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Cosmetic fix for a new clientele

Roslyn Hart-Cooper longed to wear a sundress for more than 30 years. But she didn't dare slip into one because she felt self-conscious about the size of her bustline.

Wearing a 46E bra, Hart-Cooper, 50, felt her breasts would attract too much unwanted attention. Not only did she not feel self-assured about the size of her bosom, but it also caused her pain. Her back ached, and she hunched forward because of them. She also experienced a rash underneath her breasts because they rubbed against her skin.

A teacher who lives in East Baltimore, Hart-Cooper has suffered with her bust since she was in her 20s. Among her immediate family, the women have small breasts, which has added to her agony.

But things changed in August. She had a breast reduction, joining a growing list of minorities who have gone under the knife to alter their appearance in what has become a $7.6 billion industry for the general population, according to the American Society for Aesthetic Plastic Surgery.

Once considered exclusive to wealthy Caucasians, plastic surgery has become more common among people of color -- now accounting for about 19 percent of all cosmetic surgeries nationwide. A number of plastic surgeons in the Baltimore region have said that they are seeing a growing number of minority patients.

But this phenomenon -- aided by such hit television programs as "Extreme Makeover" and "Nip, Tuck" -- also has stirred debate within certain minority groups, particularly African-Americans.

Even though doctors are improving procedures to maintain ethnic identity, and more blacks now can afford plastic surgery through credit and personal loans, many people face criticism from family and friends who say they are betraying their heritage by changing their appearance.

Hart-Cooper, for instance, faced resistance from her oldest son. He did not want her to have breast-reduction surgery because larger women often are celebrated in the African-American community for their voluptuous figures.

Still, Hart-Cooper said her self-esteem has gone up, and now she cannot wait to wear a sundress. She wears a 40 B bra, and her blouses look better on her, she added. Her plastic surgeon took six pounds off each breast.

"I was very pleased," Hart-Cooper said.

Number of procedures soars

Between 1997 and 2002, the number of cosmetic procedures performed on people of color quadrupled to about 1.3 million, according to the New York-based ASAPS. Of the 19 percent of plastic surgeries performed on minorities last year, 7.9 percent -- or 544,276 -- were performed on Latinos; 5.2 percent -- 358,235 -- on African-Americans; and 3.9 percent -- 268,170 -- on Asian Americans. The remaining 81 percent of surgeries were performed on Caucasians.

The top five surgical procedures in 2002 for the general population were liposuction, 372, 831 (up 111 percent since 1997); breast augmentation, 249,641 (up 147 percent); eyelid surgery, 229,092 (44 percent); nose reshaping, 156,973 (15 percent); and breast reduction, 125,614 (162 percent).

Generally, more women have plastic surgery than men, with women accounting for 88 percent of the 6.9 million people nationwide who had procedures in 2002, the ASAPS said, compared with 12 percent for men.

The top three procedures for women are liposuction, breast augmentation and eyelid surgery. For men, they are liposuction, nose reshaping and, also, eyelid surgery, according to the ASAPS.

More broadly, the United States led the world in plastic surgery procedures in 2001, according to the most recent statistics available from the International Society for Aesthetic Plastic Surgery.

According to a survey of 30 countries, the United States accounted for 21 percent of all plastic surgeries worldwide. Brazil was second. with 14 percent, followed by Mexico, with 8 percent.

Statistics on the types of procedures performed in the United States last year were not compiled by the ASAPS.

But -- according to Dr. Leo McCafferty, chairman of ASAPS's public education committee and a consultant to the Pittsburgh Steelers football team -- minorities are following the national trend regarding the types of surgeries they are receiving.

And, just like the general population, most doctors say people of color cite improving their physical appearance as the main reason why they want to have surgery.

The average costs for the three most popular procedures are $2,394 for liposuction, $3,301 for breast augmentation, and $2,544 for eye lid surgery, according to the ASAPS.

Hart-Cooper said that her breast-reduction surgery cost $5,000 and that it was covered by insurance because it was done for medical reasons.

'Why not us?'

If people of color can afford such procedures, they should have them, said Clyde Bradman Mathura, acting chairman of the psychology department at Coppin State College.

"Why not us?" Mathura asked rhetorically

He added that people who criticize minorities for changing their appearance also are likely to complain about them moving out of bad neighborhoods into affluent ones.

"Society is changing, and we have the freedom to be who we want to be," Mathura said.

He added that while many criticize people of color for changing their appearance, fewer whites experience such a backlash for trying to make their lips fuller -- a feature of African-Americans -- with collagen injections.

Doctors do acknowledge, however, that some people go to extremes to change their appearance. In those cases, they say, those people are caught between the reality of their looks and what they hope to be.

Still, many people of color want to maintain their racial identity, avoiding such extremes as the various procedures performed on the superstar pop singer Michael Jackson, the ASAPS's McCafferty said.

"Most people want their features to be proportional to each other, and they want to look like themselves."

For instance, McCafferty explained that African-Americans tend to want to narrow the bridge of their nose and reshape the tip without making it pointed, while Asians Americans often have the skin above their eyelids raised to make their eyes appear less flat.

As for skin-lightening products, McCafferty said there are various chemical peels and bleaching products that can help rid the skin of various kinds of brown spots and make it clearer.

But whether Michael Jackson used these methods or suffers from the skin condition vitiligo, as he claims, is unclear. "There's no way I can tell," McCafferty said.

Greater public awareness

It is no surprise that people of color want to recognize themselves after having any cosmetic surgical procedure, said Mikki Taylor, beauty director and cover editor of Essence, the New York-based magazine for African-American women.

"We are seeing that increase, and women of color are not trying to be anybody else other than the best that they can be," she said.

McCafferty added that media coverage largely has contributed to overall growth in plastic surgery procedures. "Extreme Makeover" spotlights patients who use surgical and other ways to improve their looks, while "Nip, Tuck" is a drama set in South Florida centering around the lives of two plastic surgeons.

"There's been quite a bit published about it among doctors, and those stories have filtered to the doctors' practices, the media and public," he said.

More minority patients

Several Baltimore-area doctors also have noticed an increasing number of minority patients seeking plastic surgery.

Dr. Lawrence Rosenberg of the Plastic Surgery Center of Maryland in Lutherville has seen 10 percent to 15 percent more minority patients per year in the past several years. He said he tries to give his patients exactly what they¹re looking for.

"Most people want to retain their ethnic identity," he said. "Occasionally, some will want a more Caucasian look. Everyone is different."

Dr. Eve Bruce, whose office is located in Timonium, said she's also performing more cosmetic surgery on minorities.

In 1998, she had seven minority patients. That number more than doubled, to 15 this year.

"I absolutely try to retain a person's ethnic identity," she said. "This has indeed been a trend over the past decade, as people strive for balance and proportion without changing their ethnicity."

Dr. Alexander M. Guba Jr. said he, too, sees a significant number of minority patients in his Baltimore practice.

His female patients tend to have breast surgery, while his male patients are seen frequently for liposuction and body sculpting.

Athena McPherson, a 32-year-old African-American woman from Woodlawn, said her breast-reduction surgery performed by Bruce in June was one of the best decisions she has made.

"I feel like I'm proportioned now."
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