Briefing Paper: Plastic Surgery for Ethnic Patients

More than 3.2 million cosmetic plastic surgery procedures were performed on ethnic patients in 2013, an increase of 243 percent since 2000. Twenty-five percent of all cosmetic plastic surgery patients were Asian, Black, or Hispanic, surpassing the number of men who opted for procedures in 2010.

As plastic surgery becomes more mainstream, ethnic patients are becoming increasingly aware of what options are available to people with their skin types and facial features. With the boom in the number of procedures performed and the media's coverage of plastic surgery increasing, greater numbers of minorities are seeing the results of plastic surgery in the ethnic patient firsthand. This mainstreaming has helped to erase the stigma that may have once been associated with plastic surgery. Improved technology, scientific advances, and reduced costs have also contributed to the rising demand.

Ethnic patients who have plastic surgery have similar motivations and goals as other 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 majority of patients want to maintain their ethnic identity. They do not want to lose important facial features that exhibit racial character. For instance, the typical Asian patient who has eyelid surgery desires a wider, fuller eye that is natural looking to the Asian face and maintains an almond shape. An African American patient interested in nose reshaping may want to reduce the size of their nose to achieve a harmonious balance with other facial features, but is not seeking a nose that is more European.

Everyone has different, unique facial features and bone structure, which greatly influence the outcome of any procedure. Applying a European or other "standard of beauty" to ethnic patients may produce inconsistent results that are not harmonious with other facial features.

Not every plastic surgery procedure of interest involves ethnically sensitive areas like the eyes or nose. Some of the most commonly requested procedures by ethnic patients are liposuction, breast reduction, and Botox®, as well as, other injectable fillers.

Risks and Complications

Adverse Scarring: Some ethnic patients may be more susceptible to adverse scarring due to melanin, a brown pigment, found in the skin. Keloids and hypertrophic scars are common in patients of African and Asian ancestry, for example, and appear as thickened, raised tissue along an incision line. However, not all patients may experience this risk of surgery. To limit scarring, patients may opt for less invasive techniques, which produce less trauma to underlying tissue and reduce inflammation. Incisions can be placed strategically where scars will be less visible. Post-operatively, scars can be reduced through topical and injectable medications, pressure therapy, or surgical removal.

ASPS offers patients the following information about keloids and hypertrophic scars:

• Although most common in people of color, not all ethnic patients are at risk.
• Both can appear anywhere on the body, but are most common around the breasts, chest, shoulders and ears.
• The chance of developing either may increase if there is a family history.
• The chance of recurrence increases if you've previously had them.
• The risk of developing them decreases with age.

Pigment Irregularities: Hyperpigmentation, a blotchy, unusual darkening of the skin, or hypopigmentation, an unusual lightening of the skin, may occur with certain facial rejuvenation procedures such as laser skin resurfacing, chemical peels, laser hair removal and dermabrasion. Ethnic patients should be cautious when choosing minimally-invasive cosmetic procedures that involve exfoliants, lasers or chemicals. Hyperpigmentation may be reversed in 6 to 8 months using various treatments, whereas, hypopigmentation may be harder to treat or irreversible. Patients can ask their plastic surgeon to perform a skin test before choosing these procedures to determine whether they are at risk.

Choosing the Right Plastic Surgeon

To help ensure optimal results, patients should choose an ASPS Member Surgeon who has experience performing the requested procedure(s) on ethnic skin types and ethnically sensitive areas. ASPS Member Surgeons are board-certified and trained specifically in plastic surgery, meet stringent standards of membership, adhere to a strict code of ethics and operate in accredited surgical facilities.

ASPS Member Surgeons will consider what the patient finds attractive, based on his/her personal and/or cultural ideals, and then, when possible, adapt surgical techniques to meet those requirements. Patients should ask their plastic surgeon to see before/after photos or speak with other ethnic patients who have had similar procedures. Patients can visit www.plasticsurgery.org to locate an ASPS Member Surgeon.

Common Cosmetic Plastic Surgery Procedures

Hispanic Americans: Hispanics had nearly 1.7 million cosmetic plastic surgery procedures in 2013. Hispanics led all minority groups in the number of procedures performed in 2013, comprising 11 percent of the 13.1 million cosmetic plastic surgery total. The most commonly requested surgical cosmetic procedures are nose reshaping, breast augmentation, and liposuction. The most commonly requested minimally-invasive cosmetic procedures are Botox®, injectable fillers, microdermabrasion, chemical peels and laser hair removal.

African Americans: African Americans had more than 1.2 million cosmetic plastic surgery procedures in 2013. African Americans made up 8 percent of all cosmetic plastic surgery procedures in 2013. The most commonly requested surgical procedures are nose reshaping, breast reduction, and liposuction. The most commonly requested minimally-invasive cosmetic procedures are Botox®, injectable fillers, microdermabrasion, chemical peels and laser hair removal.

Asian Americans: Asians had 988,000 cosmetic plastic surgery procedures in 2013. Asians made up 7 percent of all cosmetic plastic surgery procedures in 2013. The most commonly requested surgical procedures are nose reshaping, eyelid surgery, and breast augmentation. The most commonly requested minimally-invasive cosmetic procedures are Botox®, injectable fillers, microdermabrasion, chemical peels and laser hair removal.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

This document is designed to provide accurate and authoritative information on the topic covered as of the date of publication and is subject to change as scientific knowledge, technology advances and practice patterns evolve. The views expressed represent the collective, but not necessarily the individual, views of members of the American Society of Plastic Surgeons.

Additional Resources

Daniel, R. Hispanic rhinoplasty in the United States, with emphasis on the Mexican-American nose. Plastic and Reconstructive Surgery 2003. 112: 244-256.

Kikkawa, D., Kim, J. Asian blepharoplasty. Int. Ophthalmol Clin. 1997. 37:193-204.

Polnikorn, N., Goldberg, D., Suwanchinda, A. YAG laser resurfacing in Asians. Dermatol Surg. 1998. 24:1303-1307.

Rohrich, R., Muzaffar, A. Rhinoplasty in the African-American patient. Plastic and Reconstructive Surgery 2003. 111: 1340-1341.

Won-Min, Y., Sang-Hyeon, P., Dong-Rhyul, K. Root z-epicanthoplasty in Asian eyelids. Plastic and Reconstructive Surgery 2002. 109: 2067-2071.