CUT TO FIT.

A GROWING NUMBER OF TEENAGERS ARE OPTING TO IMPROVE THEIR LOOKS WITH PLASTIC SURGERY. SOME CRITICS SAY THEY SHOULD THINK TWICE.

Kristen Zeronis is a tall, 19-year-old with blond hair and blue eyes. "People say I'm pretty," she says.

But since the age of 13, what Kristen noticed most when she looked into the mirror were her lips, which she thought were too thin. Last year, the Long Beach, California, college student decided that lip liner just wasn't doing enough to remedy the problem. So she paid $3,000 to have a tissue graft--a small strip of processed human flesh--inserted under her lip to add fullness. She's so happy with the results that she has started saving for breast implants.

"There are so many possibilities with plastic surgery," Kristen says. "You can change anything if you want to. It's kind of a motivation because you know anything is possible."

For years, people have gone under the knife to reshape larger-than-desirable noses, alter less-than-perfect ears, and reduce or enlarge breasts. But cosmetic surgery was generally confined to the middle-aged and the privileged. Today, it is booming among the young and middle class, and teenage girls are part of that boom. For girls like Kristen, an operation can mean a quick fix for some real or perceived flaw, an easy step toward self-improvement.

But the demand for plastic surgery among high school girls has sparked untold arguments with parents, as well as a debate in society at large. Some critics are concerned that young people may be jeopardizing their health and emotional development by chasing an unrealistic dream of physical perfection. And even some plastic surgeons have expressed concern: Should someone society considers too young to buy a drink be allowed to surgically alter his or her body?

"It's very hard for teenagers," says Dr. Larry Seifert, a professor in the division of plastic surgery at UCLA Medical Center. "They are constantly bombarded by the press and media to look good. Impossible aesthetic goals are set by teenage models. You can't ever look like that, but it stimulates teenagers to change themselves, to fix it."

SUCKING OUT FAT

The number of plastic-surgery operations in the U.S. increased by 200 to 300 percent between 1992 and 1998, according to the American Society of Plastic Surgeons. While doctors say such operations for teenagers remain infrequent (teens account for no more than 3 percent of the total), the numbers have risen sharply. In 1998, breast enlargements, or augmentations, for girls 18 and under nearly doubled, from 978 to 1,840. Liposuctions, procedures that suck out fat, more than tripled, going from 472 to 1,645. Nose jobs--the number one procedure for teens--rose from 5,519 to 8,074.

Not only is plastic surgery becoming more commonplace among teenagers, it's becoming fashionable. In some trendy California high schools, breast implants are said to be a coveted graduation gift. Surgeons tell stories of teenagers arriving for a consultation bearing magazine photos of celebrities they want to look like. And while students used to have cosmetic surgery done over the summer when it would go unnoticed, "now it's almost a badge of honor at certain high schools to go in with your splint on," says Dr. Michael McGuire, a Santa Monica plastic surgeon.

BAYWATCH BABES AND MOVIE STARS

At bottom, the trend can be traced to society's fixation with a narrowly defined standard of physical beauty. Whether it's Baywatch babes filling their swimsuits to impossible extremes, or the unrelenting parade of beautiful, slender movie stars gazing out from magazine covers and movie screens, the underlying message is that physical perfection is the only route to self-confidence and happiness. It's a message to which teenagers may be especially vulnerable. And while such an unrealistic goal is not healthy for anyone, experts say, it is especially risky for young people. Teenagers are still developing an inner sense of self and psychological well-being, neither of which can be made whole by the slice of a surgeon's knife.

"There is tremendous pressure to be thin, to have a pretty face and to be buxom," says Mary Pipher, a clinical psychologist and the author of Reviving Ophelia: Saving the Selves of Adolescent Girls. "As that pressure increases, more and more girls do radical and bizarre things to be beautiful and buxom. I think it's very disturbing."

There is no minimum-age requirement for plastic surgery; doctors handle each patient on a case-by-case basis. Physicians say that different parts of the body mature at different times, and emotional maturity can be just as important as the physical kind. Some surgeons say they try to weed out those patients who come in for the wrong reasons.

A NOSE BY ANY OTHER NAME

When Mandi Bursteen, a 16-year-old student at Calabasas High School in the Los Angeles area, went in for a nose job last summer, her surgeon insisted on certain prerequisites. First, he showed her graphic slides of the operation. "That was disgusting," Mandi recalls. Then he had her play-act a scene from Cyrano de Bergerac, the play by Edmond Rostand about a man with an unspeakably large nose whose words and honor win the heart of the lovely Roxanne. The obvious moral: It's what's inside that counts.

