Cosmetic procedures are no longer just for victims of disfiguring accidents, nor are they strictly the province of the rich and famous. In recent years, the prevalence of cosmetic enhancement has crossed another historic hurdle: It has become more commonplace among people of color. Because African American, Hispanic and Asian patients have different skin characteristics and concerns regarding ethnicity-defining features, there is much to learn about selecting the appropriate treatment and finding the appropriate professional.

According to the American Society of Plastic Surgeons (ASPS), more than 1.3 million African Americans, Hispanics and Asians in this country had cosmetic procedures in 2004, an increase of 44 percent over the year 2000. The percentage of patients of color - 14 - who had cosmetic procedures in 2004 was greater than the number of men looking to alter their bodies to their liking. ASPS attributed this dramatic increase to increased coverage of cosmetic procedures in the media, improved technology and scientific advances, and reduced costs. The numbers of people of color getting cosmetic procedures are also rising while the middle class expands for these groups. "We own boats and we have summer homes, and this is just another way to use our disposable income," said Emily Pollard, MD, an African American plastic surgeon in Philadelphia, to the Pittsburgh Post-Gazette.

Just like their white counterparts, patients of color get cosmetic work done because they want to reduce the signs of aging; look refreshed and rejuvenated; or because they want to enlarge, reduce, refine, or create balance and symmetry on their faces or bodies, the ASPS found. The majority of these patients are getting procedures done not to alter their ethnic appearances, but to make adjustments that still have them resembling others of their races. For example, African Americans typically get nose jobs to obtain noses more in proportion with the rest of their features, rather than to make their noses look more European.

Though the reasons for getting procedures are similar, the most popular procedures differ in some instances. For example, breast reductions are common among African Americans, while people of other ethnicities are more apt to augment their breast sizes. And Asians often get eyelid surgery, though most still want to maintain the wider, fuller, almond-shaped eye that is natural looking to the Asian face.

If you are a person of color and are contemplating a cosmetic procedure, consider that you may have skin differences that can lead to problems with certain kinds of procedures. For example, due to melanin, the pigment that makes skin brown, keloid scars and hypertrophic scars are common among African Americans and Asians after surgery. These types of scars appear as thickened, raised tissue along incision lines and are common around the breasts, chest, shoulders and ears, ASPS explained. The best remedy for this is to have incisions placed where scars will be less visible, though these scars can be lessened after surgery with medication, pressure therapy or surgical removal.

Hyperpigmentation (darkening of the skin) and hypopigmentation (lightening of the skin) also can occur in people with brown skin after laser skin resurfacing, chemical peels, laser hair removal or dermabrasion, reported ASPS. Although hyperpigmentation can be reversed in six to eight weeks after a procedure (hypopigmentation is harder to cure), it is best to ask the professional for a skin test before getting the full procedure. This gives you and the professional a chance to determine how your skin will react.

Anthony Griffin, MD, a plastic surgeon based in Los Angeles, told the Post-Gazette that people of color also have difficulty with dissolving stitches used after surgery. Their skin often reacts negatively to the material these stitches are made of, and scars can develop. "I've had keloids [that developed 20 years prior], opened them up, and you can still see the suture material trying to dissolve," said Dr. Griffin, who is African American and regularly appeared on the television show "Extreme Makeover." A better bet for ethnic patients is stitches that have to be removed, he recommended.

When choosing a surgeon or technician, it is important to find someone with experience in dealing with patients of color, as well as someone who understands the cultural aesthetics of ethnic populations and tries to respect them. For example, with liposuction, African American and Hispanic patients don't want the natural curve of their outer thighs disturbed, while white patients want a more tapered look in the leg, Ricardo Rodriguez, MD, a Hispanic plastic surgeon in Baltimore, shared with the Pittsburgh newspaper.

When it comes to plastic surgery, "one size does not fit all," Renato Saltz, MD, told the blog BrandNoise. "Not only are techniques different for certain minority populations, but the concept of what is beautiful as well. For example, South American women typically want smaller breasts and larger buttocks than the average white American female," said the Salt Lake City plastic surgeon, who works for Spa Vitoria.

The professional should respect your cultural aesthetics not only because they indicate the look you desire, but because applying a standard of beauty outside of your cultural group "may produce inconsistent results that are not harmonious with other facial features," the ASPS briefing paper stated. Proper communication ensures that the professional knows what look you are going for, and enables the experienced professional to give it to you.

When choosing a plastic surgeon or cosmetic procedure specialist, ASPS recommends asking to see before and after pictures of people of your ethnicity who have had the procedure you're contemplating. You also can ask to speak with that professional's patients of color to get the full story from them.