When Sierra, a 27-year-old African American woman, was looking for a rhinoplasty doctor in New York and Los Angeles, the experience was so disheartening that it turned her off the procedure altogether.
“I browsed through the web pages of dozens of surgeons and only found two who had worked on black women and were able to create natural results,” Sierra says. (Sierra and some other women quoted in this piece are using pseudonyms to preserve their privacy). She ultimately set up consultations with two doctors, but those too proved disappointing. “Both of the doctors complimented my nose in such a backhanded style,” Sierra says. “One told me he loved that my nose would be easy to work on because it isn’t ‘super black,’ while the other told me that my nose would look better if it was ‘a little less ethnic.’ It just gave off this sense that these doctors did not find black traits beautiful and that I might end up with an overdone nose.”
Sierra’s experience is far from unique. Even as the beauty industry slowly adopts more inclusive skincare and makeup options, and hashtags like #ActingWhileBlack expose the frustration women of color have with the pace of inclusivity efforts, a massive disconnect remains. It’s not uncommon for a model or actress of color to bring her own foundation to set, to provide her own wigs and extensions, or even to get her hair done before showing up. Likewise, when women of color want to pursue cosmetic surgery—where DIY tactics are rightly nonexistent—the options are even more limited.
In the United States, most beauty standards are driven by Western European influence; as a result, the beauty industry mostly caters to European women. According to an article in Medscape (paywall), a site that provides medical information for health professionals, cosmetic surgeons have long based their ideal nasal proportions, for example, on Caucasian females, even when a patient is not white. That means the variations in facial and nasal anatomy inherent to different ethnic groups—and even within the same ethnic group—can get overlooked during procedures.
“There’s this huge fear with a lot of the African American patients that I meet that don’t want to look like the Jackson family,” says Dr. Deepak Dugar, a plastic surgeon in Beverly Hills. “The Jackson family is the stereotypical overdone nose in the African American community. No offense to them at all, but it’s something we hear a lot of people wanting to avoid.”
Surgeons’ lack of experience in ethnic cosmetic surgery is in some ways systemic. Dugar says that rhinoplasty, for example, is not taught until fellowship, after medical school and residency have been completed. Being assigned a mentor with a lot of experience in ethnic rhinoplasty happens by chance, and if a student’s mentor did not work on a lot of ethnic noses, that student will not practice on many ethnic noses during fellowship.
When Devi Jagadesan, a 23-year-old Indian woman, considered getting rhinoplasty, her greatest concern was that her skin is prone to keloids—abnormal tissue that forms at the site of a scar or injury. During Jagadesan’s search through different patients’ before-and-after photos, she noticed that most doctors in her area of Philadelphia had limited experience with brown patients. “My concern was less about how my nose will look and more about if my skin [would] keloid from surgery,” she says. “I don’t think most white doctors have the right knowledge about my skin type and I [wanted] to see photos of brown patients a month after their operation.”
After months of searching, Jagadesan finally found a surgeon, but the consultation exacerbated her concerns. “When I brought up my concern about keloids to the doctor, he said, ‘This isn’t a shock, brown people always keloid,'” she says. “His tone just made me uncomfortable because it seemed a bit insensitive, as if brown patients are complicated. He made me feel like being an Indian patient was problematic for him.”
Cosmetic surgery in the US is more affordable and accessible than ever. According to the American Society of Plastic Surgery, nearly 250,000 more cosmetic procedures were performed in 2018 than in 2017. Between 2008 and 2018, ASPS estimates that the number of cosmetic procedures performed on Asian Americans increased by 35%, Hispanics by 55%, African Americans by 78%, and Caucasians by 41%. Light, non-surgical procedures such as lip fillers and botox are increasingly mainstream, and surgeons are even starting to showcase more complicated procedures on social media. Rhinoplasty was the third most sought-after procedure among women last year, following breast augmentation and liposuction. All that means a growing number of people of color are looking for surgeons who can meet their needs, in a consultation and on the operating table.
“The patient’s vision being at the forefront is the best way to find the right surgeon,” Dugar says. “It’s not even about going to a surgeon that specializes in ethnic rhinoplasty. You want to go to the best surgeon for whichever rhinoplasty you want, whether it be closed or open.” (Ethnic rhinoplasty is one way to refer to any rhinoplasty that is performed on a non-Caucasian person. Closed, scarless rhinoplasty is typically used for refinements and subtle changes.) “An ideal surgeon will not look at a nose and think of ways to make it more European,” Dugar says, “but instead improve the nose while maintaining an ethnic look.”
Johanna, a 26-year-old Colombian woman in New York, decided against getting rhinoplasty after seeing four different doctors in New York and Colombia who insisted on giving her an entirely new nose instead of a refinement. “I went to a couple of consultations…and every doctor raved about their signature rhinoplasty, a ski-slope nose with a pointed tip,” she says. “All their patients, regardless of their ethnic background, had that same nose. But that nose doesn’t fit everyone.”
Surgeons, their education, and their personal biases are not the only culprits when it comes to the “botched” nose jobs we often see. Sometimes the patient’s desire to soften their ethnic features can result in an overdone procedure. But even that desire is a product of a beauty industry that caters to westernized views. North American beauty ads highlight European beauty standards at a greater scale than ethnic beauty, so it comes as no surprise that American women try to imitate those features. When ethnic women are used in beauty campaigns, they still tend to have Eurocentric features, or are Photoshopped to appear as if they do. In 2018, actress Jameela Jamil spoke out about the effect Photoshopped ads had on her mental health. “People change my nose to make it look like a little Caucasian nose,” she told Channel 4 News, “and they’ve changed the color of my skin to make it lighter, to make me look more acceptable perhaps to a Caucasian audience.”
As with cosmetic surgery itself, the solutions here are nuanced. Making the beauty industry more inclusive is not just a matter of creating new shades of foundation, or adding more ethnic hair-care products to the shelves of grocery stores. Beauty and medical professionals will need a better understanding of a diverse array of patients, more experience treating such patients, a stronger grasp of how to talk to those patients, and—perhaps most important—a wider spectrum of beauty standards.