Ethnic Plastic Surgery on the Rise

Reviewed by Julius Few, MD

Ethnic plastic surgery increased 11 percent in 2008, with more than 3 million cosmetic procedures performed among African-Americans, Hispanics and Asians. By contrast, procedures among Caucasians dropped 2 percent in 2008, according to the latest numbers from the American Society of Plastic Surgeons.

The greatest surge in cosmetic treatment occurred within the Hispanic community. In fact, Hispanics comprised 10 percent of the 12 million cosmetic plastic surgery procedures performed in 2008. African-Americans accounted for 8 percent, and Asians accounted for 7 percent.

To find out what fuels these trends and what special considerations factor into ethnic plastic surgery, the Consumer Guide to Plastic Surgery spoke with Julius Few, MD, a board-certified plastic surgeon and director of The Few Institute for Aesthetic Surgery in Chicago. Dr. Few is widely regarded as an expert in ethnic plastic surgery.

Ethnic plastic surgery is on the rise despite the current economic downturn. Why is that?

"There is an increased awareness of the availability of ethnically specific and ethnically appropriate cosmetic treatments. There is also a growing number of surgeons who specialize in ethnic plastic surgery and their techniques can allow patients to maintain their ethnicity. There is nothing wrong with a person of any given background wanting to be the best that they can be."

Are people trying to enhance or obscure their ethnic identity with ethnic plastic surgery?

"Enhance it. Ethnic identity and respect for different ethnicities is at an all-time high. Ethnic patients are not trying to change their identity with cosmetic surgery in any way. I believe that President Barack Obama has allowed for acceptance of cultural identity."

Does celebrity emulation play a role in ethnic plastic surgery? If so, who are patients looking to emulate today?

"When it comes to facial aesthetics, African-American women love Beyonce Knowles and I still often get pictures of Vivica A. Fox from patients in their 40s. Those are the two celebrities that are most recurring. And of course, many African American patients also bring in pictures of President Barack Obama and First Lady Michelle Obama. Women of all ethnicities actually like the look of Michelle Obama's arms, and this could fuel a rise in bicep and tricep liposuction to sculpt the arms."

In 2008, the most commonly requested minimally invasive cosmetic procedures for all ethnic groups were Botox, fillers and chemical peels. What can ethnic patients expect if they opt for such procedures?

"A lot. People with darker pigments, including Latinos, African-Americans and Asians don't show the obvious signs of aging until much later in life when compared to individuals with fairer complexions. If they come in during their 40s with moderate signs of aging, they can get a significant return from a lot of the non-surgical procedures that are currently available. That is a clear advantage for these populations. We get a lot of results from non-invasive approaches like Botox, dermal fillers and mini facelifts, all of which cost less than full facelifts. It's a win-win."

What surgical procedures are ethnic patients most interested in these days?

"African-Americans are coming in for liposuction, nose reshaping and breast reduction. Asians seem most interested in nose reshaping, blepharoplasty or Asian blepharoplasty, and breast augmentation; and Hispanics are drawn to liposuction, breast augmentation and ethnic rhinoplasty."

Is scarring more likely after ethnic plastic surgery?

"The risk of scarring and pigment abnormalities are definite concerns with cosmetic procedures in ethnic patients, but a plastic surgeon with experience treating ethnic skin can minimize this risk. For example, injecting wrinkle fillers deeper into the skin can reduce the risk of skin darkening (hyperpigmentation). Scarring is also a risk with laser skin resurfacing in people with dark skin, but fractionated lasers have settings that can be used safely and effectively in these populations. Pretreatment with skin bleach and Retin-A are also very effective ways to condition the skin and reduce the risk of scarring before laser skin resurfacing or laser hair removal. Pretreatment can start anytime from two to six weeks before the procedure, and can continue for a couple of weeks post-treatment. On the surgery side, it's important to minimize skin tension (stretching) in ethnic patients. Too much tension on ethnic skin can lead to a bad scar or a keloid (raised, reddish nodules that develop around a skin injury). Tension can be minimized by stitching up the deeper skin layers when closing up an incision."

What questions should ethnic patients ask of their prospective cosmetic surgeons given these special considerations?

"The key question to ask is, 'What, as a surgeon, do you do differently when treating someone like me, compared to someone who has fairer skin?' Other questions include, 'What issues have you seen occur in ethnic plastic surgery patients and how have you managed those issues?' Be direct. Ask if the plastic surgeon has experience with darker skin types. By and large, doctors will be honest."

Is there a magic number of ethnic patients that a plastic surgeon should have treated to be considered an expert in this area?

"If somebody has taken care of 25 ethnic plastic surgery patients, that is a significant number. When interviewing prospective surgeons, ask to view before and after photos of ethnic patients or ask if you can speak to previous patients who share your ethnic background and have had similar procedures."

About the Reviewer of This Article

Julius Few, MD, is the founder of the Few Institute For Aesthetic Plastic Surgery in Chicago. Board certified by the American Board of Plastic Surgery and the American Board of Surgery, he is also a clinical associate professor in the division of plastic surgery at the University of Chicago and the current president of the Illinois Society of Plastic Surgeons.

Dr. Few received his medical degree from the University of Chicago Pritzker School of Medicine, and completed his residency in general surgery at the University of Michigan Medical Center in Ann Arbor, followed by plastic surgery training at Northwestern University in Chicago. He has also received special facial and eye cosmetic training in Honolulu, New York and Atlanta.