The "plastic" in plastic surgery comes from the Greek for plastikos, meaning to mold or shape - originally often with a flap of skin. Increasingly, however, the shapes and textures of the human body are changed with the use of creatively engineered man-made or petroleum byproducts - especially in cosmetic surgery.
Along with new approaches and new medicines making possible results that were not possible a decade or so ago, new kinds of patients are appearing in doctors' offices, asking for different kinds of surgeries.
The numbers of people from minority ethnic and racial backgrounds seeking treatment continue to rise, with nearly a quarter of the cosmetic plastic surgery procedures in 2007 performed on ethnic patients, according to figures supplied by the American Society of Plastic Surgeons. (Racial and ethnic minorities accounted for 24 percent of all cosmetic procedures last year, both surgical and nonsurgical. Hispanics led with 9 percent, then blacks at 7 percent, Asians at 7 percent and other nonwhites at 1 percent.)
"If you look at market dynamics, it is almost an untapped area. ... Income levels are rising. [Plus] there have been one or two minority surgeons featured on television," says Dr. Kofi Boahene, assistant professor of facial and plastic and reconstructive surgery and otolaryngology head and neck surgery at Johns Hopkins Medical Institute. He also sees a slight increase in the number of surgeons of ethnic backgrounds doing cosmetic surgery.
"Training usually is generic, and usually Caucasian, but that is changing," he notes.
At the moment, however, he estimates there are fewer than 20 people in the United States who specialize in plastic surgery of the face, head and neck and have a notable interest in minority populations. He says that among board-certified plastic surgeons, just 3 percent are black. Dr. Boahene, who was born in Ghana, regularly travels there and elsewhere abroad on medical missions.
Minorities don't always seek out minority professionals - Dr. Boahene's practice is 60/40 Caucasian/ethnic, he says - but some patients think a doctor of similar background will have a more intuitive understanding of their special skin and bone structure.
"Biologically, ethnic skin behaves differently," Dr. Boahene says. "The skin usually is thicker and produces more melanin, or skin pigment per cell. The way [nonwhite people] lay down collagen is different, which gives some advantage and some disadvantage. There is less sun damage, but they are more prone to thick scarring caused by skin cells producing collagen in an uncontrolled fashion.
"Generally, when you have an injury, the way it heals is by making new collagen to knit the skin back together, and at some point, the body programs itself to stop," he says. "But in skin prone to scarring, that signal doesn't turn off. Asian skin also is prone to these issues, but not as much as African-American or Hispanic."
Black skin also is prone to more pigmentation and discoloration because of the nature of its pigment, he adds.
The younger generation, in general, wants refinements rather than radical work that would change their ethnic identity. They may have problems with skin tone and color.
"We know thicker skin is more likely to have pores that clog up and be oily and, hence, prone to acne," he says.
Christi Tyson, 32, of Silver Spring is typical of the trend. A corporate nutritionist who interned at Hopkins, she came to Dr. Boahene in May for rhinoplasty - a nose job - that cost $6,000. She first got opinions from two other minority surgeons, paying $100 for each consultation.
"What they wanted to give me didn't fit me. I felt rushed," she says.
An otherwise self-confident person, she unabashedly admits she grew up "with some sort of complex" about her nose because "it seemed a more distinct feature that I didn't like." Neither her mother nor her father had a similar feature.
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."