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She brought Dr. Boahene a photo of a high school classmate, actress Kerry Washington, to use as a model. Dr. Boahene made before and after pictures on a computer screen to suggest what would be best for her.

“I wanted to look natural, but not in an extreme way,” she says.

Sonya Sanders-Murray, 49, who works for the Baltimore City school system, suffered from dark circles under her eyes since childhood - a family characteristic, she says.

“Five years ago, a Caucasian woman at Hopkins told me she could help with the bags, but it didn’t help with the pigment. I had expensive cream, and nothing happened,” she says. “Dr. Boahene tightened the skin, injected fat, and did a chemical peel. He said that he could give it a shot, but there was only a certain amount he could do.”

Colleagues at school who knew about the procedure told her she looked 20 years younger.

“People of color - Asian, Hispanic, Middle Eastern - culturally are interested in refining, not restructuring,” says Dr. Wendell Miles, a plastic surgeon with an office in Chevy Chase. “That is probably best related to an acceptance generally of a societal recognition that our differences are something to be retained.”

The best candidate for any cosmetic procedure regardless of skin color, say all medical practitioners interviewed, is a person who comes in with a specific concern, not someone who comes and asks “What do I need?” A treating surgeon, Dr. Miles suggests, also needs to know how different populations perceive their ideal of beauty.

Dr. Eliot F. Battle Jr., co-founder of Washington’s Cultura Medical Spa, where two-thirds of the patients are nonwhite, cites the case of entertainer Michael Jackson as an example of what can go wrong and also what is promising about progress in the field.

“He was treated by someone who didn’t have experience with skin of color. Michael Jackson set the field back by years,” Dr. Battle says. “There is more understanding today of the nuances of skin of color…. It’s not just color, it is your ethnicity. All the ingredients play dramatically into how your skin reacts.”

For $350, his office plans to offer DNA testing for patients, “to help us find your true skin type of who you are, to treat you more safely and gather information.”

A plastic surgeon in private practice with privileges at several local hospitals, Dr. Paul Ruff says he thinks “it may be 25 to 50 years” before such testing will be of benefit.

“No way do we have ability now to effect certain changes at the DNA level,” he says.

What does happen, he says, is “finding a predominant DNA that allows doctors to predict how skin will react in treatment.”