Diversity in Plastic Surgery

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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


July 14 2008

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Trends in Ethnic Plastic Surgery

Hispanic, African, and Asian-Americans figured prominently in the United States' plastic surgery statistics for 2007, accounting for almost one-quarter of the 11.7 million cosmetic procedures performed. According to figures from the American Society of Plastic Surgeons (ASPS), in 2007 alone, cosmetic plastic surgery procedures were up by 8% among Hispanic and African Americans, and by 26% in the Asian American population.

Specifically, the numbers break down to 1,011,000 Hispanics, 847,800 African-Americans, and 767,800 Asian-Americans who underwent procedures.

This rising trend is even more impressive when compared to figures for 2000: a leap of 173% in Hispanic-Americans, 129% in African-Americans, and 246% in Asian-Americans.

"A key take-away from this data is that the plastic surgery patient profile is changing," says ASPS President Richard A. D'Amico, MD. "The majority of patients remain Caucasian women, but it is noteworthy that cosmetic plastic surgery procedures were performed on almost as many Hispanic patients as male patients."

Although all three ethnic groups shared nose reshaping, or rhinoplasty, among their three most popular procedures, they split on others. The procedures requested most often by African-American patients were liposuction and breast reduction. Asian-Americans preferred breast augmentation and eyelid surgery, while Hispanic patients opted for breast augmentation and liposuction. Among the minimally-invasive cosmetic procedures, Botox® Cosmetic, microdermabrasion, injectable wrinkle fillers, and chemical peels were tops with all three groups.

As plastic surgery has become more accessible to the population at large, ethnic patients have become more aware of the options available for their skin types and facial features, says ASPS. "Ethnic patients who have plastic surgery have similar motivations and goals as other patients," the organization reports in its Briefing Paper: Plastic Surgery for Ethnic Patients. "They want to reduce the signs of aging, look refreshed and rejuvenated, or may want to enlarge, reduce, refine, or create balance and symmetry on their face or body."

The one thing the experts agree on is that these patients want to maintain their ethnic identity, and this is particularly true when it comes to cosmetic facial surgery. Asian patients who undergo the so-called "Asian nose job" or "Asian eyelid surgery" may be seeking a narrower nose or wider, fuller eyes, but they still want these features to look natural in an Asian face. Likewise, African-Americans may undergo rhinoplasty to reduce the size of their nose, but they are expecting a new nose that's in harmony with the rest of their features, not one that's more European in appearance.

Ethnic patients do face some unique risks and complications when it comes to surgery of any kind, including cosmetic. A major concern is adverse scarring due to melanin, a brown pigment found in the skin. Both keloid and hypertrophic scars, which appear as thickened or raised tissue along an incision line, are common in patients of African and Asian ancestry, as well as in patients with a family history of this condition. The scars can appear anywhere on the body, but are most common on the breasts, chest, shoulders, and ears. Less invasive surgical techniques that reduce trauma to underlying tissue and inflammation can be used to limit scarring. Incisions can also be placed where they will be less visible, and scars can be reduced postoperatively with topical and injectable medications, pressure therapy, or surgical removal.

Ethnic patients should also be cautious when choosing minimally-invasive cosmetic procedures involving exfoliants, lasers, or chemicals because they can cause pigment irregularities. Called hyperpigmentation when the skin darkens and hypopigmentation when it lightens, these skin color changes are often associated with facial rejuvenation procedures like laser skin resurfacing, chemical peels, laser hair removal, and dermabrasion. Hypopigmentation is difficult to treat and may be irreversible, while hyperpigmentation may be reversed in 6 to 8 months with proper treatment. Patients concerned about possible pigment irregularities should request a skin test before undergoing any of the associated procedures.

For best results, ASPS recommends that patients choose a board-certified surgeon who has experience with ethnic skin types in the procedure they're pursuing. Patients should ask the surgeon to see before-and-after pictures of their ethnic patients and, when possible, speak directly with them. The surgeon should then work with the patient to achieve what he or she finds attractive based on their own personal or cultural ideals, adapting surgical techniques when possible to meet those goals.