Marriage changes lives.

So does cosmetic surgery.

Marriage is a long-term decision that affects more than the couple involved. The same is true for cosmetic surgery. According to Dr. William Sando, a local plastic surgeon, such surgery is "a choice that you live with for the rest of your life, and it's a choice that affects your relationships with other people."

Currently, there is no law that dictates a minimum age for cosmetic surgery, but the national plastic surgery organization recommends that patients generally be at least 16 years old. Also, youths under 18 usually need a parent's consent.

"In general, there's a recommendation that certainly it doesn't hurt to discuss their dream before or by age 16, but if that person and their family are willing, over several visits and several meetings and you really get to know them well, then any time from age 16 on you can consider cosmetic surgery," he said.

Teens make up about 10 percent of Sando's practice. They most frequently want to remove moles, scars and breast tissue, he said.

Cari Mayhill , 18, of Fishers had her first cosmetic surgery at 17. For Cari, the decision was not difficult to make -- her mother works for Dr. Stephen Perkins, a cosmetic surgeon in Carmel.

"I was always around it anyway, and so I always said, 'Mom, I want my nose done, I want my nose done, 'cause my mom has had surgery, too."

Cari got her chance by accident.

"I got in a car accident and I broke my nose and had to have the surgery anyway, for like reconstruction. Dr. Perkins was gonna do it, and he was like, 'Well, we can go ahead with the cosmetic surgery, too,' and I was all (for) it."

Cari met with Perkins several times before the surgery.

Sando explained that there are several reasons for these meetings: to assess the patients' maturity and financial state, and to try to find out why they want the surgery in the first place.

"If a person really doesn't know what they want -- if they come in and say, 'Make me beautiful,'or 'What do you think needs to be done, doctor?'-- that is a person of any age that I would steer out of the office," he said. "If that young or older person is not a happy person, don't operate on them."

Cari said part of her motivation came from how people talked about her. "My nose wasn't that bad; it wasn't awful. But when I was little . . . the boys would tease the girls, and they would tease me about my nose."

Understanding the risks

Sando also meets with patients several times because "they have to be well-educated to understand that there are risks with any operation." These risks include infection, excessive bleeding, scarring, numbness and reactions to the general anesthetic.

A patient's family's reaction also needs to be considered, Sando said.

"One of the toughest things is if there's, for instance, a nose deformity in a young person. If it happens to be something that Mom and Dad have in their noses, so it's a family trait, I want to make sure that if we proceed to fix something or change something that is considered normal, that (the patient is) not going to be rejected emotionally by their family for changing the family appearance," he said.

Sando said the discomfort during the healing process often makes a patient second-guess the decision to have surgery.

"During the healing phase, there is some regression that most patients go through very temporarily, wondering about the discomfort, the swelling, the numbness of the skin, the bruising, wondering if they're ever going to be normal again.

"But what we expect, if we and the patient have chosen well -- teen-ager or whatever -- is that there is a general level of happiness."

Cari described her ordeal after surgery: "It was a lot of pain. It would throb."

Within a week of Cari's surgery, she went back to school.

"I went to school for two days 'cause my dad wanted me to. Everyone stares at you. . . . The people who aren't my friends, they talked about me."

During the healing process, patients must avoid hitting the altered part of the body. Cari had to give up cheerleading for a while after her surgery.

"I couldn't do it for a long time. I think it was like four months," she said.

When Cari did resume cheerleading, she tried to be careful about her nose. However, another cheerleader slipped and struck her in the mouth.

"She caught my lip just by my nose, and my lip started bleeding, and I started crying. I was really kind of scared 'cause I didn't want to do it again," she said.

The incident did not break her nose, but another car accident a few months later did.

"It's really fragile the first year. That's why it broke so easily on me. The air bag is what broke my nose."

Cari was not looking forward to having the surgery again. Still, she said it was easier the second time around.

After going through two surgeries, Cari said, "I'd do it again, but I really don't have to 'cause I did have to do it again."

Sando hopes surgery makes all his patients happier. Sometimes he can see the changes.

"Some people become extroverts; they were real shy, and suddenly they just start talking to everybody, opening up. I've seen dramatic changes in personality," he said.

"I've had so many notes from patients, or comments, of how much it has meant to them to make this change, even though it's cosmetic, and how much happier they are in their daily life," he added.

After her experience, Cari has advice for other teens looking to have cosmetic surgery.

"It's their decision. . . . Go for it if that's what they want to do. I don't think they should let anyone influence it.

"But cosmetically, if it will make them feel better, and if that's what they want to do, then I'm all for it, and if I were their friend I would help them with it."

ASSISTANT EDITORS: Michelle Brackney, 18; Colleen Merkel, 16; and Stefanie Neumeyer, 16.

REPORTERS: Gabrielle Bibeau, 12, and Kelly Daniels, 12.