After years of of inconveniences — chronic back pain, expensive alterations, custom-made bras and shirts two sizes too large — Rachel Weiser wanted a physique that would make her life easier.

"Every time I went to buy a formal dress, I would end up in tears," said Weiser, 18, of her FF- and G-cup figure. "I looked like a porn star."

File photo (ENLARGE)

Celebrities who changed their looks, such as singer Ashlee Simpson. Click the image for more familiar faces.

Chris Hunt/AJC

Photos: Celebrities who change their looks Blog: Should teens go under the knife? How do you feel about teenagers getting plastic surgery?   Why not?   Oh Please Voter Limit: Once per Hour View Poll Results QUESTIONS TO ASK ABOUT YOUR PROCEDURE During the consultation with your surgeon, make sure you understand what to expect from the procedure. Here are some questions to ask: How long is the recovery? What are the risks? What types of complications are associated with this procedure? If I have a complication, can it be corrected and at what point will it be corrected? If I need to undergo surgery a second time, is there a second fee? Will there be an additional charge for the operating room and anesthesia? Will my healing time be longer because the area has been operated on twice? Are there alternatives to the procedure I want to have done? Will you (the doctor to whom you're speaking) be the one performing the surgery? Is it possible to talk to some former patients about the experiences they had with this procedure? Will you be available to me after my procedure? Where will the incision(s) be made? Source: Carol Martin, consultant, www.theinformedchoice.com MOST COMMON SURGERY PROCEDURES AMONG TEENS Here's a look at the most common surgical procedures in 2007 and the average cost: Otoplasty (ear) 12,419 $2,951 Rhinoplasty (nose) 10,709 $4,188 Liposuction 9,295 $2,697 Breast augmentation 7,882 $3,583 Breast reduction 4,207 $5,500 * Breast reduction for females is considered reconstructive surgery so costs may vary Source: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons For a complete list of procedures, associated costs and recovery times, visit tinyurl.com/5oeds8. Related health articles: Study: Clozapine may have saved schizophrenics  Obesity a risk factor in swine flu?  Study: 1918 flu survivors seem immune to swine flu  Fall swine flu: Obama urges vigilance, not panic  Swine flu shots at school: Bracing for fall return  Topics: Atlanta hospitals | Weight loss | CDC | Cancer | Swine Flu Back to Health news DOCTOR IS IN Why worry? THINNER YOU Lose weight. Together.

In December, the high school senior underwent a breast reduction to give her a bust more in proportion to her 5-foot-9-inch frame.

"It's an incredible feeling," she said. "I was just really happy."

For vanity reasons, plastic surgery has long been the domain of celebrities and the rich and famous. But for a generation that has yet to see its first wrinkle or pocket of cellulite, such procedures are less about looking good than they are about alleviating a source of physical or emotional pain.

Among teens 18 and younger, the number of plastic surgery procedures has increased from 59,890 in 1997 to more than 205,119 in 2007, according to the American Society for Aesthetic Plastic Surgery. That number includes surgical procedures such as breast reduction and nonsurgical procedures such as laser hair removal, microdermabrasion and chemical peels.

The overall increase can be linked to a greater level of acceptance by society, widespread availability of surgeons, and information that's fueled by the Internet and television.

"Younger patients are trying to fit in and appear more like their peers, while older adults are trying to improve things, enhance them or make them appear different," said Walter Erhardt, a plastic surgeon in Albany.

Nearly 8,000 breast augmentation procedures were performed on females 18 and younger in 2007. But that number pales in comparison to the number of teens who opted for surgery to correct a deformity of their ears, nose or breasts.

The most frequently performed surgical procedure among teens in 2007 was otoplasty (having ears pinned or reshaped) with more than 12,000 cases.

Such procedures for teens "can be transformational in terms of their attitude and mood and how they feel about themselves," said Dr. Diane Alexander, a plastic surgeon with Northside Hospital. She performs a lot of reconstructive procedures, including correcting congenital breast deformities and breast reductions for girls with breasts not in proportio to their body frames.

While plastic surgery may produce positive physical and emotional results, it is not recommended for younger patients who lack the physical and emotional maturity to handle the procedures. Operating on body parts that have yet to fully develop may interfere with growth. Patients also should be able to understand the procedure and risks, set realistic expectations, and devote time to recovery.

The decision to have a procedure should be driven by a personal desire and not one to please others, including parents.

Well-meaning moms and dads have brought in patients — some, for instance, with physical scars from childhood — who are not interested in having surgery, said Erhardt.

"It bothers Mom, and they want to get it fixed, but you have to ask how much does this bother you?" he said.

To ensure success, patients must also make a commitment to follow-up care, recovery and maintenance. Recovery periods vary and often require patients to remain immobile at times and may require bandage changes. Also, devices such as breast implants do not last forever and may require maintenance or even replacement surgeries.

