Many teenagers pester their parents about plastic surgery, whether it is for their nose, breasts, thighs, or whatever. It is difficult for parents to know what to do, because often the teen is already attractive and is seeking the kind of perfection that the parents never considered attainable when they were young.

Your daughter's concern about her nose may just be a reflection of pressure from teen magazines, movies, and TV to have an appearance that rarely occurs in nature.

Body Dysmorphic Disorder (BDD) is defined as a disabling condition that is characterized by serious distress and preoccupation with some aspect of ones appearance (while others say that the individual looks fine). This worrying may lead to compulsive behaviors or rituals, as well as surgical procedures to conceal or change the problematic body part(s).

Any aspect of a person's appearance can be the focus of concern. For example, a normal-appearing person may think s/he has a bad complexion, a large nose, an asymmetrical body or one that is not sufficiently muscular.

Symptoms may include:

• excessive grooming or camouflaging the perceived flaw with clothing, make-up, a hat, hand, posture, etc.

• frequent checking of one's appearance in mirrors or total avoidance of mirrors;

• frequent touching or measuring the feature of concern;

• excessive attention to the physical attractiveness of others;

• constantly comparing one's appearance with others;

• feeling anxious around other people and avoiding social situations because of the perceived flaw;

• frequent requests for reassurance about one's appearance;

• excessive reading or talking about the perceived flaw; and

• seeking help from cosmetic surgeons, dermatologists, or dentists to remedy the perceived flaw, even after doctors have said that treatment isn't necessary or advisable.

Like many new diagnoses, this one is controversial. For example, how do you distinguish this disorder from the vanity or self-consciousness of adolescence? In her recent book, "The Broken Mirror," Katharine Phillips, a psychiatrist at Brown University School of Medicine, says that more than 5 million Americans suffer from BDD. However, she admits that the "difference between BDD and normal appearance concerns may be largely a matter of degree."

Ask a few close friends or relatives what they think of your daughter's request. If they agree that plastic surgery seems like an excessive response, you may want to encourage your daughter to wait a few years; by then, she may have gotten past the self-consciousness of her teenage years. You may want to help her find other ways to feel more self-confident about herself or her appearance. If, on the other hand, others are less convinced than you are that your daughter's nose is fine, you may want to consider her request more seriously.

If your daughter sounds like she might have BDD, you should speak to your family practitioner or a specialist before agreeing to any kind of surgery.