As high school seniors worry about finding the perfect university, pick meal plans, and prepare for their first year in college, they may also be considering another big change: plastic surgery. According to the American Society of Plastic Surgeons, surgical procedures on patients 18 years and younger increased 24 percent between 2000 and 2002. Many of those patients have cosmetic surgery performed over the summer between high school and college.

The most popular procedure for teens remains rhinoplasty. More than 42,000 nose jobs were done last year on teenagers, representing a 43 percent increase between 2000 and 2003. Female breast augmentation was less popular with teenagers than older patients-perhaps in part because most cosmetic surgeons are hesitant to perform such a procedure on a teenaged woman, preferring to wait until patients are at least in their twenties. Regardless, breast augmentation increased 24 percent between 2002 and 2003, with 3,841 documented operations. Liposuction was close behind, at 3,017 procedures, while otoplasty (ear pinning) remained a popular choice with teens: almost 16,000 elected to have that surgery done in 2003.

Perhaps reflecting the level of acceptance of male cosmetic surgery in larger society, the biggest increase in procedures came in male breast reduction (gynecomastia). A 51 percent rise in the number of surgeries in 2002 resulted in 3,033 procedures being performed on teenaged men.

Plastic surgeons say that their teenaged patients can be some of the most gratifying cases to work on-but they are also concerned that adolescent patients receive the proper counseling prior to deciding on the surgery. And some procedures, such as liposuction and breast augmentation, are more commonly deferred until the patient is in his or her twenties, at least.

For teenagers, the pressure to look good seems higher than ever, and the ability to gain self-confidence in one's appearance can make a huge change like going to college seem like an exciting new adventure, rather than a terrifying prospect.