COSMETIC SURGERY - PARENTS' DISCRETION - When Mom or Dad wants a face-lift, do the kids need to know? Or approve?

WHEN Kanye West's mother, Donda, suddenly died of complications following cosmetic surgery last month, the media homed in on the troubling history of her doctor and the risks associated with the procedure. The hip-hop star has yet to speak out on his mother's death, and there are many unknowns. But one question that may never be answered is this: How did Kanye West feel when his mother decided to undergo a tummy tuck and breast reduction at age 58?

Or did she even tell him beforehand?

Maybe not. With nearly 11 million cosmetic surgery procedures performed last year, it's more likely than ever that someone in your family has had work done. It may be as subtle as the spot removal of a stepmom's under-eye baggage. Or perhaps a parent's sudden and suspicious jaunt to Tuscany without packing more than pajamas.

With all the emotional issues -- including a betrayal of genes and a resistance to aging -- that a nip or tuck can stir up, it's no wonder that cosmetic surgery causes frown lines in a family. So much so that some parents are now keeping mum about their procedures.

"A lot of patients don't even tell their adult kids about it because they're worried that their children will think it's vanity," says plastic surgeon Dr. Babak Azizzadeh of Beverly Hills, who estimates that 25% of his patients want to discuss how to tell their children. "They just don't know how to bring it up."

The 'other' talk

THAT'S not shocking. It is always an awkward topic. The issue itself calls into question the most basic values that parents teach their children -- that superficiality only reigns on the schoolyard and what's on the inside is what matters most. And what about moms who tighten up to the point of looking as attractive as their teenage daughters? No adolescent girl wants to hear, "Your mom is so hot!" Or be forced to reconsider a parent's political ideology.

"My mom was a huge feminist who didn't even want me to work at Elle magazine," says Clio Manuelian, a fashion publicist who lives in Los Angeles. "Then she got a face-lift, which was very perplexing."

For her mother, Taffy Manuelian, a psychotherapist and stand-up comedian who lives in Manhattan, the procedure made her feel sheepish enough to play down its significance.

"I taught Clio not to make evaluations based on appearance," she says wistfully. "What can I say? I felt like a hypocrite."