Mandi ultimately decided that fixing her outside would help her with self-esteem inside, and says she has no regrets. Her new nose, she says, "made me feel more confident."

Emotional risks aside, surgery can have physical risks. Several deaths of liposuction patients have led some doctors to question the procedure. One well-known casualty is Kathy Griffin, star of TV's Suddenly Susan. Already a petite size 4, Griffin opted for liposuction in hopes of shrinking to a size 2. She recently disclosed that she was rushed to the hospital because of a bad reaction to the anesthesia used during the procedure. She was unable to go to the bathroom for several days; her kidneys backed up and were almost damaged permanently.

Breast implants have other risks: implants are known to rupture, and may require additional surgery over the years. (Silicone-gel implants, which were blamed by thousands of women for a variety of serious illnesses, have been banned since 1992.) Even nose jobs can be problematic if the original results are not what the patient expected; subsequent operations to fix the fix can be much more difficult.

"It's not just a matter of coming in and writing a check and having the surgery," says Dr. Malcolm Paul, a Newport Beach, California, plastic surgeon. "If you make the wrong choice when you're buying a car, you can trade it in; if you make the wrong choice with surgery, it may be difficult to change."

NO MAGIC IN SURGICAL MAKEOVERS

Many teens who have braved the knife, however, report no desire to return to their original selves. Jennifer Anderson, 19, of Downey, California, recently had liposuction to remove a double chin. The procedure "changed my life completely," she says. "I was scared to go out in public because I thought all people saw was my chin. I wouldn't even talk to guys. Now I have a new best friend who is a guy."

But as more and more teenagers undergo surgical makeovers, some experts wonder whether surgery is the proper tool for addressing perfectly normal teen insecurity. "What I'm concerned about is that at 16, it's too easy to give in to outside pressures," says Dr. Gia Crecelius, a fellow in child psychiatry at UCLA. "There's a kind of thinking that if I get bigger breasts or a smaller nose, somehow everything will magically be all right.

"Adolescents need to develop their identity, their morality," she says. "Rather than doing that, they're looking to change the way they look--and that will never be perfect."

BIG CAN BE BEAUTIFUL

In her odyssey from overweight child to skinny, teenage model to the self-confident, plus-size model she is today, Kate Dillon has viewed the American obsession with weight, body image, and beauty from a front-row seat.

Taunted as "Overweight Kate" when she was 12, Dillon was miserable. So she did what many self-conscious young girls do: She starved herself thin, losing 30 pounds in one year. She was so successful that a talent agent discovered her near her home in San Diego, California, when she was 16. She quickly became a well-known model, appearing on the coven of magazines, and modeling in New York, Paris, and Los Angeles.

After three years, however, Dillon had had enough.

One day, in the middle of a modeling session for Harper's Bazaar magazine, watching the photographer, the makeup assistants, and the other model, she realized how hard everyone was working "to make me look thinner, and the other girl look prettier," she says. "And we were trying to sell this as what all the women in the world should look like."

Disenchanted with modeling, Dillon quit. "I couldn't starve myself anymore," she says. "I just hit a brick wall, and I couldn't do it. I wanted the freedom to be whatever I needed to be--ugly, fat, thin, or whatever. I wanted to know myself, no matter what."

She gained weight, started exercising, and focused on the things that were important to her, "like laughing, dancing, and having friends. I realized I didn't care about being cool," she says. "And I suddenly felt comfortable."

SHE'S BACK BIG TIME

She then went back into modeling-as a plus-size model, a fashion category for women who do not fit into single-digit sizes. Now 26, Dillon, says she has achieved even greater success than most skinny models she knows. "it's vindication," she says. "And I also get to send out an alternative message."

The message: Young women must look within for self-affirmation, because the media and society will not provide it.

"I'm not going to say just be yourself and it's going to be great," she says. "it's going to be hard. The hardest thing is to accept your imperfections. This society seems bent on making people feel bad if they're at all different--different color, different religion, different sexual preference, or different size."

EAT RIGHT, EXERCISE, AND RELAX

Dillon advises young women to eat healthful food, rather than starving themselves, or yielding to the opposite extreme and binging on junk food. She also advocates exercise--Dillon herself runs a few times a week and is a devotee of martial arts. If you are honest with yourself, eating well, and exercising, Dillon says, you can tell yourself that you have done all the right things--and you should try to relax.

"Believe me," she says, "models have the same problems as anyone else. No matter what you do, you're not going to make your life problem-free. What's really cool is to be who you are. People will respect you more. The question really is, do you want people to like you because you're thin?"

--Sharman Stein