No Color Barrier
Cosmetic Medicine for Non-Caucasians
The volume of cosmetic procedures performed on non-Caucasians continues to grow. In 2005, nearly a quarter of all procedures were performed on non-Caucasians, defined by the ASPS as mainly Hispanics, African Americans, and Asian Americans, whereas in 2004, these groups composed only 16 percent of the reported cosmetic surgery volume. These percentages probably do not adequately account for substantial numbers of immigrants and others who undergo cosmetic procedures in undocumented circumstances. When the numbers that are available are examined, it can be seen that each of these ethnic categories, but especially the Hispanic and African American groups, comprised a greater percentage of the cosmetic medical population in 2005 than it did a year earlier. For all ethnic and racial groups, rhinoplasty remains one of the most commonly requested operations, although for Hispanics breast augmentation and liposuction lead the list. As with the general population of cosmetic patients, Botox, injectable fi llers, and chemical peels are especially popular. There has always been a certain demand for cosmetic interventions by those who want to look less ethnic, more Caucasian, less Asian, less African, and so on. Sometimes the desire is generalized, other times it applies only to specifi c features, such as eyelids or noses. Cosmetic surgeons have been criticized for trying to “Westernize” their patients, but the demand comes from the patients themselves and often reflects social pressures to conform to the appearance of the prevailing power elite. Long before it was commonly performed in the United States, blepharoplasty (eyelid surgery) to create a more Caucasian shape was popular in Asian countries. As discussed in earlier chapters, nose surgery to remove the common Mediterranean (for example, Jewish, Italian, Arab) hump or to increase the profile of the typically fl attened Asian or African nose was very common in the early twentieth century and is still performed frequently today. For many years, rhinoplasty has been popular with Arab women who can afford it, and the operation is almost a rite of passage for Arab American female teenagers. Nonetheless, while racism has hardly been eliminated from our culture, the range of what is considered desirable has expanded. In most parts of the country it is no longer social death to carry a drop of Jewish or non-Caucasian blood. The social risk now for some patients undergoing cosmetic interventions is that they will be accused of cultural betrayal, of shunning their communities if they seek to alter a physical connection to their roots.
Beyond rhinoplasties and blepharoplasties, non-Caucasians also seek out rejuvenation procedures. However, certain considerations related to skin type apply. For any given occupation or lifestyle, non- Caucasians and certain other ethnic groups have more baseline skin pigmentation than do people of northern European extraction. As a result they sustain less skin damage from sun exposure and tend to age more gracefully. Although people of these ethnic and racial backgrounds may seek cosmetic interventions, they are less likely to seek rejuvenation procedures at as early an age. Darker skin types are also susceptible to certain undesirable effects of surgery and other injury:
• Patients with darker skin, especially African Americans, seem to be more prone to the formation of keloids (see Chapter Nine). Most patients who have a tendency to form keloids will have a history of developing a keloid after a prior injury or operation, and those patients probably are not good candidates for cosmetic interventions. Having said this, the vast majority of African American patients do not develop keloids after surgery. Also, thick scars do not develop only in dark-skinned individuals. Some of the most troublesome scars develop in fair-skinned redheads.
• Dark skin tends to depigment at the site of injury, although the loss of color is usually temporary. Wounds that result in delayed or complicated healing are more likely to have permanent pigment irregularities. Steroid injections, often used to treat thick scars, can also depigment skin.
• Any type of skin resurfacing or laser treatments (such as for hair removal) can lead to undesirable changes in skin color. All dark-skinned patients should use sunscreen beginning several weeks before treatment, and many doctors will also recommend bleaching solutions for several weeks in preparation for treatment. Very dark-skinned individuals may not be candidates for these kinds of procedures.
If an individual is considering undergoing cosmetic surgery to alter an ethnic characteristic, he or she should keep in mind that technical expertise and finesse in performing such procedures is always going to be greatest in those surgeons who specialize in or at least do large volumes of these partic ular procedures. Therefore, one should be sure to ask for referrals and inquire about the surgeon’s case volume.
Tags: bleaching solutions, depigment skin, laser treatments, No Color Barrier, skin resurfacing, Steroid injections, treat thick scars