" In 2002, according to statistics compiled by the American Society of Plastic Surgeons, minorities accounted for 16 percent of plastic surgery patients. Four years later, minorities accounted for 23 percent of patients. "

" The rise in the number of ethnic patients is noticeable in Washington, cosmetic surgeons say, because of its diverse population and high levels of disposable income in some minority groups. "

" Doctors in such cities as Baltimore, Chicago and Philadelphia ? places that, like Washington, are not considered hotbeds of plastic surgery ? are reporting similar increases. In the past few years, Chicago's Northwestern University has opened a Center for Ethnic Skin, while Henry Ford Hospital in Detroit has launched a Multicultural Dermatology Clinic. "

" Surgeons say that minority women request many of the same procedures as whites, but there are some differences. Surgery to create a crease in the eyelid to give the eye a more open look is popular among Asian-American women, while breast reduction, virtually the only cosmetic procedure that may be covered by insurance because it is usually considered functional, is popular among African-Americans. "

" Some patients say minority physicians are more sensitive to their aesthetic concerns and have greater skill in treating darker skin, which is more prone to scarring and pigment changes than white skin. "

" "I was looking for a doctor with a laser background" who was experienced with African-American skin, said Miriam Rudder, 50, a Cultura patient since 2001, when she underwent laser hair removal on her underarms. "I didn't want to get burned." "

" Ten years ago, nonwhite women ? and whites with a suntan ? were warned that they risked permanent scarring if they underwent laser hair removal as Rudder did, cosmetic dermatologists say. "

" In those days, Battle said, few cosmetic options were available to women of color. Mostly "what we could offer was a bleaching cream and Cetaphil," Battle said, referring to a skin cleanser often recommended by dermatologists to patients of all races. (Bleaching cream is used to even skin tone and minimize the appearance of dark patches.) "

" Battle, 50, left a career in international marketing at IBM when he was 34 to enter medicine. A graduate of Howard University and its medical school, he completed a laser dermatology fellowship at Harvard Medical School and displays an evangelical fervor about ethnic skin care. While at Harvard, he helped develop laser treatments now widely used to treat dark skin. "

" First-generation lasers, he recalls, were designed for light skin and dark hair ? and the risks of scarring dark or tanned skin were well-known. But the newer lasers he helped pioneer mean "I can treat the darkest African and Indian skin safely." "

" Equal parts glossy retail cosmetics counter, candle-scented day spa and white-coated medical practice with a stable of 30 lasers, Cultura treats about 85 patients six days a week. "

" They include former Miss America Ericka Dunlap, who flies in from Nashville, Tenn., for treatments of acne flare-ups and other skin care; tennis stars Venus and Serena Williams; and basketball stars Patrick Ewing and Alonzo Mourning. Some patients have come from as far as Turkey, Iran and Brazil. "

" The growing acceptance of cosmetic procedures reflects a change in attitude, particularly in the black community, surgeons say. "

" Until about five years ago, said Chicago plastic surgeon Julius W. Few, cosmetic surgery was typically regarded as worse than frivolous in the African-American community ? and often associated with the race-effacing look of Michael Jackson. "

" "There really was a sense of taboo, that if you were looking at plastic surgery you were seen as being ashamed of your ethnicity," noted Few, an associate professor of surgery at Northwestern. "I've seen a tremendous swing." "

" Many patients, he said, flatly tell him they don't want to "look white. Most people want to preserve their original look," while making subtle changes. "

" "There are indeed cultural differences," observed Baltimore plastic surgeon Ricardo Rodriguez, chief of plastic surgery at Greater Baltimore Medical Center. "

" White women favor a thinner silhouette, Rodriguez said, "while Hispanic and African-American women want to be more curvy." "

" Even the terminology differs: Whites often disparagingly refer to their "saddlebags" ? fat deposits on the lower hip and upper thigh ? while black and Latina women "never use that word," Rodriguez said. They call them "thighs" and rarely request liposuction there. "

" Bahman Teimourian, a clinical professor of plastic surgery at Georgetown University School of Medicine, said it behooves surgeons of all races to be knowledgeable about cultural standards. "

" A chin that might be considered weak by traditional American standards and a candidate for plastic surgery, Teimourian
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