Ellie* was nine years old when her Chinese mother first told her she would take her to get her eyelids “fixed” when she was old enough. She hadn’t had her growth spurt, hadn’t had her first period, hadn’t even finished primary school. Yet double eyelid surgery was already established as a milestone in Ellie’s life that her mother couldn’t wait to experience with her. “I remember my mom would tell me: ‘Oh, when you go to college and you get [double eyelid] surgery, I’m going to drive you to the clinic, and then I’ll take care of you, and then you’re going to wake up and look so much prettier’... And I was like, ‘Wow, that’s so wonderful!’”

But the illusion didn’t last, and her mother’s repeated remarks about surgery slowly chipped away at Ellie’s self-worth and their bond. “I would look at myself in the mirror and pinch my skin in different places, and hear her voice [in my head]: ‘You’re almost good enough for me, you’re so close,’” says Ellie. It got to the point where she didn’t want to spend any time with her mother. “There are people out there who actually looked forward to going home at the end of the school day, but I didn’t.”

When a stranger online with a random username and blank profile leaves a comment about your nose or lips, it might sting, but it’s easier to shrug off. When it’s your own mother telling you your features are ugly, the impact runs deeper. Dr Kimberly Lee, director of the Beverly Hills Facial Plastic Surgery Centre, regularly sees teens and young people come in for consultations accompanied by their parents. Over the years, she’s got pretty good at telling whose desires she’s really fulfilling. “I saw a patient who was specifically told by a parent that she should get a rhinoplasty done,” says Dr Lee. “She didn’t really know much about it, but just went along with it. And as she was older, she actually really hated the fact that she had had a rhinoplasty, and came in and tried to go back to her original nose.” 

So why would a parent risk damaging their relationship with their children and causing a lasting negative impact on their self-esteem? Often, it comes from cultural mindsets embedded deep within the community. In Iran, rhinoplasties have become a cultural rite of passage, while in South Korea, double eyelid surgery is seen as “job prep”. “Some [parents] see cosmetic maintenance as something routine and not necessarily a negative thing, while others want to just help their children feel more confident,” says Dr Lee. 

In an essay reflecting on her own experience with cosmetic surgery culture in South Korea, author Carol Lee wrote: “[My grandmother] meant no ill will – in South Korea, where a headshot is often required in the hiring process, your perceived attractiveness could open more doors in your career. She simply wanted to maximise my chances of flourishing.”

However, Thomas Midgley – a behavioural and cognitive psychotherapist, highly specialised eating disorders dietitian, and director of the Body Image Treatment Clinic – says these comments do more harm than good. “The problem with the parents saying [these things] is that love starts to become conditional,” he says. “What the child is hearing is, ‘I’m not lovable, I’m not valid, I’m not worthwhile enough because of my eyelids or my nose.’” Midgley has seen many patients who struggle with body image issues as a result of being viewed as an “extension” of their parents, who believe it’s a shameful reflection on them if their child isn’t ‘beautiful’. “Some parents are vicariously living through their kids,” he says. “And it’s like, ‘I need to fix my child’, an extension of me. So it’s, sadly, that ego extension.”

A common issue Midgley sees patients for is Body Dysmorphic Disorder (BDD). People with BDD commonly approach cosmetic surgery as a way of “fixing” their flaws, but fewer than 10 per cent of BDD patients end up satisfied with the results, and Thomas says that it can lead to an obsession and multiple surgeries. “It doesn’t matter what surgery they get... it’s never good enough,” he says. “The internalised shame and fears are still there, so it’s just going to push on to another area. If the driving force comes from a place of fear and shame, it’s going to be unrelenting.”

Love starts to become conditional. What the child is hearing is, ‘I’m not lovable, I’m not valid, I’m not worthwhile enough because of my eyelids or my nose’ – Dr Thomas Midgley

Despite the endless pressure, Ellie, now 21, never ended up getting her eyelids done. Andie*, on the other hand, was 14 when she went under the knife for her nose job; a quinceañera gift. “You obviously need to get it at least six months before your quinceañera so it can heal in time,” she explains. Andie grew up in Monterrey, Mexico, an environment she describes as conservative, religious and affluent. While she says that her family didn’t explicitly tell her to get her nose done, she felt the pressure through their subtle snarks and remarks. “They were sure to make plenty of comments on my appearance, which made me feel like I needed one,” she says. 

It’s a bittersweet feeling. Andie admits her nose job changed her life for the better as a 15-year-old in her Monterrey bubble, confident that it is the reason her high school experience was so enjoyable. But being a 22-year-old student at Columbia University gave her a new perspective on it. “I think interacting with different cultures made me reflect a bit more on the greater implications of my nose job.” While Andie doesn’t regret it entirely, being so young, she does feel robbed of the power she could’ve had in the decision-making of it all, had she been older. 

“You’re not the one who’s at the centre of the discussion [with the surgeon], because you’re 15 years old. Your parents are,” Andie says. “I wish I had the ability to choose a different doctor. I did it with a family surgeon who has done many things for my aunts and my cousins. He went to school with my aunt and uncle. He’s a family friend. I didn’t even get to ask, like, ‘Hey, can you show me more photos [of work] he has done?’ Or like, with Photoshop, show me how it would look at the end. I was going into it pretty blindly.” 

Andie’s thoughts on her surgery are in a complicated place: a mix of satisfaction, reflection, and a tinge of regret in hindsight. “I think it’s one of the dangers of coming into one of these surgeries in the position of a child. Your parents are paying for it, your parents are organising it, and your parents are making all the decisions.” What she’s left with isn’t just a new nose, but the unsettling feeling that she never truly got to ask for it.

*Andie and Ellie’s names were changed on request to remain anonymous