This story is the first part of Young and injected: Electing to have a major cosmetic surgery by 17 and 18. Click here to return to the home page and introduction or click here to read part two of the story. 

Before surgery was ever a thought for Burge, she says her childhood was fairly typical. The active, fashion-loving girl grew up mainly in Calgary with her parents and five siblings, whom she says she would go exploring in the woods with. “We always said that we were an army of siblings,” she says. “We were kind of our own friends.”

After being bullied in school as a child, she describes her teen years as being angsty. “I had a big mouth on me. I moved out when I was 16,” she says. “I kind of grew up after that.” Burge says she paid rent by picking apples and baking pies. “It was weird,” she laughs.

She describes her early teenage years being full of heavy eyeliner and dark makeup. “I loved eyeliner. I still love eyeliner but now I’m a little better at it,” she laughs.

She doesn’t like wearing a lot of makeup now, especially with an active lifestyle. Instead, she started getting cosmetic procedures done such as microbladed eyebrow tattooing, lip fillers and eyelash extensions.

Burge isn’t the only young woman that elected aesthetic surgery before escaping her teen years.

Sofia Azami, 24, was packing for a weekend getaway to San Francisco with friends when she shared how she too got cosmetic surgery as a teen. The fourth-year University of Calgary business student said during a phone interview that she moved to Canada from Afghanistan with her family when she was just five years old. She married in 2008 and divorced by the time she was 19.

Growing up, Azami says she never liked her nose. Particularly a bump she couldn’t help but notice when she would look in the mirror. Being accidentally hit in the face during a wrestling lesson in a high school gym class only encouraged her to get the surgery even more.

“It was an accident; some guy hit me in the face, and he hit me pretty hard to the point where the cartilage had slightly … kind of moved to the right when I got x-rays done.”

She first went under the knife for a rhinoplasty at 17 before her high school graduation, electing the surgery to enhance the appearance of her nose. “I think it boosted my confidence a little bit,” she says of her new nose and positive outlook on cosmetic enhancements.

Since her first surgery, Azami has had multiple lip fillers as well as a second rhinoplasty in September of 2017. The business student felt that the bump on her nose continued to grow after her first nose job.

“It wasn’t drastic. It was only something that I could see,” she says of the reason she went back in. But when she would mention the bump to other people, they couldn’t see it.

glossary of termsGraphic by Deanna Tucker.

Beauty trends that cost a pretty penny

Most of these procedures aren’t cheap either. Both women had money saved up – Azami from her previous marriage, and Burge from bartending.

Azami, 24, cost breakdown

  • Dermal fillers: $150 per one-quarter of a syringe
  • Initial rhinoplasty: between $7,000 – $8,000
  • Second rhinoplasty: $5,000

Burge, 23, cost breakdown

  • Eyelashes: $80 – $100 full set of eyelash extensions
  • Microbladed eyebrow tattoo: $600 initial session, $125 to touch up
  • Dermal fillers: $125 per one-quarter of a syringe
  • Breast implants: $9,400 – $9,500

Both women have had multiple fillers, and Burge gets eyelash extensions off and on. She says after an eyebrow tattoo touch up shortly after the initial session, she hasn’t had to go back in. She will go back when they begin to fade however.

Neither of the women say they would have considered getting lip injections when they could only find injectors offering a full syringe (they say they were quoted anywhere between $400 and $1,000 for a full syringe), but started only after finding places that offered smaller doses.

Regardless of what is being offered, the trend is growing in Calgary. Azami says her anesthesiologist mentioned plans to retire to become a full time injector, travelling between offices in Calgary and Vancouver.

Some doctors see around 30 women a day.

Instagram influences beauty trends

Although Burge says there is pressure to look a certain way in the bar industry, the biggest influence of beauty standards is Instagram for herself. “It’s insane. I think that we’re constantly looking at other people and constantly comparing,” she says.

Currently, there is no research available on the impacts of young Canadian women electing cosmetic procedures or surgery, and little research available on how social media influences young women in Canada.

One recent study on the issue suggests there is a correlation between body dissatisfaction among young Canadian females who spend a significant amount of time online. The 2017 study claims to be the first of its kind, and reveals that among participating females aged 12 to 29:

  • Nearly 15 per cent reported dissatisfaction with their bodies
  • When spending 20 or more hours a week online, body dissatisfaction increased significantly
  • Those who spent 11 to 20 hours online per week were also more likely to be less satisfied with their bodies

The study reports that current research suggests girls and young women are highly exposed to online images and messages about female beauty, where the unattainable ideal is often someone who is “tall, young, usually white, has long, flowing hair, is surgically enhanced, blemish-free, and very thin.”

Another 2009 study suggests, however, that while their participants felt pressure from the media regarding appearance, social comparisons were made only when the participant wasn’t cognitively preoccupied while looking at the images.

As powerful as Instagram can be, Burge says it’s important for her to ignore images that may influence her to think negatively about herself. “I’m like, you have no idea, that person could literally be all photoshopped.”

The lifestyle blogger says she takes it with a grain of salt, since she too has altered photos of herself.

“The situation for women is insane,” she says about online pressures to conform to trending beauty standards. “It’s very, very tough on women to look a certain way.”

Dr. Brown, both a reconstructive and aesthetic surgeon, says he too believes social media influences standards of cultural norms in beauty, but says, “the way I’ve tried to look at it is these pressures have been in place for ages. They’re just becoming more visible today.”

