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

K. Mathews on 21 Feb 2012 at 11:00am

“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.

ethnic plastic surgery photosAs 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. 

African American plastic surgery

"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.

Comments (14)

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Wow,amazing this is really impressive information about improvement in plastic surgery of body with new and attractive looks actually it is the result ofplastic surgery website designing and development which help to get information about plastic surgery.
As an African American woman in her early 40's, Iet me be the first to tell you that, "Yes we do opt for Plastic Surgery". I can speak for myself, cousin and several girlfriends, and we live in different cities; Las Vegas, NV, Rochester, NY and Chicago. I'm sure these doctors have had at least 1/2 African American patients for whatever surgeries, those patients before and after pics should be online to help promote diversity in their work and clientele regardless of facial structure and location.
yes, i know, let me add it to my to-do list.
and i do really feel like female surgeons do understand what we want. it is also my experience that female surgeons ENJOYED working on me. i drive hours to my injector because i love seeing her, she loves working on me...it's like a really expensive beauty salon =)
Drr Epstein is right. Though I ended up preferring a white female surgeon up north over non-white male surgeons who had more practice and experience with non-white patients. I believe I have quite a bias toward female surgeons as they seem to "get" what's going on much better.
I will try to be better at posting before/after shots. I always try to but then I start cropping the photos and get distracted and wander off.

It's a benefit if you post even 1 photo :) I know what you mean though, I always intend to post updated photos on my review and then get distracted...

I have heard that sentiment about female surgeons before -- that they understand the female aesthetic because they are a female, not just because they've had lots of practice with female patients. Though I had a great experience with my male doctor, I can understand why you hold that opinion. 

Dr. Batniji in Orange County speaks at great length in his blog about ethnic rhinoplasty if you are looking for more information. However it may be that african american patients are not consenting to having their photos up on the web as often. With every 50 surgeries a surgeon performs, only a handful are ok with having their photos published, particularly when the face is shown.

Thanks for pointing out about the consent factor, MBast.

If it were true that black patients consent to share photos less often, I'd be quite interested to know why! Though I too am inclined to attribute it to the lack of black (or any other ethnic minority) patients overall. But as the number of minorities having plastic surgery continues to rise, I hope more and more people will consent to share their photos to make it easier for the next person on that journey. 


And I say that as someone who's openly shared her own surgery experience, face attached, knowing that it will benefit so many women who are making the same decision I did :)

I also agree with "think about it"...maybe not many african americans get that procedure or get any procedure done as frequently. So it may not be the doctors not wanting to put there pre or post op pics on the website. Great post.
Maybe African Americans do not make up a large part of the patient pool. Plastic surgery may be rare in that community, whether the doctors practice in those areas or not.
As I was reading your comment I could not help but agree with you, i.e. there is definitely limited photos of black african-americans for before and after photos. Being caucasian, I have taken it for granted. Embarrassed, I complain quietly to myself that there are not enough photos of people in my age group (45) to compare with.

So that being said, I congratulate you! This is how change begins to happen when someone takes the time to point out the obvious.
Just a few more thoughts on this topic. African-American rhinoplasty, which is something on which I can provide an intelligent comment given my experience with this procedure, is very similar in certain components to rhinoplasty in those of Hispanic ethnicity, especially those of Central America, where cartilage support is typically weak and the nose underprojected.
For this reason, surgeons who practice in such areas as LA, NYC, San Antonio, and of course Miami, will usually be able to provide photos of actual before and after results.
Thank you so much for your enlightening comments. I am positive that your expertise on the subject will allow us all to feel much more reassured on the issue.

Some extra food for thought, that I think worth sharing... Dr. Jack Gunter said this to me about why it can be difficult for anyone of any race to find a representative rhinoplasty photo:

"For a nose to look good it has to be in harmony and balance with the surrounding facial landmarks (the brows, eyes, cheek bones, lips, teeth, chin, and lower jaw). Because these landmarks vary between individuals, the goal for the surgery should be to sculpt a nose to the size and shape that blends with the surrounding landmarks. A nose that looks good on one person does not necessarily look good on another. That is the reason if you want to show your surgeon the type of nose you want try to find a photograph in which the person in the photograph has facial landmarks that are similar to yours. You will find this is not easy to do. The facial features are what give everyone their individual look. Features vary so much from person to person you seldom see people who look similar to each other unless they are identical twins and even them there are still some differences. Patients should be aware that it is not the nose that makes a person’s face attractive, it is the whole package."