It was the otoplasty procedure heard ’round the world – or at least the country. When 11-year-old Bella Harrington’s otoplasty (otherwise known as an ear-pinning surgery) was featured on the tabloid news show “Inside Edition,” reaction to the procedure was mixed at best. Harrington received the procedure from Midlothian, Virginia-based plastic surgeon Dr. Joe Niamtu, and was shown sobbing with happiness following the procedure. But even Harrington’s happy tears weren’t enough to sway some critics.

“I think most people saw it as a heartwarming story, that this little girl could finally smile at herself in the mirror. But Dr. Niamtu got a fair share of hate mail for it,” says Berkeley, Michigan-based plastic surgeon Dr. Bruce Chau. “Some people thought the patient was simply too young for plastic surgery.”

Children receiving plastic surgery of any kind is a topic that’s already widely debated. Critics argue that children need to finish growing before altering their bodies, and that they’re too young to understand the implications of cosmetic procedures, while proponents say some procedures can reduce bullying and increase self-esteem.

“It may not seem like a big deal, but bullying during the formative years can have lasting effects on a person’s self-esteem. It can follow them around for the rest of their lives,” says Chau.

And those lives may not be very long, either. According to a recent article by Melissa Holt, assistant professor of Counseling Psychology at Boston University, children involved in any aspect of bullying are at an increased risk of suicide. A Yale University study found that children who are bullied are two to nine times more likely to consider suicide than children who are not bullied.

So, what about those people who say bullying is just a part of growing up, and kids should just brush it off?

“This ‘sticks and stones’ mentality isn’t really helping anyone,” says Chau. “The truth is, names do hurt, and we shouldn’t be making kids feel like they’re in the wrong for being hurt by this type of behavior. Bullying isn’t the same animal it was 20 years ago, thanks to the internet.”

Chau’s not wrong. What used to be isolated to school and the playground has an after-school afterlife that lasts forever. Cyber bullying can be extremely difficult to stop, because it can be easily done anonymously, and it can be posted in forums that are impossible to remove, haunting the victim for years to come.

“It’s like a permanent reminder of their bullying that will follow them around for the rest of their lives unless they can manage to get that content removed,” says Chau.

So, where exactly is the line in the sand for what procedures can and cannot be performed on children? The good news is that reasonable restrictions do exist, according to Chau.

“Patients must be over 18 to get breast implants, though the exact age may vary by state,” he says. “But rhinoplasties can be done at age 16, and otoplasties can be done much younger. It all has to do with the growth and development of the child, and whether or not the procedure can be done safely and the results permanently. We are performing cosmetic surgery, but we’re still doctors. We still want the best for our patients.”