Making plastic surgery a more welcoming and diverse specialty

Multiple studies have shown that diversity among healthcare teams leads to improved patient care, compliance and satisfaction – particularly among patients of color.

"You definitely need different ideas and perspectives to come up with solutions that are going to make America a healthier place and allow us to provide better care for the patients we serve," said ASPS President Steven Williams, MD, private practice owner of Tri Valley Plastic Surgery in Dublin, Calif.

Patients also get better outcomes when they have a choice of physicians.

"There is evidence that patients feel as if they are better acknowledged and heard if they have a racially concordant physician," said ASPS Member Surgeon Paris Butler, MD, MPH, associate professor of plastic surgery at the Yale University School of Medicine and the inaugural vice chair of Diversity, Equity and Inclusion for the Yale Department of Surgery. "There have also been studies revealing that compliance with post-op instructions and medication management is also superior. So, simply evaluating the data, it shows that the patients tend to have better outcomes."

Meeting the challenge of increasing diversity among all physicians to more closely resemble the population at large, however, will require the support of all races and ethnicities. For instance, African Americans represent 13 percent of the United States population, but fewer than 4 percent of plastic surgeons are Black.

"For people who don't identify as part of an underrepresented minority, it's important to be an ally," said Williams, who became the first African American president of ASPS in October 2023. "We want allies – we want people to help because it will take all of us. Unfortunately, there's definitely a phenomenon where underrepresented minorities and women are expected to be the primary resource responsible for fixing the problem, and that's probably not fair. It's really something that we should all want to work to improve because it means progress as a society and better care for patients."

Butler suggests that all doctors should strive to acquire "cultural dexterity," an ability to navigate skillfully through various cultures and climates.

"I'm not going to know absolutely everything about a patient (which is what 'competency' implies), but if I have the empathy and vernacular (dexterity) to show them that that I hear them, appreciate them and recognize that their lived experience is going to be different than mine – that should yield a patient-physician relationship that transcends all cultural barriers," said Butler.

ASPS Member Surgeon Aisha Baron, MD, private practice owner of Breast Body Beauty Plastic Surgery in Marietta, Ga., said all physicians can begin by taking two actions with every patient: listen and ask questions. Baron said she will methodically ask patients not only what outcome they seek but also ask many questions about what they do and don't like about the area they want to change.

Finding the best doctor of any color

Despite these benefits, patients of color often do not have access to doctors of color. When it comes to consulting a plastic surgeon, however, each surgeon interviewed for this article stressed that the first qualification all patients should seek is board certification – all ASPS members have achieved board certification.

"I think any well-trained plastic surgeon can safely incorporate patient preference in terms of how they're crafting their surgery," said Williams. "There's nothing about me that uniquely is able to produce outcomes in a patient just because we share skin color, but the difference can be working hard to listen, understand and recognize barriers to effective care that may exist."

"It starts with listening and an open mind. It sounds so simple," said Williams. "It's important that we recognize patients deserve those moments of listening and for us as physicians to engage and understand the things that they want, what they're afraid of – the things that prevent effective care. This isn't just for aesthetic surgery or reconstructive surgery but for all types of medical care because if we're not understanding the barriers patients have, they're going to get poor care, and none of us want that."

Butler recommended patients start by getting referrals from friends. Next, he suggested patients use a discerning eye when it comes to viewing any surgeon's results.

"One way to determine if a plastic surgeon is interested and committed to taking care of patients from diverse backgrounds is asking to see before-and-after photos," said Butler. "If they're all of majority people, then that's likely one way to determine whether or not that practice frequently accommodates patients from diverse backgrounds."

Baron advised patients to meet with the surgeon at least two times in advance of the operation to determine whether they feel an appropriate level of comfort and trust.

"You can do all the screening online, but you're really not going to know until you actually make a consultation," said Baron. "For some people, personalities may not click. See if you feel comfortable with that surgeon, see if you feel like they're listening to you and that they understand you."

In addition to the ASPS Find a Surgeon online referral service, patients who specifically want to consult a surgeon of color can also visit the Arthur L. Garnes Society website. It's named after the first Black plastic surgeon in the U.S. It offers support, scholarship and mentoring opportunities for medical students and residents of color. Baron and Butler serve on its board.

"People can go on there and see plastic surgeons that are in practice," said Butler. "We use that Society so medical students and residents can get access to us, but there's no reason that patients, in theory, couldn't look."

Shifting attitudes about people of color and plastic surgery

Attitudes toward plastic surgery are also shifting in some communities of color.

"There is an impression in the African American community – and I think this is changing, but there has been that opinion – that plastic surgery isn't for people of color," said Williams.

Williams recalls a Black nurse he worked closely with for two decades who eventually asked him to perform a procedure. She was happy with the results but told Williams she didn't think she "deserved" her new body.

"It wasn't clear that anyone told her directly, 'Well, as a Black woman, you shouldn't have these things done, or this isn't for you,' but she clearly incorporated it into her very being that plastic surgery was something she didn't know she could have. That has to come from somewhere, and I've heard it from an increasing number of African American patients. It's clear that, at least in my experience, these patients don't feel like they have the jurisdiction to make changes on the outside to better align with how they feel inside. That's unfortunate."

Including more plastic surgeons of color in the specialty

The ASPS members interviewed for this article are not only making plastic surgery accessible to more patients of color, but they are also taking steps to help more physicians of color become plastic surgeons. All three say they serve as mentors to up-and-coming plastic surgeons but agree that greater awareness is needed before someone becomes a medical student.

Butler said planting the seed needs to start by having plastic surgeons speak to young students.

"I think we (plastic surgeons) need to more readily get to the elementary, middle and high schools to share with these students about what it is like to be a plastic and reconstructive surgeon, particularly in our Black and brown communities," said Butler.

He also stresses the importance of making STEM classes available to all students early.

"If we wait until high school, many times these students are behind and not prepared for their college entrance exams, which could also put them behind for preparation of the MCAT," said Butler. "That, obviously, leads to challenges with being admitted into medical school. Exposure at a very young age is key."

Baron said it is crucial to strengthen the support system for plastic surgeons of color while they are training so they can thrive in the specialty. She said it's necessary because due to implicit biases, not all residents are treated equally or held to the same standards.

"Unfortunately, I've heard of many instances where once they get into a program, they might just have the odds stacked against them, and people do things in order to get them fired or to make them quit," said Baron. "So, where the same resources might be poured into someone who is not of color to support them during rotations or providing tools to help with board preparation, sometimes those same concessions may not be openly offered to people of color. It's only fair to offer the same support to everyone."

Williams said people of all colors are needed to contribute to the solution.

"It's important year-round to pay attention to how we can all be better allies and make sure that we understand there may be barriers that keep people from realizing their potential," said Williams. "I would hope that during Black History Month, people might reflect and say, 'I'm not African American, but I understand what some of the issues are, and I want to be part of the solution.' In those moments, we all become better, and the problem gets a little bit better, because it's going to take all of us to make progress."

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.