Wall Street Journal (July 2003)

The Ethnically Correct Nose Job

As More Minorities Seek Plastic Surgery,
Doctors Aim to Preserve Racial Features


Linda Parker never liked her nose. She thought it was too flat, too wide and too big for her face. She considered having plastic surgery. But she feared the results would be even worse.

"I didn't want it to look like a Caucasian nose," said Ms. Parker, a 38-year-old Dallas office manager, who is black.

Plastic surgeons long worked according to an Anglo-Saxon ideal of beauty. Medical schools and textbooks never gave the slightest nod to racial distinctions, instructing students only in how to produce, for instance, a classically Roman nose.

But driven by interest from minority patients, some young plastic surgeons in the U.S. are designing techniques to preserve ethnic characteristics and help patients erase perceived physical flaws while maintaining their racial identity. In performing rhinoplasty on a black person's nose, these specialists try not to make it too pointy, which to some looks European. More doctors are giving Asian patients eye lifts without removing too much fat near the lower lid; otherwise, the eye may look more Caucasian. A cosmetic procedure called microdermabrasion removes acne scarring without lightening the color of African-American skin, unlike an older skin-smoothing technique known as chemical peeling.

Ms. Parker of Dallas found a plastic surgeon who narrowed the bridge of her nose and reshaped its tip but didn't refine it beyond recognition. After undergoing the procedure about a month ago, Ms. Parker says she is thrilled with the results.

The trend is largely the result of increasing requests from minority patients, doctors say. "More and more surgeons are being asked to do something that's going to enhance someone's look without erasing" ethnic identity, says Julius Few, a professor of plastic surgery at Northwestern University's Feinberg School of Medicine in Chicago. Dr. Few, who is black, says that when he started medical school in 1988, ethnic identity in plastic surgery "was a subject that was not even close to being talked about," and his textbooks showed only examples of European-looking features. Now, that is starting to change. Articles on the subject are popping up in medical journals and making their way into textbooks.

Between 1997 and 2002, the number of cosmetic procedures performed on minority patients quadrupled to about 1.3 million -- outpacing the overall increase by more than a third, according to the American Society for Aesthetic Plastic Surgery. Minority patients now get nearly 19% of all the procedures performed in the U.S.

The new attention to preserving ethnicity may help account for the increase in minority patients. But economics also plays a role. Rhinoplasty and eyelid surgery can cost $5,000 or more. "Plastic surgery has always been a sign of social mobility," says Sander L. Gilman, a professor of medicine at the University of Illinois in Chicago, who has studied the cultural history of aesthetic surgery. He predicts that as members of minority groups become more affluent, they will increasingly seek out anti-aging treatments such as Botox.

The notion of preserving ethnic integrity in plastic surgery stands in sharp contrast to the profession's history of trying to conceal ethnicity, dating back to crude 19th-century surgeries that some light-skinned blacks underwent to thin their lips and noses. For many blacks, a contemporary cautionary symbol is pop star Michael Jackson, whose face lost some of its ethnic character at the hands of plastic surgeons.

Making Changes Subtler

But today, many patients seek subtler changes in their look, aiming for younger or differently proportioned features. Edmund Kwan says that more of the Asian-American patients who come to his plastic-surgery practice in New York City are asking him to preserve the ethnicity of their features than a few years ago. Only about one in 20 wants to look more Western -- usually by having their eyelid folds raised to make the skin above the eye look more rounded.

Increasingly, Dr. Kwan says, most Asian-American patients, like other patients, are simply self-conscious about some aspect of their appearance or are battling the signs of aging. "Preserving ethnicity is the biggest concern of Asians having plastic surgery," he says.

Alison Lee wanted to have some excess skin and fatty tissue removed around her eyes. But images of people she knew who had undergone the procedure haunted Ms. Lee, a 24-year-old graphic designer who moved to Honolulu from South Korea three years ago. Though many Asians undergo eyelid surgery hoping it will make them look more Caucasian, Ms. Lee says she just wanted her eyes to look "healthier and more beautiful."

'Really Unnatural'

"I saw it on a lot of people and it came out really bad, it looked really unnatural," she says. "It gave them a more Caucasian look."

Of course, the plastic-surgery business is still fueled by pressure to live up to common beauty standards. Still, there are signs that those ideals are becoming more complex and multiracial. In the past decade, Renato Saltz, a plastic surgeon in Salt Lake City, has noticed more Hispanic-Americans seeking buttocks implants, which used to be more popular in Rio de Janeiro than in Los Angeles. He attributes the phenomenon to increasing access to foreign media on both sides of the equator and calls it "the breakdown of the beauty barrier."

The American Society of Plastic Surgeons offers a referral service, 888-4-PLASTIC (888-475-2784), which can point a prospective patient toward a local plastic surgeon who works primarily with patients of a certain ethnicity. Most major cities have such surgeons, the society says.

Robert Flowers, Ms. Lee's surgeon in Honolulu, says preserving ethnic looks is the only way to make plastic surgery look good on minority patients. "I wouldn't put a Greek nose on an East Asian face, even if they ask for it. Any way you do it, it's going to look awful, it's going to scream out" that it's been altered, he says.

Write to Jay Krall at jay.krall@wsj.com