Where's the Black Representation in Cosmetic Before and After Photos?

“Almost every website I visit, the pictures are the exactly the same; someone is getting a bump shaved off of their bridge ... aren't more doctors anxious to become experienced in African American rhinoplasty?” asks RealSelf member College Girl in Houston.

College Girl touches on a problem that anyone of an ethnic minority may face: finding before and after photos that look like them.

As it turns out, even for doctors whose practices are in predominately African American communities, only about 10% of the before and after images on their websites feature black patients.

I looked at sample photos from plastic surgeons' websites in the three U.S. cities (pop. 500k+) with the highest percentage of African American residents according to the 2010 Census:

1. Detroit (84.3% black)
2. Baltimore (65.1%)
3. Memphis (64.1%)

Upon examining about ten sites per city, I discovered that they were severely lacking in diversity, with an average of 10.29% of before and after photos featuring black patients,* way less than the racial makeup of the cities themselves.

Key insights:

• 84% of Detroit residents identify as black, but only 7.24% of the photos I found were of African-Americans
• In all of the cities, several of the doctors’ sites featured no photos of African-Americans
• Most of the photos that are showcased of black patients were limited to just a few categories including butt augmentations and breast reductions (although that may be reflective of the demographics of the people who have these particular procedures)

The lack of diversity can be seen here in the RealSelf galleries, too. For most of the procedures, less than 5% of the photos are of black patients. 

"For nearly every procedure -- and especially rhinoplasty -- comparing similar before (and resultant after) photos showing similar characteristics to that of the prospective patient can help provide not only realistic expectations, but also assist in the choice of a surgeon," says facial plastic surgeon Dr. Jeffrey Epstein. And when it comes to surgery techniques and healing, ethnic differences can mean more than just skin color.

So was College Girl right to assume that the lack of Internet photo evidence means doctors aren’t interested in performing certain procedures on minority ethnicities? No, say the surgeons who answered, but plastic surgeon Dr. Kenneth Francis gives us two tangible reasons why so few before and afters exist:

As a percentage, African Americans comprise a small number of the rhinoplasties performed in this country every year. It is a basic tenet of advertising that your ads target the greatest population that is likely to respond. For rhinoplasty, that population is the Caucasian with a large hump on the nose. It is also very easy to show a nice result with this kind of rhinoplasty. For these two reasons alone you may not see many African American rhinoplasty photos online.

According to the American Academy of Facial Plastic and Reconstructive Surgery, 26% of their members “reported an increase in their Hispanic, Asian American and African American patients in 2011.”

Even though Dr. Francis’ reasons are valid, on behalf of all the minorities searching for solutions on RealSelf we’d like to ask our doctor community to be sure they are uploading as many relevant photos as they have. And to our community -- keep sharing those pictures in your reviews, because you never know who you could be helping. 

Have you had issues finding photos that “look like you”?

*It should be noted that because of lighting issues and only being able to see a limited portion of the body, it was not always possible to be 100% confident on the patients’ race. In these cases, I used my best judgment.