Cosmetic Surgery Goes Ethnic

The advertising slogan is a sly double entendre: Washington's Cultura Medical Spa bills itself as ``a place where it's appropriate to treat people based on the color of their skin.''

Founded six years ago by two African American physicians -- cosmetic dermatologist Eliot F. Battle Jr., an expert in laser treatments, and Monte O. Harris, a board-certified otolaryngologist who specializes in rhinoplasty and other facial plastic surgery -- Cultura is one of the first centers in the country to focus on the burgeoning field known as ``ethnic plastic surgery.''

Two-thirds of the center's patients are nonwhite, many of them black women who in increasing numbers are seeking such procedures as nose jobs and laser hair removal that until recently were largely the province of well-heeled white women. Many of these patients, doctors say, are also seeking treatments that seek to enhance -- not obscure -- their racial or ethnic characteristics.

Although white women continue to dominate the ranks of cosmetic medicine, the number of black, Hispanic and Asian patients has escalated dramatically in the past five years, according to officials at the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgery.

Experts say the growth reflects increased acceptance of such procedures within these groups, greater economic clout and larger numbers of minority specialists whom many ethnic patients regard as more attuned to their needs.

In 2002, according to statistics compiled by the ASPS, minorities accounted for 16 percent of plastic surgery patients. Four years later minorities accounted for 23 percent of patients.

The rise in the number of ethnic patients is noticeable in Washington, cosmetic surgeons say, because of its diverse population and high levels of disposable income in some minority groups.

Doctors in such cities as Baltimore, Chicago and Philadelphia -- places which, like Washington, are not considered hotbeds of plastic surgery -- are reporting similar increases. In the past few years, Chicago's Northwestern University opened a Center for Ethnic Skin, while Henry Ford Hospital in Detroit launched a Multicultural Dermatology Clinic.

Surgeons say that minority women request many of the same procedures as whites, but there are some differences. Surgery to create a crease in the eyelid to give the eye a more open look is popular among Asian American women, while breast reduction, virtually the only cosmetic procedure that may be covered by insurance because it is usually considered functional, is popular among African Americans.

Some patients say minority physicians are more sensitive to their aesthetic concerns and have greater skill treating darker skin, which is more prone to scarring and pigment changes than white skin.

``I was looking for a doctor with a laser background'' who was experienced with African American skin, said Miriam Rudder, 50, a Cultura patient since 2001, when she underwent laser hair removal on her underarms. ``I didn't want to get burned.''

Ten years ago, nonwhite women -- and whites with a suntan -- were warned that they risked permanent scarring if they underwent laser hair removal as Rudder did, cosmetic dermatologists say.

In those days, Battle said, there were few cosmetic options available to women of color. Mostly ``what we could offer was a bleaching cream and Cetaphil,'' Battle said, referring to a skin cleanser often recommended by dermatologists to patients of all races. (Bleaching cream is used to even skin tone and minimize the appearance of dark patches.)

Battle, 50, left a career in international marketing at IBM when he was 34 to enter medicine. A graduate of Howard University and its medical school, he completed a laser dermatology fellowship at Harvard Medical School and displays an evangelical fervor about ethnic skin care. While at Harvard he helped develop laser treatments now widely used to treat dark skin.

First-generation lasers, he recalls, were designed for light skin and dark hair -- and the risks of scarring dark or tanned skin were well-known. But the newer lasers that he helped pioneer mean ``I can treat the darkest African and Indian skin safely.''

Equal parts glossy retail cosmetics counter, candle-scented day spa and white-coated medical practice with a stable of 30 lasers, Cultura treats about 85 patients six days a week.

They include former Miss America Ericka Dunlap, who flies in from Nashville for treatments of acne flare-ups and other skin care; tennis stars Venus and Serena Williams; and basketball stars Patrick Ewing and Alonzo Mourning. Some patients have come from as far as Turkey, Iran and Brazil.

``This place is a mini-U.N.,'' Battle said, referring to its clientele and staff.

The growing acceptance of cosmetic procedures reflects a change in attitude, particularly in the black community, surgeons say.

Until about five years ago, said Chicago plastic surgeon Julius W. Few, cosmetic surgery was typically regarded as worse than frivolous in the African American community -- and often associated with the race-effacing look of Michael Jackson.

``There really was a sense of taboo, that if you were looking at plastic surgery you were seen as being ashamed of your ethnicity,'' noted Few, an associate professor of surgery at Northwestern. ``I've seen a tremendous swing.''

Many patients, he said, flatly tell him they don't want to ``look white. Most people want to preserve their original look,'' while making subtle changes.

``There are indeed cultural differences,'' observed Baltimore plastic surgeon Ricardo Rodriguez, chief of plastic surgery at Greater Baltimore Medical Center.

White women favor a thinner silhouette, Rodriguez said, ``while Hispanic and African American women want to be more curvy.''

Even the terminology differs: Whites often disparagingly refer to their ``saddlebags'' -- fat deposits on the lower hip and upper thigh -- while black and Latina women ``never use that word,'' Rodriguez said. They call them ``thighs'' and rarely request liposuction there.

Bahman Teimourian, a clinical professor of plastic surgery at Georgetown University School of Medicine, said it behooves surgeons of all races to be knowledgeable about cultural standards.

A chin that might be considered weak by traditional American standards and a candidate for plastic surgery, Teimourian said, is seen as beautiful among people from the Middle East, where a small chin is regarded as a desirable sign of femininity.

Recently Teimourian said he repaired the nose of an African American patient who was unhappy with the ``very Caucasian nose'' a previous surgeon had given her. Teimourian said he removed some cartilage from behind the woman's ear to reshape her nose to better fit her features.

Moving beyond ``Eurocentric'' notions of beauty has been integral to Cultura's success and is central to its philosophy, said Harris, 40, a graduate of Case Western Reserve University School of Medicine who trained at the University of Michigan.

``Half the world's going to be brown-skinned by 2050,'' he noted. ``We're not going to close our eyes to all those patients.''

Similarly, he said, Cultura has been catering to men, who account for about 10 percent of its clients. Many have been sent by wives or girlfriends for ``beard management'' and treatment of ingrown hairs.

Eric Ellerbee, 44, a UPS driver who for years has made regular deliveries to Cultura, is among its male patients.

Last fall, he received complimentary injections of Restalyne, a cosmetic filler, to soften the lines that run from the side of his nose to the corner of his mouth and are among the first signs of facial aging.

``I didn't even tell my wife I'd had it done,'' said Ellerbee. ``I wanted to see if she noticed.'' (She did and was impressed, he said.)

But a 47-year-old African American nurse said she would never tell her mother and sisters about the collagen injections, facelift, tummy tuck and breast implants she received from Rodriguez, which cost her $21,000.

``My mother says, `You look different,' but I would not tell her -- she would not be accepting,'' said the woman, who did not allow her name to be used. ``My husband and children know, and they're fine with it.''

Ellerbee said he's so pleased with the results that he keeps ``before'' and ``after'' pictures of himself on his cellphone.

``Everyone wants to age gracefully,'' he said, adding that Restalyne didn't hurt nearly as much as the tattoo he got years earlier.

source: www.cantonrep.com