girls hope for. "Teens are usually trying to solve a deeper issue, like low self-esteem or not fitting in," Styer continues. "But those problems can't be solved by changing your appearance. Nine times out of 10, it does nothing to help them on the inside."

Often, a teen who chooses plastic surgery comes from a family in which looks have been over-emphasized. "More and more, mothers are putting pressure on their daughters to fulfill the dreams that never came true for them," says Styer.

"They're pushing their daughters to be 'perfect'--even if it takes surgery." And with so many morns these days getting nipped and tucked themselves, teens are much more likely to think it's OK for them to do it, too.

'I Wanna like Jessica Simpson!'

When you're feeling blah about your looks, you might dream of trading in that bod for a new and improved one. "There is very little that teens like about their bodies," says Styer, "so they pick a celebrity or a model from a magazine who is airbrushed, and they say, 'I want to look like this.'"

"Exposure to sexy advertisements and TV shows like The Swan causes teens to think, 'Look how easy it is!' and makes plastic surgery look like an appropriate way of dealing with body image problems--when it isn't," says Dr. Steven Shelov, chairman of pediatrics at Maimonides Medical Center in Brooklyn, N.Y.

The Pressure be Perfect

There's so much to deal with during the teens--school, relationships, popularity, boys--that it can overwhelm. Some teens figure that if they were to look a certain way--fix that bumpy nose or have bigger boobs--everything would be perfect. "There's pressure to look good," says Dr. Shelov.

So much so, according to Styer, that teens feel that if they don't look "good," they won't be successful in life. "A teen's appearance is how they determine their social acceptability," says Styer. "They really feel it's necessary to look a certain way or life will be hell for them."

Julie agrees: "Although it sounds crazy, I felt everything in my life that went wrong--breaking up with my boyfriend or not making my best time as a competitive swimmer--was because of my flabby stomach! Even when I was doing something like studying, I'd get so worked up about the way my stomach hung over my pants that I couldn't concentrate."

Stephanie, 19, never even considered that anything was wrong with her looks until she compared herself to other girls. "I never thought about my nose," she says. "But in seventh grade, we drew profiles of each other and, when I saw mine, I couldn't believe it! I looked like a witch."

From then on, she did everything she could to hide her nose. "Whenever I talked to someone, I'd make sure I was facing them. And, every day, I wore my hair in front of my face. I'd look at other girls and think, 'They're so much prettier!' and I became obsessed with their noses. I really felt I wouldn't be happy in life with my ugly nose." So, at 18, she got her nose fixed. '"I'm so glad I don't have to be embarrassed about my looks anymore," says Stephanie.

Risky Business

Sure, plastic surgery appears to be a quick and easy solution to problems with your appearance. But aside from the costs of surgery--which can be seriously steep--there are many physical and emotional risks to getting "sliced and diced."

"As with any surgery, there are anesthesia risks and ... it can lead to potential errors and even death. It's ridiculous that a young, vital girl could die from something unnecessary like plastic surgery," reports Dr. Shelov.

There are also added risks since a teen hasn't stopped growing. Breasts haven't fully developed by around 17. So if you get implants when you're young, you could end up with unexpectedly humongous breasts by the time you're a college freshman. "You're putting a foreign object in your body that needs to stay there for a lifetime, so it's not something you want to do without great consideration," says Dr. Glat.

Though liposuction for teens is growing in popularity, Dr. Shelov is firmly against it: "When you're a growing teen, you are still depositing fat. Many changes seen with liposuction will be reversed with time. Then you'll be back where you started and feeling like a failure. There's also the risk of your scars not healing, so now you actually could have a disfigurement due to plastic surgery."

There can be emotional risks involved, as well, according to Styer. When you're so focused on your outside, it really doesn't allow you to develop on the inside. "Part of growing up is learning to deal with the 'ugly duckling' stage, which all girls go through. That's when you learn self-acceptance. So if you have plastic surgery rather than go through that stage and learn to deal, you really won't be prepared for the world."

