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As the school year comes to a close and spring drifts into summer, many young women make the same, predictable enough purchases: a new gown for the prom, a new swimsuit for the beach. But a new nose?

That's what Jessica Cruz, 19, bought for herself back in January in anticipation of sunglass season.

"I have a flat nose ... I don't have a bridge," the Toronto teenager says. "My glasses didn't sit well on my face so I wanted the bridge to be more prominent. I wanted it to look good and to feel better about myself."

Cruz is one of a growing number of North American teens who are turning to what was once a recourse of much older women - plastic surgery - to alter their bodies and appearances for reasons unrelated to health.

According to the American Society of Plastic Surgeons, teen surgeries have doubled in the last eight years. In 2008, 219,000 cosmetic procedures were reportedly performed in the U.S. on patients aged 13 to 19. Almost 39,000 of those procedures were cosmetic enhancements such as breast reductions and augmentations, liposuction, tummy tucks and nose reshaping.

Although there is no equivalent data for Canada, doctors such as Oakley Smith, a cosmetic surgeon who works out of Toronto East General Hospital, say that the amount of teenagers seeking cosmetic enhancements in this country is also on the rise.

"The number of teens I treat has definitely doubled over the last 10 years," says Smith, who typically deals with youths seeking rhinoplasty. Cruz is one of his patients.

What exactly is prompting increasingly younger women without major flaws or deformities to go under the knife?

"I think there are a lot of influences driving it," Smith surmises.

"There's the adolescent pressure to fit in and not stand out. There's a bigger pressure toward perfection in today's society. There's a media pressure, too. All the media [portray]are perfect people and that seeps into young people's consciousness to become a goal."

Indeed, today's media influences aren't just upholding what many regard as unrealistic standards of beauty, the doctor says.

Many are specifically touting plastic surgery as a cure-all for supposed imperfections, he notes, citing the MTV reality show The Hills and star Heidi Montag, a young woman who has had multiple cosmetic surgeries before the age of 23, as especially suggestive.

As savvy about pop culture as he is, however, Smith can still be surprised by its reach, allowing that even he was taken aback when Cruz told him she wanted a new nose to better accommodate the large Paris-Hilton-style shades she favours.

"When I first heard that, it made me sit up and say: 'What?'"

Although her reason for wanting the procedure may have been atypical, however, Smith ultimately agreed to treat Cruz after determining that she knew what she was doing.

"I spoke to her and was impressed by her level of maturity. With all patients - not just teenagers - you want to make sure that they're psychologically and emotionally mature enough to undergo surgery. The desire to have surgery has to come from within, and surgeons must assess potential candidates to make sure it isn't parental pressure or peer pressure that's driving it."

Still, peer pressure is huge in teenland, where constant teasing or even a single barbed comment about another's appearance can wound.

Bria Dasilva-Mason was on the receiving end of such attention until last year, when, at age 15, she underwent breast-reduction surgery to downscale her size-38E chest.

Although the Toronto teen's large breasts were causing her back and neck pain and also preventing her from playing sports, it was the unwanted attention from her peers, who she says would stare at and taunt her, that cemented her decision to operate.

"Guys wanted to talk to me all the time and I felt frustrated because they didn't want to know me. They wanted to use me," she recalls, adding that the attendant insults often reduced her to tears.

"It was too much unwanted attention," says Martin Jugenburg, the full-body plastic surgeon who reduced Dasilva-Mason's breast size to a more manageable C Cup after determining she had the maturity to undergo the procedure.

"I know surgeons who flat out refuse to see teenagers, but I do not," says Jugenburg, who operates out of Humber River Regional Hospital in Toronto.

"I don't think age should be a factor. I think that maturity should be a factor. I think it is very important for any patient to fully understand the ramifications of their choices and their long-term impact on their lives."

In Dasilva-Mason's case, the impact of her surgery has been overwhelmingly positive, she says.

"It was a great decision. I have more freedom to do what I want and it's no longer my main focus. People are getting to know me now, not my breasts."

Cruz, the rhinoplasty patient, is likewise thrilled with her new nose: "I feel much better about myself. I think my self-esteem has increased."

As a result, she says, she is now considering more surgeries in the future, directly invoking The Hills' Montag.

"I think she looks good. If I had the money, I'd totally do it. I'd call it body maintenance."