Race influences response to cosmetic surgery

The phrase “cosmetic surgery” might bring to mind certain Caucasian celebrities, but the percentage of non-white people seeking facial procedures has increased dramatically over the past two decades, in some cases by hundreds of percent.

Currently, a quarter of US patients who undergo rhinoplasty – that is, a nose job – do not identify as white, and these patients tend to report higher percentages of dissatisfaction with surgery outcomes.

A team of US scientists, led by plastic surgery researcher Halley Darrach from Johns Hopkins University School of Medicine, recently found that race – of both the observer and the patient – seems to influence the perceived attractiveness of rhinoplasty patients. 

Their findings are reported in a paper published in the journal JAMA Facial Plastic Surgery.

The study involved 134 observers of Caucasian, Latin American, Asian and African-American descent; they were recruited from the Johns Hopkins University campus, limiting the sample size and potentially biasing the distribution of their backgrounds.

The participants were presented with pre- and post-operative images of both white and Latin American rhinoplasty patients; 75% female and 25% male. One group was asked just to look at the images while their eye movements were tracked, but the other had to grade the patients’ attractiveness on a scale from 0 to 100.

Eye-tracking revealed that white, Asian and African-American observers were more visually fixated on white patients. No statistically significant trend was seen in Latin American observers, although the limited sample size – only 13 individuals participated – may explain this.

In the other group, white graders reported an increase of attractiveness post-surgery for both white and Latin American patients; white patients, however, were thought to increase in attractiveness more significantly. Latin American graders, on the other hand, only observed a significant attractiveness increase in patients of their own race.

The findings also show that observers did not regard any specific race of pre-surgery patients to be more attractive. Darrach and colleagues do not examine this result in detail, instead assuming that rhinoplasty automatically improves appearance.

A 2018 study published in the same journal supports this assumption, suggesting that casual observers perceive post-rhinoplasty patients as “appearing more attractive, healthier, and more successful” – though notably, the race, gender and background of patients studied is unclear.

Darrach and colleagues suggest that an influential factor in observed attractiveness may be the “other-race effect”: the psychological tendency for individuals to more easily recognise and display preferential attention to faces of their own race.

Independent researchers disagree.

Gemma Sharp from the Monash Alfred Psychiatry Research Centre in Australia notes that the findings “may also reflect different appearance ideals between ethnic groups. We certainly see this difference in appearance ideals across the world when it comes to female body shape.”

Cultural anthropologist Alvaro Jarrin from the College of the Holy Cross in Massachusetts, US, says the other-race effect seems unlikely given that “Latin America is very diverse and many people fit into the ‘white’ category – in fact, whiteness is very closely associated with beauty in Latin America due to a long legacy of colonialism and a racial hierarchy that is based on bodily aesthetics”.

Jarrin, author of the 2017 book The Biopolitics of Beauty, suggests a more likely explanation for the results. In the eyes of Latin American observers, he says, “white people do not require plastic surgery to be beautiful, because they already fit the standard”.

Laurie Essig, a sociologist at Middlebury College in the UK, says that regardless of the results, the research is interesting because it “provides data for what has always been true of cosmetic surgery historically: it is a racialised as well as a gendered project”.

Though commercial cosmetic surgery seems like a modern phenomenon, it began in the late nineteenth century. In the US, signs of racial difference in the growing populations of Jewish and Irish immigrants and African Americans were seen as atypical for white people and therefore ugly, and surgeries were developed to “correct” these features.

According to Essig and Jarrin, cosmetic surgery is still mired in its ugly roots.

But Darrach and colleagues barely touch on these wider and more pressing issues. Why, for example, are more and more non-white people choosing to undergo rhinoplasty? And how do the overarching frameworks of our society – such as capitalism, colonialism and patriarchal ideals – continue to drive the industry?

Despite the fact that 75% of patients were female, the study also makes no comment on the influence of gender on our perceptions of rhinoplasty. But there are clearly strong links. A German study published in 2014 found that women are more likely to consider having cosmetic surgery than men, and that this consideration is strongly associated with sexist attitudes.

“These results,” the authors write, “indicate that attitudes to cosmetic surgery for oneself and one’s partner are shaped by gender-ideological belief systems in patriarchal societies.”

This is not surprising; it is no secret that we are taught from a young age to judge and characterise women based on their physical appearance. This dominant ideology creates a sense of self-loathing that drives the lucrative, multi-billion dollar cosmetic surgery industry – as if beauty is a thing that can be built.

The same ideas likely also hold true for race, yet another framework that influences and often limits the way we navigate the world.

According to Jarrin, Darrach’s study seems to be “unwilling to examine how plastic surgeons themselves are embedded in cultural systems of power that already assume certain features are more attractive than others”.

Researchers in an earlier paper, however, insist that philosophies have changed over the years from “the perspective of racial transformation, defined as the use of a common set of surgical goals for all ethnicities, toward a view of racial preservation, with the goal of preserving one’s racial and ethnic features”.

These authors – two of whom are practising cosmetic surgeons – say that the racial mix of those seeking surgery is “changing to reflect our multicultural society”. This seemingly self-congratulatory statement is mirrored in Darrach’s recent paper, which says “the patient pool has increased in diversity” due to “growing accessibility”.

But understanding the motives and desires of “diverse” patients seems to only be important to the cosmetic surgery community in order to capitalise on this growing market.

A 2009 study published in Seminars in Plastic Surgery is open about this fact, admitting that “escalating economic power within [non-white] populations has created an additional potentially lucrative market for interested plastic surgeons”.

Essig concurs. “In the US most cosmetic surgery is done with medical credit,” she explains, “so it’s not just about an obsession with whiteness and gender norms, but also a way of extracting high levels of profit from people.” 

In her 2010 book American Plastic: Credit Cards, Boob Jobs and Our Quest for Perfection, Essig found that many of the people she interviewed were not wealthy but were rather working or lower-middle class. They “were getting surgery not just to look ‘better’ – which is to say whiter, more gender normative and younger – but also because they thought it could provide a more secure future”.

Jarrin agrees, but notes that his research has found that race and class intersect: “Rhinoplasty is closely associated with upward mobility precisely because it whitens those who receive it. People imagine it will consolidate their financial gains or that it will provide more job opportunities and help in the marriage market as well.

“Beauty is about social power in Latin America, and cannot be divorced from the history of racism in the region,” he concludes.

Despite the flaws of their study, Darrach and colleagues have opened a dialogue about these issues – now what remains to be seen is how we carry on the conversation.