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Economically, the ethnic demographic population has made a significant contribution to the cosmetic industry. As previously mentioned, ethnic persons accounted for ~21 to 22% of all cosmetic surgical procedures in 2007. In that year, about $13 billion was grossed for all cosmetic procedures reported to the ASPS. Therefore, by a crude estimation, it can be inferred that the ethnic population possibly contributed approximately $2.86 billion to this industry. Demographic shifts have also rendered ethnic populations more diverse, and minorities have become more affluent, thus giving them greater expendable incomes that are potentially applicable toward cosmetic procedures. Currently, 34% of the nation's population is composed of ethnic minorities, and these groups represent the fastest growing segments in the United States. These minority groups wield significant economic clout and are positioned to continue their exponential economic growth with resulting expansion in disposable income. According to studies by institutions including the Selig Center (University of Georgia, Terry College of Business), expected growth in buying power of these minorities will continue to far outpace that of the Caucasian population.16 Plastic surgeons positioned to capture these growing markets must pay attention to the concerns of these minority groups and cater to their needs accordingly. Mainstream forces continue to broaden the public's understanding of the options and benefits of plastic surgery while erasing the stigma once associated with it, both for traditional and ethnic patients.17 Increasing public acceptance of cosmetic surgery, expanding media coverage, and a greater number of general cosmetic procedures as well as ethnically sensitive procedures have all contributed to the explosive growth seen in the field. This increasing awareness and prevalence increases rates of first-hand exposure and encourages others to consider undergoing these procedures. The rapid growth of these ethnic communities, their escalating economic power, and their increasing awareness and acceptance of plastic surgery techniques have created burgeoning markets for ethnic plastic surgery that are likely to surpass other cosmetic modalities. Engaging with debates about the re-emergence of the race concept in science, this article opens up facial plastic surgery’s expertise of racial phenotypes to inquiry. Drawing on ethnographic fieldwork and analysis of medical discourse, it analyses how this expertise is made and put into practice in three nations with large cosmetic surgery markets: the US, Korea, and Brazil. Plastic surgery has drawn on the scientific knowledge of race from fields such as anthropology and anthropometry to make racial features (nose and eyes) into an object of medical intervention. Race has been enacted differently, however, in the three national contexts we discuss according to the changing politics of difference and beauty ideals. While contemporary surgery attempts to sidestep the ethical problems raised by earlier scientific racism and whitening practices, it continues to pathologize non-white racial features by operating on traits it sees as “excessive” or merely typical, rather than beautiful. Position Position Nonwhite (roportion of white/nonwhite academic plastic surgeons by years of postresidency experience. Overlay of white averages of postresidency experience for academic and leadership positions. The red asterisk highlights positions where nonwhites are significantly underrepresented. 274 Plastic and Reconstructive Surgery • January 2020 explain why ethnic diversity among full professors has remained paradoxically constant in the face of overall decreases in minority academic representation. As highlighted by the nonwhite cohort peaks present in Figure 2, it appears that appreciable numbers of minority academics currently in the field are only now starting to reach experience milestones typical of academic advancement for white academics. As this cohort gains experience over the next 10 to 20 years, further gains in proportional representation at senior academic positions may be expected. However, these gains are largely reliant on the ability for plastic surgery programs to retain minority faculty throughout the career development process.30–32 Minorities interested in pursuing a career in academic medicine routinely encounter a range of career barriers, including racial discrimination from colleagues, isolation, and low morale.27,33,34 When faced with these challenges, minority physicians overwhelmingly prefer to seek the assistance of senior personnel who have encountered similar issues.26,33 However, lack of effective mentorship remains a persistent issue affecting academic entry and promotion for many minority physicians.26 Improving minority faculty representation has brought regular benefits, including improved student education, academic productivity, and an increased diversity of research interests.35–37 The Harold Amos Medical Faculty Development Program developed by the Robert Wood Johnson Foundation achieved an 80 percent retention rate for underrepresented minority faculty in academic medicine over a 21-year period by connecting minority clinician-researchers with multiple underrepresented minority mentors within their own institution and as part of a national network of program alumni.38 However, it is important to ensure that these programs do not become a burden to minority faculty. The growth in interest in minority mentorship initiatives has created concurrent concern about a growing drain on faculty Table 7. Position Racial Differences with Adjustment for Years of Postresidency Experience Position Unadjusted., reference; AUROC, area under the receiver operating characteristic curve. *Full professor only position to retain significant sex difference after adjustment for years of experience. Table 8. Leadership Differences in Institution Diversity and Faculty Advancement Programs with Nonwhite Chair (%) Programs with White Chair Change with Nonwhite Chair (%) p No. 25 74 Mean no. of nonwhite faculty per institution 6.70 (42.5) 4.12 (20.9) 21.6 Engaging with debates about the re-emergence of the race concept in science, this article opens up facial plastic surgery’s expertise of racial phenotypes to inquiry. Drawing on ethnographic fieldwork and analysis of medical discourse, it analyzes how this expertise is made and put into practice in three nations with large cosmetic surgery markets: the US, Korea, and Brazil. Plastic surgery has drawn on the scientific knowledge of race from fields such as anthropology and anthropometry to make racial features (nose and eyes) into an object of medical intervention. Race has been enacted differently, however, in the three national contexts we discuss according to the changing politics of difference and beauty ideals. While contemporary surgery attempts to sidestep the ethical problems raised by earlier scientific racism and whitening practices, it continues to pathologize non-white racial features by operating on traits it sees as “excessive” or merely typical, rather than beautiful. Keywords: plastic surgery, race, facial features, beauty, phenotype, international comparison 2 Introduction In the twenty-first century, cosmetic surgery rapidly expanded in Latin America, the Middle East, and Asia, and amongst racial minorities in the West, raising concerns about whether operations on racial traits were being used to whiten non-white patients (Kaw 1993). This important ethical question raises a more basic one, which is whether facial features could be said to even “have” a race? In this article we examine how plastic surgeons have responded to this question. Drawing on our respective ethnographic fieldwork on plastic surgery in South Korea (Leem 2016a, 2016b, 2017) and Brazil (Edmonds 2007, 2010), as well as medical and historical sources, we analyse plastic surgery’s expertise regarding racial phenotype and how it has been put into practice. We focus on three nations: the US, Brazil, and South Korea, which by some estimates rank respectively first, second, and third, in terms of cosmetic procedures performed per year (Heidekruger et al 2016).1 Our juxtaposition of these contexts is a deliberate critical strategy made in response to debates about the changing medical and scientific status of race. The reintroduction of the race concept into the biological sciences in the twenty-first century, particularly in research on genetics, has raised problems for the social constructionist view on race that has long
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