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Cosmetic surgery was once considered a hush-hush procedure, reserved primarily for society's high-rollers. But these days, the face of those seeking a nip or tuck here, a zap or lift there, is changing -- and getting a whole lot younger.

According to the American Society of Plastic Surgeons, kids under 18 had nearly 332,000 cosmetic procedures in 2003. Although that accounts for only 4 percent of the total aesthetic adjustments Americans had that year, the number represents an astounding 48 percent increase from the year before.

Staten Island, often thought to be behind the times when it comes to what's hot and what's not, is no exception to this trend. Like their counterparts nationwide, plastic surgeons here are encountering increasing numbers of teens seeking rhinoplasties (nose jobs) -- the most popular request -- otoplasties (ear surgery), collagen injections, breast enlargements and reductions, and, occasionally, liposuction.

Some experts believe that this rise is due in part to the popularity of radical makeover reality shows like ABC's "Extreme Makeover" and FOX's "The Swan," as well as FX's drama, "Nip/Tuck," all of which have made plastic surgery about as taboo as a haircut.

"In general, there is a higher acceptance and a better understanding of plastic surgery today, but the rise is also due to a stronger economic climate and the maturity of parents," said Dr. Robert V. Vitolo, a plastic surgeon with offices in Dongan Hills, Brooklyn and Manhattan. "The parents may have had surgery themselves, and wish they'd had their nose done when they were 16, instead of 35. They're becoming more receptive to the idea, and they're more able and willing to help their children afford this type of surgery."

Actually, in his 25-plus year experience, Dr. Vitolo said it's not unusual for cosmetic plastic surgery to be given as an extravagant "gift" for a Sweet 16 or high-school graduation.

Teens as young as 14 come into his office, most in search of a nose job. Sometimes, Dr. Vitolo, notes, the surgery is done to correct an injury, but more often, it's simply an issue of development.

"They come in because their nose is too big. The nose is a feature on their face that people see first, so they want it to look a certain way," he said. "We definitely get more girls coming in for rhinoplasties, but I'd say about 25 percent are boys."

For those considering the procedure, his Web site, www.drvitolo.com, offers virtual makeovers, where teens (those under 18 need parental approval) can send in their picture, and then receive a computerized image via e-mail of their "new" nose.

There's also a big market for breast enlargements among females between ages of 18 and 20. Dr. Vitolo has performed such procedures on girls as young as 16, since, as he explained, if a girl doesn't develop breasts three years after the onset of menstruation, she probably never will. However, the FDA recently suggested the age of 18 as the "lower limitation."

Breast augmentations are also performed on girls with noticeable breast asymmetry. Other less popular teen-requested procedures are otoplasties for those with prominent ears, and liposuction.

"Most teens come in for the right reasons. They don't say, 'I want to look like Pamela Anderson,'" concluded Dr. Vitolo.

Dr. Michael Gartner, a plastic surgeon with offices in Graniteville and in Edison, N.J., agrees that the teens he sees, often as young as 16, are indeed coming in for practical purposes.

Some female patients with a condition known as macromastia (large breasts) may seek a breast reduction, for example, because of excruciating back or neck pain and/or the inability to play certain sports. Others, some as a result of merciless teasing, come in for a rhinoplasty or otoplasty to improve their overall appearance.

"In the case of rhinoplasties, they may have been teased about their nose their whole lives, so they want to do something to make a nice improvement in themselves," he explained. "In all of these cases, we talk to the teenager. We take the whole patient into account, and always make sure the parent is involved."

How do the teens feel when the procedure is complete?

"When they walk in, the average teen is insecure ... but when they walk out, most of them experience a dramatic positive effect on the course of their lives," said Sunnyside plastic surgeon Dr. Fredric Marks, who estimates that teens make up between 15 to 20 percent of his practice.

With this said, however, it's worth noting that not every teen dream of "perfection" is made into reality. Some do get turned away, particularly those who are looking to have a breast augmentation before their breasts are fully developed, those obsessed with looking like a specific Hollywood star, as well as those hoping to "magically" shed pounds via liposuction.

"My personal feeling, as far as liposuction, is that the teen years are too soon for such a procedure, which is why I'm so hesitant about it," said Dr. Gartner. "Some teens want the quick route, but I usually tell them to try diet and exercise first."

In general, the American Society of Plastic Surgeons recommends that teenagers and parents move cautiously when considering cosmetic procedures, making sure they know the potential risks, and have realistic expectations about the outcome. tail Tamara Valles is a Lifestyle reporter. She can be reached at valles@siadvance.com