The demand for cosmetic surgery within non-Caucasian ethnic groups has risen dramatically in the last two decades. The desire to maintain a youthful appearance and preserve beauty through surgery crosses ethnic boundaries. Unfortunately, many of the standard cosmetic surgery procedures were developed for Caucasians and do not necessarily address the aesthetic concerns of darker skinned individuals. Furthermore, there are structural differences between Caucasians and non-Caucasians with regard to skin, facial anatomy and body type.
The most obvious example is the different characteristics of skin between Caucasians and non-Caucasians. Plastic surgeons and dermatologists categorize skin type based upon a scale, called the Fitzpatrick skin type classification, developed by Dr. Thomas Fitzpatrick in 1975. It is based upon six categories, which include:
Type I (very white or freckled): Always burn
Type II (white): Usually burn
Type III (white to olive): Sometimes burn
Type IV (brown): Rarely burn
Type V (dark brown): Very rarely burn
Type VI (black): Never burn
Darker racial ethnic groups are often classified as Types IV through VI. Although the classification system was originally designed to assess sensitivity to sun exposure, it is now used to determine the safety of certain cosmetic surgery procedures. For example, laser resurfacing of skin is an effective method for reducing fine wrinkles, sun-spots, and dilated blood vessels on the face. The procedure was developed for Caucasian skin types and is not considered safe in patients with skin types IV or higher.
There are concerns in darker skinned individuals that often deter them from procedures commonly performed in Caucasians. Brown or black skin may be predisposed to unsightly scarring or even keloid formation – the process whereby a scar enlarges outside the normal margins of the wound site. Certain cosmetic surgery procedures, such as facelifting or breast reduction, rely on optimal scar healing to achieve patient expectations. The locations of the scars in these procedures are not inconspicuous, on the side of the face or on the breast, respectively. The procedures often have to be modified in order to achieve the best result and minimize the chances of an unsightly scar.
Perhaps even more important are the societal differences in the perception of beauty. Whereas one set of aesthetic ideals may be used for Caucasian men and women, there are major differences that exist in non-Caucasian ethnic groups. Before embarking on cosmetic surgery it is of the utmost importance that the patient and the plastic surgeon have the same expectations and goals with regard to the desired result. Furthermore, some patients may have an unconscious desire to change their ethnic appearance in order to appear more Caucasian. In our society we are constantly bombarded by popular media portraying beauty as a petite light-skinned woman with delicate facial features. Over time it would be only expected for women of color to think they need to try and achieve this so-called “aesthetic ideal”.
By exploring the anatomical and psychosocial differences that exist between Caucasian and non-Caucasian groups we are able to refine standard cosmetic surgery principles and practices to better serve the multi-ethnic groups in our society.
Matthew R. Kaufman MD, FACS
Plastic & Reconstructive Surgery
The Plastic Surgery Center & Institute for Advanced Reconstruction
535 Sycamore Avenue
Shrewsbury, NJ 07702
Dr. Matthew Kaufman is board certified in both Plastic Surgery and Otolaryngology- Head and Neck Surgery, and he is a Fellow of the American College of Surgeons (FACS). He has been consecutively named as a Top Plastic Surgeon for 2009, 2010 and 2011 in both the Castle Connelly Guide (New York metro area) and Inside New Jersey magazine. Dr. Kaufman’s training was completed at the best training programs in both New York and Los Angeles. He received his undergraduate degree from the State University of New York at Binghamton where he graduated with Honors and was named to the prestigious Phi Beta Kappa Society. He attended medical school at the State University of New York at Syracuse, graduating in the top 5% of his medical school class. While there, he received numerous honors including acceptance into the AOA medical honor society and an endowment scholarship for outstanding academic performance.