Facial Plastic Surgery Gains Popularity with Racial and Ethnic Minorities

Dr. Brissett reported on racial and ethnic trends in a paper published in Facial Plastic Surgery (2010;26:69-74). This survey of cosmetic procedures performed in 2008 found that rhinoplasty is one of the top three surgical procedures performed in African Americans, Asian Americans and Hispanics. Eyelid surgery, Botox and injectable fillers were also high on the list of procedures sought by this patient population.

The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) reports that 10 percent of its members have seen an increase among Hispanic, Asian American and African American patients in their practices from 2011 to 2012. Further, the AAFPRS reports that African Americans and Hispanics were most predisposed to undergo rhinoplasty, Asian Americans were most likely to undergo blepharoplasty or rhinoplasty, and Caucasians were most likely to have facelifts or rhinoplasty (See “Most Common Facial Cosmetic Surgical Procedure, by Racial Group, next page).

Kofi Boahene, MD, a facial plastic surgeon in the department of otolaryngology-head and neck surgery at the Johns Hopkins University School of Medicine in Baltimore, has seen the trends in his own practice, which includes elective and reconstructive surgery in equal measure. “I see a lot of people of African descent from Europe, the U.S. and the Caribbean islands,” he says, noting that the numbers of minorities he’s treated has gone up every year.

Talking to Patients

While otolaryngologists are trained in facial plastic surgery, they receive no instruction in ethnically sensitive esthetic standards, said Dr. Boahene. “It means making the result more ethnically congruent—refining features without losing ethnic identity,” he said. And elective plastic surgery isn’t the only area in which ethnic sensitivity is important. Patients undergoing removal of head and neck cancers are equally concerned about how they’re going to look after their surgeries.

Crucial to a successful result is taking the time to talk to patients, and really understanding what they want. Dr. Boahene described a common observation in patients of African descent seeking nose-shaping surgery: A woman comes in and says her nose is too flat. The surgeon in-terprets that as the need for a high bridge and nasal projection and puts in an implant to raise the bridge, and raises the tip. But, then, the nose looks Caucasian. In actuality, what the patient may mean by a “flat” nose is that her nose lacks definition, that her nose seemed to disappear when she was photographed. Dr. Boahene said that creating a subtle contrast of highlights and shadows, areas that strategically reflect and absorb light, can address the problem without the high and sharp Caucasian appearance.