Stacy Innerst, Post-Gazette Reality shows like "Extreme Makeover" have made plastic surgery increasingly popular for members of all ethnic groups. Click photo for larger image.

Four years ago, Flora Piombino decided to have a face-lift.

Then 58, the teacher from Passaic, N.J., had her surgery done in Pittsburgh by plastic surgeon Dr. Leo McCafferty.

"I still look better today than I looked four years ago before the surgery," she said.

Ms. Piombino, who is Hispanic, is part of a growing trend of ethnic patients undergoing cosmetic surgery.

"About 20 percent of our practice involves various different ethnicities, Hispanics, African-Americans, Asians and other minorities," said Dr. McCafferty, a board member of the American Society for Aesthetic Plastic Surgery, based in New York City. "I think it just mirrors what's going on in the rest of the country."

Nearly 11.5 million cosmetic surgical and nonsurgical procedures were done last year, 20 percent of which were conducted on racial and ethnic minorities, according to the ASAPS.

The number of cosmetic surgery procedures on African-Americans, Asians and Hispanics in this country jumped 65 percent last year, reports the American Society of Plastic Surgeons, another professional organization, based in Arlington Heights, Ill.

In fact, Dr. Anthony Griffin, a noted Los Angeles plastic surgeon who appears on the ABC-TV show "Extreme Makeover," believes that in five years plastic surgery for people of color will become a specialty in the profession. For the highly competitive cosmetic surgery market, this area is virtually untapped.

"If you look at cosmetic surgery, they have never targeted us, but the reason they're marketing to us is because everywhere else is saturated," said Dr. Griffin, who is African-American.

Doctors cite a number of reasons why more ethnic patients are choosing plastic surgery.

	Patti LaBelle in 1983 ... Click photo for larger image.

"I think clearly there's been an awareness throughout the media, and every American, regardless of gender or race, is being essentially bombarded with plastic surgery issues," said Dr. Guy Stofman, director of plastic and reconstructive surgery at Mercy Hospital and president of the Pennsylvania Plastic Surgery Society.

Reality shows such as "Extreme Makeover" and "The Swan" increase the public's exposure to plastic surgery, he said, and that exposure leads to people becoming more educated about the subject, especially with the advent of the Internet.

The growing middle class within all minorities is also a factor.

"We own boats and we have summer homes, and this is just another way to use our disposable income," explained Dr. Emily Pollard, an African-American plastic surgeon in Philadelphia.

	And with her new nose today. Click photo for larger image.

Traditionally, many African-Americans shunned plastic surgery because the attitude was "this is what God issued me so I'm going to make the best of it," Dr. Pollard said.

Generally for Hispanics, whether or not to have plastic surgery has never been an issue, said Dr. Ricardo Rodriguez, a Hispanic plastic surgeon in Baltimore, Md.

"They take to it, they love it," he said. "In Brazil, it seems everybody has plastic surgery. Even the housekeepers do it."

For Hispanics and African-Americans, the most popular procedures last year were nose reshaping, breast augmentation and liposuction. For Asians, they were nose reshaping, eyelid surgery and breast augmentation, according to the American Society of Plastic Surgeons.

"Like everyone else, an operation or procedure is customized to the individual, and it's important they do not lose their ethnicity because they would look awkward," said Dr. Stofman. "The classic example is Michael Jackson, who's lost a great deal of his ethnic features."

He said there are certain Asian cultures that have two folds in the eyelid or heavy hooding on the eyelids.

"They like to have it changed," Dr. Stofman said. "In many ways it's Western influence. I mean, there are certain things that you can change that don't exactly change their heritage."

Although the number of plastic surgeons of color is small, it's growing, Dr. Pollard said, and that also is leading to an increase in ethnic patients seeking surgery.

About 3 percent of the board-certified plastic surgeons in this country are African-American.

"I think it helps to have someone who understands what cultural issues there may be," she said.

For example, many African-Americans have concerns about keloids, which Dr. Pollard described as thick raised scarring that can occur beyond the area of incision.

Keloids, however, are prevalent in all ethnicities; African-Americans, Asians, Latinos and even redheads can develop the thick unsightly scars, she said.

"We know more about scarring, and we can do things to lessen that."

Ms. Piombino, the patient from New Jersey, said she was concerned about the scarring a face-lift might cause.

"He said you're not going to get anything on your face because all the incisions will be under the hairline," Ms. Piombino recalled. "In eight or nine days I was like totally another person, beautiful. I didn't have any marks."

She also had a breast reduction surgery.

Dr. Griffin, the Los Angeles plastic surgeon, said doctors must take a different approach in dealing with people of color.

Their skin, he said, is thicker, more fragile and more prone to scarring.

One thing he suggests that plastic surgeons do is to use suture material at the skin level that has to be removed instead of the kind that dissolves. Dr. Griffin said the skin reacts negatively to the material used in dissolving stitches and scars develop.

"I've had keloids [that developed 20 years prior], opened them up, and you can still see the suture material trying to dissolve," he said.

Dr. Griffin, who said 70 percent of his patients are people of color, said he has tried for years to get those who make surgical equipment and supplies to consider the needs of his patients such as suture sizes.

"I said, 'Look, nobody wants scars no matter what your race,'" he said. "As you solve our problems everyone else will follow suit."

In addition to the different techniques that are used in dealing with ethnic patients, there are sometimes cultural aesthetics that come into play.

Dr. Rodriguez said when his African-American and Hispanic patients undergo liposuction, they don't want the natural curve of their outer thighs disturbed.

His white patients, he said, desire a more tapered thigh area, requiring more liposuction.

Dr. Rodriguez also performs more Brazilian buttocks lifts on African-American and Hispanic patients, he said.

Technically, the procedure is not a lift but a process in which fat is liposuctioned from one part of the body, purified and injected into the buttocks to give it more prominence.

Larger, more rounded derrieres, a la a Beyonce or Jennifer Lopez, are looked upon very favorably in their respective cultures.

Still, he said, "nobody needs what I do. It's just a quality-of-life issue. People do it because it makes their lives better in some way."