Last February, The New York Times released an article about ethnic diversity in plastic surgery in New York City. The article described the plastic surgery procedures that different ethnic groups, such as Hispanics, African Americans, and Asians, were more likely to undergo to help preserve their cultural identities. With that article in mind, I’d like to offer my perspective as a plastic surgeon about the role of cultural differences in plastic surgery. In Atlanta, I see a variety of ethnicities seeking plastic surgery, and while preserving cultural identity is important, it’s also important for a plastic surgeon to understand the complications that can arise with different skin types.
Going beyond color, skin type differs from ethnicity to ethnicity. According to the Cosmetic Dermatology for Skin of Color, the stratum corneum of black skin has more cell layers and elevated lipid content compared to white skin even though the overall thickness is similar, meaning darker skin is more compact. Patients with darker complexions, especially African American patients, have more melanin in their skin than patients with lighter complexions. Because there is more melanin present with darker skin tones, there is an increased risk of pigmentation changes with any incisions or trauma to the skin, including surgery.
Rhinoplasty (nose surgery) is more complex among diverse ethnicities due to differences in cartilage texture and should be performed by plastic surgeons with ethnic plastic surgery experience. Cartilage is flexible, connective tissue found in many parts of the body such as the nose, ears, rib cage, in many joints and between bones. A black patient’s cartilage is typically softer and less prominent than that of a white patient. Not to mention, there are dissimilarities in bone structure from ethnicity to ethnicity. The difference in cartilage and bone structure, accompanied by the density of dark skin, further adds to the complexity of procedures like otoplasty (ear surgery) and other plastic surgery procedures that involve cartilage. Besides that, aesthetic goals typically vary from ethnicity to ethnicity.
Black patients are also more prone to keloids and hypertrophic scars. Hypertrophic scars are the result of an overproduction of collagen and appear as raised lumps on the skin. Keloids are actually a type of hypertrophic scars, but they are typically larger and grow beyond the area of the original wound. Scarring and pigmentation complications are not limited to specific cosmetic plastic surgery procedures, so a surgeon must know how to prevent these possible complications.
While certain aspects of ethnic diversity can pose possible surgical complications, there are benefits as well. In fact, black patients experience less post-operative swelling than white patients. Also, the signs of aging typically appear more slowly among black patients, so procedures like facelift surgery and blepharoplasty (eyelid surgery) can be postponed longer. Liposuction surgery can create a lumpy appearance beneath the skin if not performed properly, but due to the density of a dark skinned patient’s dermis, they are less likely to experience this unsightly effect than light skinned patients.
Choosing the right plastic surgeon for the procedure is very important, especially with diverse ethnicities. Since Caucasians made up 70% of plastic surgery procedures in 2010, it’s no surprise that complications arise in ethnic plastic surgery. Be sure to find a board certified plastic surgeon who has experience working with your specific ethnicity to avoid surgical complications and maintain your cultural identity in surgical results. Although it’s often speculated that people undergo ethnic plastic surgery to “fit in,” in my experience with a variety patients, that’s not the case. If the ever publicized JLo booty, Rhianna eyes, or Halle Berry jawline are any indication, there has been a major shift toward embracing one’s ethnically specific aesthetics.