Recently a number of articles have been written about the Little Baby Face Foundation (LBFF), a nonprofit providing free plastic surgery for children with facial deformities worldwide.  Controversy has flared over LBFF’s acceptance of cases in which children or adolescents are seeking facial plastic surgery due to severe bullying following a recent Dateline episode covering the issue.  For some people, including many mental health professionals, the idea of a child or teen seeking – and getting – facial plastic surgery to “fix” a physical feature which has garnered them relentless bullying, such as an overly large nose or too-small eyes, seems misguided at best and catastrophic at worst.


After all, the real problem is the cycle of bullying itself, not the reason for it, right?  Children need to be taught to accept and love their bodies, right?  That sticks and stones may break their bones but words can never hurt them, and that the real conversation should be about how to effectively stop bullying and prevent it in the first place, right?


Certainly, these statements have merit.  For the vast majority of youth bullied about their appearance, teaching them to accept and love their bodies, to ignore the bullies, to surround themselves with a protective network of friends, teachers and family members, and to remind themselves that bullies inevitably hide their own secret pain are certainly all positive and helpful approaches to take. 


The problem is, these and other traditional strategies don’t always help.  Sometimes, a child’s physical appearance may deviate from societal norms to such an extent that they become the target of bullying so relentless and cruel that the usual strategies amount to fighting a forest fire with a garden hose.  Adding to this pain are inevitable the chorus of adults encouraging the youth to “buck up” and “blow it off” and sharing parables about turning the other cheek.  Simply put, most people do not understand what it feels like to be severely and chronically bullied.  While well-meaning, these messages can often convey to the bullied child that their inability to “just blow off” severe and recurrent bullying must be due to a weakness or failure within themselves.  The more hopeless, powerless, and desperate a bullied youth feels, the more encouragements to simply “be the better person” begin sounding less like empowering bits of wisdom and more like a different kind of bullying itself, seemingly reminding them that if they were only better or more resilient, the bullying wouldn’t hurt so much.


The effects of chronic and severe bullying can be catastrophic to a child’s mental health and well being, as the frequent media reports of teens committing suicide due to bullying can attest, and can contribute to severe mental and physical health problems which may last well into adulthood.  Severely bullied youth need all the help they can get, and their self-esteem, resiliency, and coping skills may have been flattened by years of abuse.


While facial plastic surgery would be inappropriate for the vast majority of youth who are bullied about their appearance, for some with genuine physical differences different enough from their peers so as to attract ruthless and relentless bullying, surgery may represent not a “victory” for the bullies, but perhaps the way out of a vicious cycle.  Sometimes you have to change one thing to potentiate other changes.  Changing a problematic circumstance of a child’s physical appearance may give them the space, and emotional boost, needed to rebuild their self-esteem and provide them with a fresh start.


The key to determining whether a surgical procedure might be part of a solution to a truly severe bullying problem should be a thorough and detailed vetting process.  For example, care must be taken to ensure that the child is surrounded by a support system to help them through the transition post-surgery.  In addition, psychological screening can assist in discovering potentially problematic issues which may rule out surgery, such as the presence of an eating disorder, self-injurious behavior like cutting, evidence that the youth’s appearance is not the primary or sole source of bullying, and assessing the youth’s risk of negative psychological effects from the surgery.  Finally, any youth elected to undergo such a procedure should be receiving regular counseling from a qualified mental health professional to aid with the stresses of the transition, develop more effective coping strategies and support systems, a plan to deal with the likely-inevitable instances of future bullying, and ensuring that the surgery is viewed not as a “band-aid” quick fix, but as merely the first step down a challenging but more hopeful new path.