Plastic Surgery Among Ethnic Groups Mirrors Beauty Ideals

 - NYTimes.com

In Flushing, Queens, surgeons have their attention trained a few feet higher, on upturned noses that their Chinese patients want flipped down. Russian women in Bay Ridge, Brooklyn, are having their breasts enlarged, while Koreans in Chinatown are having jaw lines slimmed.

As the demand for surgical enhancement explodes around the world, New York has developed a host of niche markets that allow the city’s many immigrants to get tucks and tweaks that are carefully tailored to their cultural preferences and ideals of beauty. Just as they can find Lebanese grape leaves or bowls of Vietnamese pho that taste of home, immigrants can locate surgeons able to recreate the cleavage of Thalía, the Mexican singer, or the bright eyes of Lee Hyori, the Korean pop star.

They can also find a growing number of doctors offering layaway plans to help them afford operations. If the price is still too high, illegal surgery by unlicensed practitioners is available in many neighborhoods.

As these specialized clinics reshape Asian eyelids and Latina silhouettes, they provide a pore-level perspective on the aspirations and insecurities of immigrants in 21st-century New York — a mosaic portrait buffed with Botox.

“When a patient comes in from a certain ethnic background and of a certain age, we know what they’re going to be looking for,” said Dr. Kaveh Alizadeh, the president of Long Island Plastic Surgical Group, which has three clinics in the city. “We are sort of amateur sociologists.”

Dr. Alizadeh, himself an immigrant from Iran, admits that the results can seem less like science than like stereotyping. Still, he and other doctors who work in ethnic communities say they can scan their appointment books and spot unmistakable trends: Many Egyptians are getting face lifts. Many Italians are reshaping their knees. Dr. Alizadeh says his fellow Iranians favor nose jobs.

And there is no questioning the surge in demand in immigrant neighborhoods, where Mandarin and Arabic are spoken in the operating room and patients range in age “from 18 to 80,” as one doctor put it.

About 750,000 Asians in the United States underwent cosmetic procedures, from surgery to less invasive work like Botox injections, in 2009 — roughly 5 percent of the Asian population, and more than double the number in 2000, according to projections by the American Society of Plastic Surgeons. Among Latinos, the number was about 1.4 million, nearly 3 percent of that population and a threefold increase from nine years earlier. In 2009, about 4 percent of whites had cosmetic work done.

In New York, new clinics have opened in immigrant enclaves, and existing practices have expanded to keep up with demand.

The extreme makeover is, in many ways, a tradition among the city’s immigrants. A century ago, in the early days of cosmetic surgery, European Jews underwent nose jobs and Irish immigrants had their ears pinned back in attempts to look “more American,” said Victoria Pitts-Taylor, a professor of sociology at Queens College who has written about popular attitudes toward plastic surgery.

“The bulk of those operations were targeted at assimilation issues,” Ms. Pitts-Taylor said.

Today, the motivations appear as varied and complex as the procedures. Rather than striving to fit in to their new country, many immigrants reshape themselves to their home culture’s trends and tastes.

“My patients are proud of looking Hispanic,” said Dr. Jeffrey S. Yager, who speaks Spanish and has tripled the size of his office since opening it in 1997 in Washington Heights, a largely Dominican neighborhood in Manhattan. “I don’t get the patients who want to obscure their ethnicity.”

While clinics that advertise in the local Russian, Spanish and Chinese media have much in common with one another and with those serving nonimmigrants — everyone wants a flat stomach and a smooth forehead — their core businesses are as different as the languages spoken by their patients.

Dr. Holly J. Berns, an anesthesiologist, feels as if she is on a seesaw when she travels from Dr. Yager’s office to suburban clinics. On Long Island, she said, “they’re doing everything they can to get the fat taken out of their buttocks.” In Washington Heights, “it’s the opposite — they just want their rear ends enlarged and rounded.”

Italia Vigniero, 27, a Dominican patient of Dr. Yager’s, received breast implants in 2008 and is considering a buttocks lift to attain, as she called it, “the silhouette of a woman.”

“We Latinas define ourselves with our bodies,” she said. “We always have curves.”

“My personality doesn’t go with small breasts,” she added. Using the words “pecho” and “personalidad” — Spanish for “breast” and “personality” — she coined a term that could serve as Dr. Yager’s motto: “Now, I’m a person with a lot of ‘pechonalidad!’ ”

In Flushing, home to a vibrant Asian community with many recent immigrants, Dr. Steve Lee, a native of Taiwan, performs some procedures that are rarely, if ever, done in Dr. Yager’s clinic. Some Chinese, he said, believe that prominent earlobes are auspicious, so Dr. Lee was not surprised when a male client asked him to inject a cosmetic filler into his earlobes to make them longer.

“The bigger the earlobes, the more prosperous you are,” said Dr. Jerry W. Chang, another plastic surgeon in Flushing who understood the impulse.

Other patients request that an upturned nose be turned “all the way down,” in keeping with a traditional belief that prominent nostrils allow fortune to spill out, Dr. Lee said.

Perhaps the most sought-after procedure among Asians is “double-eyelid surgery,” which creates a crease in the eyelid that can make the eye look rounder. Some people criticize the operation, which is hugely popular in many Asian countries, as a throwback to medical procedures meant to obscure ethnic features.

“You want to be part of the acceptable culture and the acceptable ethnicity, so you want to look more Westernized,” said Margaret M. Chin, a professor of sociology at Hunter College who specializes in Asian immigrant culture. “I feel sad that they feel like they have to do this.”

During consultations before surgery, Dr. Lee shows patients a slide show of a white woman with a natural crease in her eyelids and Asian women without it. He discusses the techniques — a stitch here, a cut there — that can bridge the anatomical differences. But he, like several other Asian plastic surgeons, said the procedure had little to do with assimilation.

“One of the traits of beauty is to have large eyes,” Dr. Lee said, “and to get that effect you have to have the double eyelids.”

For all the cultural differences, New York plastic surgeons acknowledge that ethnic neighborhoods are not islands. American pop culture, they say, has strongly influenced how immigrants and their children believe they should look, and reality television shows like “Bridalplasty” have encouraged surgical solutions.

In Bay Ridge, Brooklyn, Dr. Elena Ocher, a Russian immigrant, attributes the wave of young Russian women requesting breast implants — by far her clinic’s most popular procedure among that group — to American culture, not Russian. “The new generations of Russians are very American, and there’s something in America about large breasts,” she said. “What is this fixation?”

Maya Bronfman, 30, an accountant from Moldova, said many of her Russian friends had undergone procedures, but she shrugged off notions of American beauty ideals. “Everyone in New York is some sort of an immigrant,” she said. “They’re just doing it to feel good.”

Dr. Ocher said that about 90 percent of her Russian patients seek operations on the body. But among her Arab clients, the vast majority want surgery on the face. “Arab people never completely expose any body parts,” she explained.

Iranian and Italian women sign up for an array of procedures, from the face to the feet, Dr. Ocher said. She has noticed that Italians tend to care more about their knees.

“The knees should look young,” she said. “Italian girls wear a lot of miniskirts.”