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Cinderella. The Ugly Duckling. The Frog Prince -- the myth that we can be something we're not, something beautiful, runs deep in our culture.

We all want to believe that a fairy godmother can wave a magic wand and turn us into candidates for the "Most Beautiful People" issue of People magazine.

Teenagers, who can spend hours a day thinking about their appearance, are more vulnerable to this myth than most adults. The latest focus of their transformation fantasies is a crop of TV shows that tout plastic surgery, including "The Swan," "I Want a Famous Face" and "Extreme Makeover."

The shows are fueling a bonfire of the vanities that already was burning hot. The number of surgical and nonsurgical cosmetic procedures in the United States increased by 20 percent from 2002 to 2003, to nearly 8.3 million annually. That's a fourfold increase since 1997, according to the American Society for Aesthetic Plastic Surgery.

Teenagers contributed -- but only slightly -- to the increase. People 18 and under had 220,077 cosmetic procedures in 2002 and 223,594 in 2003.

Debbie Weeter's daughters -- Brittany, 17, and Brooke, 15 -- are fans of the shows, but their interest played no role in the family's recent decision to have Brittany's ears pinned closer to her head, a procedure known as otoplasty. Weeter said they'd been considering the procedure for years.

"She's a pretty girl -- very petite. But then she had these ears. We thought for a while that she'd grow into them," said Weeter, of Lakewood, Colo. "When she didn't, we started considering it seriously."

Brittany had always been self-conscious about her ears and tried to hide them with long hair. Now she's comfortable wearing her hair on top of her head, which is great for cheerleading.

The surgery, which took place in December, cost $5,000 and was considerably more painful than Brittany had expected. Her ears still hurt occasionally.

Cosmetic procedures

Otoplasty traditionally has been among the top five cosmetic procedures for teens. In order, in 2003, those were: chemical peel, laser hair removal, microdermabrasion, rhinoplasty and otoplasty.

Chemical peels and microdermabrasion are acne treatments. These, or rhinoplasty to reshape an unsightly nose, can be godsends for children who face ridicule and rejection from classmates.

"If a teen's appearance has affected their ability to make friends and participate in school life, a cosmetic procedure is appropriate," said Dr. John Grossman, chairman of the plastic surgery department at Rose Medical Center in Denver. "But if it's anything less than that, I'd advise waiting until the teen is emotionally mature.

"These kids have plenty of time to decide if they like how they look and whether changing it is worth the pain," Grossman said. "These shows tend to imply that cosmetic surgery is risk free. But this is real surgery, not glorified cosmetology."

More inquiries

The news for teens is in the rising popularity of breast augmentation surgery. FDA regulations prohibit augmentation for anyone younger than 18, but for 18-year-olds, it's a different story. In 2002, breast augmentation came in eighth, behind breast reduction and collagen injection. In 2003, it became No. 6, nearly tripling from 3,872 cases among 18-year-old girls in 2002 to 11,326 last year.

With the addition of plastic surgery shows to the cultural mix, many are thinking that's No. 6 with a bullet.

Dr. Joseph Serota, who performed Brittany Weeter's otoplasty, estimated that he had received 20 percent more inquiries about teen cosmetic procedures since the plastic surgery shows debuted. Nevertheless, teenagers still made up only a small percentage of his practice, Serota said.

"We've definitely been busier, and the shows are a big part of it," he said. "People call and tell us they've just watched ‘Extreme Makeover' or ‘The Swan,' so they're thinking about plastic surgery."

TV influences

Michael Wood, vice president of Teen Research Unlimited in Chicago, which tracks teenage trends, says teens started mentioning the shows in focus groups and mail-in questionnaires almost as soon as they hit the air.

"Overall, teens aren't really comfortable with the way they look to begin with," Wood said. "And they're fascinated by the idea of looking better. Then you throw in the notion of sudden and immediate change through plastic surgery, and teens are all about that. They love immediate gratification, so they're captivated."

Wood says the most captivating of the shows for teens is MTV's "I Want a Famous Face."

The program documents the progress of young adults who get cosmetic procedures in a quest to look like celebrities. So far, the subjects of the show have ranged in age from Sha, 19, who got breast implants in an effort to look like Pamela Anderson, to Mia, 27, who got breast implants to look like Britney Spears. Both women said they thought plastic surgery would help them in their performing careers.

Soon after "I Want a Famous Face" debuted, Dr. Rod Rohrich, president of the American Society of Plastic Surgeons in Arlington Heights, Ill., took aim.

"The new wave of plastic surgery reality television is a serious cause for concern," he said in March. "Some patients on these shows have unrealistic and, frankly, unhealthy expectations about what plastic surgery can do for them."

Rohrich expressed particular concern for the "young, impressionable audience watching these shows who are already self-conscious about their body image."

"I have witnessed plastic surgery disasters where someone tried to look like someone else," Rohrich said. "Patients need to be careful of any physician claiming they can make you look like someone else. Everyone has different and unique facial features and bone structures, which greatly influence the outcome of any plastic surgery procedure."