Instagram is currently one of the most popular social media apps, currently boasting 800 million active monthly users.

Sarah DeLaet, 35, came into Second Cup on 17th Ave S.W. after leaving a meeting in the city’s Southwest in four inch black heels and a long black blazer. Her recently highlighted blonde locks frame her face, which physicians and nurses alike have injected with fillers in her lips, tear ducts and nasolabial folds – otherwise known as smile or laugh lines. This is something she does a lot in the following hour or so – she laughs. A lot.   

The licensed practical nurse (LPN) formerly worked at the Alberta Children’s Hospital where a fellow colleague encouraged her to learn how to inject neuromodulators, more commonly known as the brand Botox. Eventually, she began working in a dermatology clinic in aesthetic medicine where she was then recruited as an aesthetic injectable consultant for Clarion Medical Technologies, representing a Swiss-made injectable – Teoxane.

While she has seen the trend for North America continues to be everyone to looking the same – high cheekbones, chin comes to a point, lips are full – Europe is moving away from this standard and into more individualized looks.

Sofia azami quote

From her time in the clinic, the LPN says a lot of young women would bring in photos of celebrities or Instagram influencers they wanted to look like. “But you have to remember, that’s what looks good on them,” She says. “What you get done needs to be tailored to you.”

Sofia Azami says she had been influenced by popular actresses in movies, but beauty standards are now determined by Instagram influencers. “I think now, growing up, it’s more like these Instagram models or you know, like these Kylies and Kendalls and Gigis,” she says.

“Obviously I’m not going to lie, social media did influence me; seeing all these girls on Instagram. They do all these makeup tutorials and stuff, and they have these full lips and lipstick looks so nice on them.”

Azami first started getting her lips done earlier this year, but wonders if younger women are prepared to make these types of decisions. “They’re not going to be mature enough to really think about it and what they’re doing, and accepting the consequences.”

Who can do what now?

Dr. Brown says regulations are a challenging area, and part of a bigger problem, “which is that there’s quite varied regulations, depending where you are in the country.”

Varied regulations means it’s important for anyone electing aesthetic procedures or surgeries to be an active participant in responsibly choosing their provider.

The College and Association of Registered Nurses of Alberta – CARNA – said in an email response that physicians, dentists and nurse practitioners are considered authorized prescribers of Schedule 1 drugs such as Botox in Alberta.

The organization says these regulations are in place because Schedule 1 drugs like Botox are “identified as involving a significant degree of risk to the public and demand specific competencies on the part of the person performing them.”

According to CARNA, Nurses are required to have additional education and experience to ensure that they are competent if they engage in these interventions. Although the type of education required isn’t made clear in their regulations, she says nurses need to carefully consider the following:

  • Do they fully understand the risks and benefits associated with the procedures?
  • Are they able to deal with complications?
  • Can they provide appropriate recommendations and counselling to clients?
  • Do they have the technical capacity and liability protection for their practice?  

Nurse and dermal filler representative DeLaet says as an LPN, if she wanted to inject, “It is mandated in my regulations the physician is onsite during my injections.”

She says regulations for registered nurses require clients to have “a consultation by a physician, and once a year they need a reassessment. Because at the end of the day it’s a drug that’s still being prescribed and it’s a medical device that’s being implanted.”

Even with regulations in place for authorized providers, there are still concerns about who can perform cosmetic medicine in Alberta.

Kelly Eby is the director of communications and government relations with the College of Physicians and Surgeons of Alberta and says they have had concerns brought to them about non-physicians providing cosmetic procedures. But she says, “we don’t have any jurisdiction. So all we can do is ask them to take it to the courts or the police.”

Eby says Alberta regulations don’t allow family doctors to perform cosmetic surgeries. Although the description is oversimplified, she says a cosmetic surgery can be defined as anything cutting into the skin.

“They can do things like fillers, but I mean, they’re certainly not going to be doing implants or breast reconstruction after cancer, or rhinoplasties or things like that,” she says.

Dr. Brown says plastic surgeons are trained for five years following medical school and certified by the Royal College of Physicians and Surgeons of Canada to ensure proper patient care. He says educating his clients or potential clients about the benefits and risks is vital.

“In the end, it’s about appropriately informing people about that upfront so that they can make a proper, informed decision whether they decide to undergo the procedure.”

He says this all came to a head in Ontario in 2007 after Krista Stryland underwent liposuction in a private surgical facility and died subsequently. “It turned out the person who was performing the surgery was a family physician,” he says. “That was their Royal College certification – they were trained as a family physician.”

Another Oct. 2017 article recounts how a 19-year-old Toronto woman with a high school diploma posed as a plastic surgeon in advertising materials, performing botched procedures in a basement, which resulted in infection and corrective surgery for at least one person.

Dr. Brown says in Ontario, if a family physician wanted to market that they specialize in Botox treatments, they must first explicitly state that they are a family doctor, and on the second line can say they specialize in cosmetic medicine.

“So, you couldn’t say “I’m a family physician specializing in cosmetic surgery” because you can’t refer to what you do as surgery.”

Eby says Alberta doesn’t have obvious rules surrounding how physicians and surgeons refer to themselves online or in print.

Editor: Amber McLinden | 

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