By C. Downey © 2005-2009
PlasticSurgery.com Staff Writer
When Valerie Ablaza, M.D., a plastic surgeon in Montclair, N.J., was performing plastic surgery a decade ago, she primarily saw patients with a Northern European background. Then, approximately four years ago, she performed facial surgery on an African American patient on television, and afterwards, she noticed more people of color frequenting her practice. Dr. Ablaza was always among the first to notice race and ethnic differences in not only plastic surgery, but other areas of life because her father is Philippino and her mother, Anglo-Saxon.
“Early on, it became clear to me that all people want to look the best they can while retaining the usual features of their race,” says Dr. Ablaza. “Traditionally, many minority groups felt plastic surgery was unacceptable because it changed ethnic features too much, and because the healing of scars would not match darker skin.”
In the last several years, the number of Dr. Ablaza’s patients who are Asian, African, Latino, and of Middle Eastern ancestry has quadrupled.
According to the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS), ethnic minorities accounted for about 20 percent of the 11.9 million cosmetic procedures done in 2004. Moreover, one of the largest trends in plastic surgery is an increase in minorities undergoing surgical rejuvenations. For instance, since 2000, requests for plastic surgery among Latino patients have increased 49 percent.
Medicine is constantly learning how various ailments – and even the drugs taken to combat those medical woes – have different effects on various ethnic and racial groups.
And that goes for plastic surgery as well. Surgeons say that differences in skin textures and internal supporting structures must be understood. For instance, depending on your ethnic background, a “typical” nose can include low, flat bridges, bulbous tips, plunging or hooked tips, wide, flared nostrils, short noses or nasal humps.
At the top of the list of concerns among surgeons who treat patients of African descent is possible keloid scarring. Keloids are hard, wide scars that often must be treated for life.
“The darker the skin, the more likely of keloid scarring,” says Dennis Hurwitz, M.D., F.A.C.S., a plastic surgeon in Pittsburgh, Pennsylvania “Often the surgeon’s best clues are how past scars have healed.”
Facial Plastic Surgery
Because darker skin tends to be thicker, it usually ages much slower than people of Northern European backgrounds; lighter, thinner skin wrinkles earlier in life than darker, thicker skin, and is extremely sensitive to the sun.
“Anglo-Saxon background people also tend to lose their facial fat earlier in life and that, too, promotes aging via sagging skin,” says Dr. Hurwitz.
Popular operations among people of Northern European background include facelifts, nose reshaping, liposuction, and breast augmentation. Meanwhile, many African-Americans often opt for nose reshaping, breast reduction and liposuction.
The Fitzpatrick Skin Type test is a medical chart that describes six types of skin, from very light and highly sun sensitive to very dark and sun resistant. “However, every race has members who have type 1 through VI skin types,” says Min-Wei Christine Lee, M.D. M.P.H., a cosmetic dermatologic surgeon at East Bay Laser and Skin Care Center in Walnut Creek, Calif. “So I know I can’t treat all patients of one ethnicity alike. Depending on the actual type skin, I may have to do an operation on an Asian like I would on a black person.”
Boris M. Ackerman, M.D., a plastic surgeon in Newport Beach, California, adds: “An incision I may consider for an Anglo patient would be placed differently in a non-Caucasian. Or, I may not want to use any deep resurfacing methods on dark skin because it may lighten the color too much. I would also watch surgical scars in darker skin carefully because I can intervene at various stages.”
Experts report that as many as 90 percent of people with Asian backgrounds seek a “double eyelid crease,” opting for a procedure known as Asian blepharoplasty or double-eyelid surgery. The surgery provides a more open-eyed look while retaining the traditional shape of an Asian eye. These patients may also notice an improved upward gaze and easier application of makeup. Other common procedures favored by people of Asian heritage include nasal reshaping, because the bridge of the nose tends to be low.
Surgeons additionally report cultural preferences. Many Latino women prefer a slightly larger and shapelier rear end, thanks to influences from South America where a large derriere has long been favored over larger breasts, says Miami plastic surgeon Constantino Mendieta, M.D., who appeared last season on Bravo’s documentary series “Miami Slice.” Many female patients from the Middle East concentrate on rhinoplasty because due to traditional dress, the beauty emphasis is on their face.
“In Korea, people look down on scarring,” says John Kim, M.D., assistant professor of plastic surgery at Northwestern University. Dr. Kim spent a sabbatical in Korea, Japan and China studying Far Eastern methods of plastic surgery. “So surgeons there work harder to reduce scars,”
So no matter a patient’s ethnicity, surgeons have a way of specifically enhancing one’s looks while still maintaining his or her unique characteristics.