Luckily, under Dr. Glat's care, Julie had no problems except for bruising, swelling and pain, all of which are normal with this procedure. "I had a lot of areas done at once--stomach, hips, outer and inner thighs. But even with the pain, it was worth it to me. After the swelling went down, I was like, 'Oh, my God! I see my waist!' After a month, I wore bikinis for the first time. I'd definitely do it all over again." In a way, she did. Julie later had her arms and back done.

When Things Wrong

Some girls aren't as lucky as Julie. Kacey, now 20, got breast implants at 18. "My best friend's morn worked at a plastic surgeon's office. I mentioned to her that I thought it would be cool to get implants. She told me she could get them done at her office really inexpensively. She also said they were safe, which was really important to me. Although my morn was against it, I told her I'd pay for it and, since I was 18, she really couldn't say much about it.

"When I got my implants, they looked great and I was really excited. But after two months, I got a shooting pain up my arm. I couldn't even lift my arm to do my hair. Several doctors said it was no big deal and that I was probably exercising too much. Finally, after an extremely painful year, I was diagnosed with rheumatoid arthritis. By that point, I felt like I was dying. I couldn't exercise or think straight and, sometimes, I had to be spoon-fed since my jaw wouldn't open! It took another year, during a gynecological exam, for my doctor to link my illness to the implants.

"Aside from rheumatoid arthritis, I developed other painful, incurable auto-immune diseases--fibromyalgia, which is severe muscle pain; chronic fatigue syndrome, where I can sleep 18 hours a day; and arthritis of the spine. I had my implants removed and felt so much better-although, I'll always have these illnesses. Before surgery, I had no idea what risks were involved--no one told me."

Is Plastic Surgery Ever a Idea?

Obviously, teen plastic surgery is very controversial Some people, like Julie, think it's great, but many think it's plain crazy. Styer and Dr. Shelov are in the latter category. "For certain procedures--like nose repairs when there is a nasal obstruction and ears when there is a disfiguration surgery is appropriate at the right age, which is 16 or older. Otherwise, plastic surgery doesn't have a place," says Dr. Shelov.

But Dr. Glat has a different point of view: "I'm a proponent of plastic surgery for the right teen." And the right teen for him is someone who is mature enough to make this decision, has realistic expectations and is doing it for the right reason. "The wrong reason would be, 'My boyfriend broke up with me and I'd like bigger breasts,' Well, that doesn't work," says Dr. Glat. "But if they need to have something done when there is nothing more they can do to feel better about themselves, it's appropriate. The benefit of plastic surgery at a young age is that it can increase self-image, which results in increased self-confidence. It can change their lives. They feel they can do things they never considered before. It can just make you more comfortable to date, make new friends or find a job you'd never have gone after."

"The change in my confidence was unbelievable," Julie concurs. "It's sad it took so much to do that for me, but it did." But even Julie recognizes plastic surgery isn't for everyone. "The big thing for me was that I was comfortable with all other aspects of my life. I wasn't like, 'I hate myself, and this is going to change my life.' I knew it wouldn't change who I was or how people looked at me. It was going to change how I projected myself to others."

Dr. Shelov thinks there are better ways of dealing with body image problems: "Rather than handle these insecurities in such an extreme way, parents should reassure their kids about their appearance while they're growing up, and promote a healthy diet and good exercise habits."

A recovering Kacey adds, "Once you realize that whatever you look like is OK, you won't need to risk your health--or life--to look 'beautiful.'" Kacey suggests girls wait until their 20s, when they're fully grown, before even considering surgery. "Research everything," she warns. "Plastic surgeons are only going to lead you to patients who are happy with their results. You need the full picture. Actively seek out someone who has had bad results, like me. If everyone knew what I know about breast implants, I don't think anyone would want them."

THE REAL RISKS OF PLASTIC SURGERY

Think plastic surgery is a breeze? Here's what many docs won't tell you about....

The anesthesia Dangers include blood clots, heart attacks, brain damage, stroke and even death.

The chance of asymmetry That's when the outcome looks crooked, only fixable with a second surgery.

Numbness When nerves have been cut, you lose the feeling in that area, either temporarily or permanently.

Dimples, puckers and other irregularities Sometimes, this happens because of a doctor's error or just your body's reaction. This also can be permanent.