"One of the biggest misconceptions among young patients is thinking they can have surgery on Friday and go to the party Saturday night," said Carol Martin, a cosmetic surgery consultant. If teenage patients cannot devote the time necessary to recover, they probably should postpone surgery.

Allie Micciche broke her nose in eighth grade, but waited until she was 20 and no longer involved in sports to have it repaired.

"It was a confidence booster," she said of the procedure that reshaped her nose, removed the lump and returned it to its original size. It fits her face again, she said.

Once the decision to have surgery has been made, understanding the risks is critical. Plastic surgery requires anesthesia and therefore carries the potential for complications such as temporary paralysis, heart attack or stroke.

"Forget the word cosmetic and remember the word surgery," said Dr. Foad Nahai, an Atlanta plastic surgeon who said that many younger patients mistakenly think there are no risks, no downtime and no permanent scars.

"It's not having your fingernails done or your hair colored," he said. "If it doesn't turn out fine, there could be serious consequences."

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ASSESSING PATIENTS

The American Society for Aesthetic Plastic Surgery offers these guidelines for evaluating teenagers who are considering cosmetic plastic surgery:

• Assess physical maturity. Operating on a feature that has not yet fully developed could interfere with its growth, and continued growth could negate the benefits of surgery in later years.

• Explore emotional maturity and expectations. As with any patient, the young person should appreciate the benefits and limitations of the proposed surgery and have realistic expectations.

• Check credentials. State laws permit any licensed physician to call themselves a "plastic" or "cosmetic" surgeon, even if not trained as a surgeon. Look for certification by the American Board of Plastic Surgery. If the doctor operates in an ambulatory or office-based facility, the facility should be accredited. Additionally, the surgeon should have operating privileges in an accredited hospital for the same procedure being considered.

• Explore risks and expected recovery times. Teens and their parents should understand what might happen during surgery, postoperative restrictions on activity and recovery times.

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WHAT TERMS MEAN

Here's a look at some of the most common surgical procedures performed on those 18 years of age and younger:

• Otoplasty: Corrects protruding or disproportionate ears. For the most part, the operation is done on children between the ages of 4 and 14.

• Rhinoplasty: Nose reshaping is one of the most requested aesthetic surgical procedures by teens. It can be performed when the nose has completed 90 percent of its growth, which can occur as early as age 13 or 14 in girls and 15 or 16 in boys.

• Breast reduction: This is frequently performed on girls with overly large breasts that may cause back and shoulder pain, as well as restrict physical activity. Breast reduction usually is delayed until the breasts have reached full development.

• Correction of breast asymmetry: Surgery can be performed when one breast significantly differs from the other in size or shape. Except in cases of asymmetry and post-trauma reconstruction, federal regulations prohibit breast implants for those younger than 18.

• Breast reduction (boys): In some teenage boys, excessive breast development (gynecomastia) can become a significant psychosocial problem. Excess tissue can be removed to achieve a more masculine body contour.

• Chin augmentation: This is often performed in conjunction with rhinoplasty to achieve facial balance.

Source: American Society for Aesthetic Plastic Surgery

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EVALUATE THE MOTIVATION

When considering a surgical procedure, make sure that your motivation, commitment and expectations are clear. Ask yourself the following questions to make sure the surgery is a fit:

• Why am I having the surgery?

A patient's motivation should be internal. It should be something that he or she wants to do for themselves, and not for some outside reason.

• What kind of result am I expecting?

Good communication between you and your surgeon is critical to be sure that you are on the same page. Also, doing some research about the procedure you're considering is helpful to give you a frame of reference about what can and, just as importantly, what cannot be accomplished. Bringing in pictures can be helpful.

• Is this a good time for surgery?

All surgery, even elective cosmetic surgery, requires some recovery time. If you want to get a good result, you will need to allow your body to heal and remove other distractions and activities that prevent you from focusing on getting well.

Source: Walter Erhardt, plastic surgeon

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DON'T ASK, DON'T TELL?

If you undergo a procedure, the decision to disclose the information is a matter of personal preference.

Florida State University student Shea lost 15 pounds her freshman year and reshaped her body through exercise and living a healthier lifestyle. Still, her breasts did not fit her new, improved physique.

Last month, the Atlanta native had breast augmentation surgery — her parents paid for the procedure as a 21st birthday present — to help her feel more confident in her clothes and her skin.

"I will feel that I look the best I can possibly look," she said before the procedure. "My confidence will improve, and I will feel very comfortable with myself."

Days after surgery, Shea e-mailed that the procedure was successful.

"It couldn't have gone better," she wrote. "Recovery was as easy as it could be. Not too much pain. I really couldn't be happier! I have absolutely no regrets at all!"

She asked that her full name not be used, fearing a negative impact on her sorority.

A desire for privacy is understandable, said Decatur psychotherapist Jeannie Ingram. But if a patient feels a degree of shame, that should raise a red flag, she said.

"I don't necessarily tell people when I go to the dentist or have something done to my body," she said. "Why should anybody have to?"