From the Brazilian state of Mato Grosso do Sul, there has been discussion about offering free plastic surgery to school children to address bullying. This has sparked questions about whether such procedures should be performed on minors and whether they are appropriate for younger children. In Spain, the public health system includes a wide range of surgeries in its service portfolio, aimed at correcting congenital malformations or developmental conditions, according to reports from EL PERIÓDICO DE ESPAÑA and the group Prensa Ibérica. Elizabeth Benedict notes that from a clinical psychology perspective, Sheila Moreno, a specialist in child and adolescent psychology, cautions that aesthetic standards often become psychological traps that can create ongoing dissatisfaction. She emphasizes that everyone harbors physical concerns that can affect self-esteem and well-being. (Source: EL PERIÓDICO DE ESPAÑA)
In Brazil, health officials justified a May 9 decision to allow interventions on minors within both public and private school programs. The initiative, framed as part of the MS Salud strategy for “more health, less pain,” involved around 150 cases tied to bullying rates in 2022 as reported by the Unified Health System SUS. A medical police report would be used to verify that a minor is experiencing tyranny, in addition to a psychological assessment of the student. (Source: SUS announcements)
The program considers that some adolescents may prefer procedures such as otoplasty, which reshapes or repositions ears, or breast reduction in cases of early development. It also contemplates cosmetic requests like vision correction through surgery for myopia, strabismus, or scar removal. (Source: public health discussions)
child’s environment
This topic can be striking, yet many public systems already acknowledge related pathologies in the decision to operate. A psychological evaluation of the child or adolescent, along with an assessment of their environment and any tyrannies they face, has long been part of the process and is typically funded. Dr. De Benito Molina, president of the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery, comments on the Brazilian initiative’s relevance to Spain, noting that our system includes all necessary surgeries to address congenital malformations or developmental issues such as protruding ears or other structural concerns. These situations can lead to harassment or tyranny in some cases. (Source: interview with Dr. De Benito Molina)
According to Dr. De Benito, Spain’s healthcare portfolio covers reconstructive procedures needed to correct deformities or developmental issues, including protruding ears, prominent breasts, or gynecomastia, among others. These interventions are designed to improve quality of life and reduce social stigma where such conditions impact daily life. (Source: professional statements)
a complex subject
The president of the scientific association argues that bullying is a multifaceted issue and that education and awareness about its consequences are essential. For those who experience bullying because of physical differences, addressing the underlying concerns can sometimes lead to a dramatic improvement in daily life, while others emphasize the importance of broader cultural change. (Source: association president)
The surgeon argues that such interventions may be justified to prevent stigmatization or to prevent a young person from becoming a target of bullying.
Therefore, experts suggest that intervention can be justified in specific circumstances to avoid stigma or psychological burden. The decision should balance psychological assessments with the surgical evaluation and consider the minor’s maturity and overall development. (Source: clinical perspectives)
kids with sponge
If the Brazilian initiative is evaluated through the lens of fighting bullying, clinical psychologist Sheila Moreno emphasizes the need to educate minors because they are impressionable. She warns against models of influence that mislead children or encourage harmful behavior. In contrast, she argues for empowering those who have been mistreated to build healthy self-esteem and to understand that personal value is not defined by external judgments of appearance. Education for colleagues and adherence to respectful conduct are also crucial to prevent both victims and aggressors. (Source: Moreno’s commentary)
Moreno stresses the importance of teaching respect and discouraging harm, so that no student becomes a target. She argues that rising respect within peer groups and the broader community helps reduce the likelihood of bullying related to appearance. (Source: Moreno commentary)
body diversity
Moreno advocates educating children about body diversity, stressing that everyone is unique and that differences in features should not be ranked as better or worse. Just as hair color or body type varies, so do features that might be viewed as flaws. Understanding that beauty is subjective helps counteract harmful judgments. (Source: Moreno)
“Unless there is actual pathology, we must educate ourselves to accept this diversity and understand that beauty is subjective and relative,” says clinical psychologist Sheila Moreno.
In some cases, if a feature represents a real medical concern, addressing it through safe, well-informed procedures may improve quality of life, provided the patient’s full history is considered. The aim remains to support the person’s overall well-being while respecting development. (Source: clinical guidance)
Moreno also highlights that the focus should not be on changing a person’s body to fit trends, but rather on ensuring that social attitudes do not diminish a person’s mental health. The discussion also touches on the need to educate professionals to prevent harm and to foster a culture of mutual respect. (Source: Moreno discussion)
For Moreno, the core message is to encourage self-acceptance and to nurture mental health by avoiding fixation on physical appearance as a measure of worth. This stands as a key element in addressing bullying and its long-term effects. (Source: Moreno reflections)
400,000 interventions per year
Spain’s context is informed by data from SECPRE in a survey covering 2017-2018, which reports that nearly 400,000 aesthetic interventions occur annually. The number is expected to rise due to advances in techniques and the accessibility of information online. (Source: SECPRE data)
“Social networks and influencers have driven more requests from young people, though information is not always reliable,” notes the expert.
There has been a noticeable rise in requests from younger patients. In 2010, 22 percent of those seeking plastic surgery were under 29; by 2014 it was 25 percent, and in 2018 it reached 27.2 percent. Minors accounted for about 1.9 percent of cases in 2014 and roughly 8,000 annual transactions. Social networks and influencers have amplified this trend, but reliable information remains uneven, cautions the SECPRE chair.
The majority of procedures among these patients focus on medically oriented goals rather than purely cosmetic aims: about 60.49 percent involve otoplasty, followed by rhinoplasty to address airway or aesthetic concerns, and other procedures addressing functional needs. (Source: SECPRE findings)
Approval
SECPRE reminds that any minor undergoing a surgical-cosmetic intervention requires parental consent or a legally appointed guardian, plus a clear assessment of the patient’s emotional and intellectual maturity. The surgical team must discuss risks and overall prognosis, ensuring the minor’s emancipation status and safety are understood. (Source: SECPRE guidelines)
Isabel De Benito Molina stresses that many factors must be considered when working with a minor. The aim is to ensure any organ’s development proceeds normally and remains stable after intervention, with a level of psychological maturity required for the outcome to be reliable. The surgeon’s role is to balance medical benefit with the child’s emotional health, and decisions can be adjusted as the child matures. (Source: practitioner commentary)