Dr. Lawrence Rosenberg performs plastic surgery.

Dr. Lawrence Rosenberg in Lutherville performs plastic surgery recently on a patient. His operating technicians are Lada Shchetinkin (left) and Pamella Angel. Rosenberg has noticed a growing number of people of color who are having cosmetic surgery. (Plastic Surgery Center of Maryland / October 13, 2003)

Roslyn Hart-Cooper longed to wear a sundress for more than 30 years. But she didn't dare slip into one because she felt self-conscious about the size of her bustline.

Wearing a 46E bra, Hart-Cooper, 50, felt her breasts would attract too much unwanted attention. Not only did she not feel self-assured about the size of her bosom, but it also caused her pain. Her back ached, and she hunched forward because of them. She also experienced a rash underneath her breasts because they rubbed against her skin.

A teacher who lives in East Baltimore, Hart-Cooper has suffered with her bust since she was in her 20s. Among her immediate family, the women have small breasts, which has added to her agony.

But things changed in August. She had a breast reduction, joining a growing list of minorities who have gone under the knife to alter their appearance in what has become a $7.6 billion industry for the general population, according to the American Society for Aesthetic Plastic Surgery.

Once considered exclusive to wealthy Caucasians, plastic surgery has become more common among people of color -- now accounting for about 19 percent of all cosmetic surgeries nationwide. A number of plastic surgeons in the Baltimore region have said that they are seeing a growing number of minority patients.

But this phenomenon -- aided by such hit television programs as "Extreme Makeover" and "Nip, Tuck" -- also has stirred debate within certain minority groups, particularly African-Americans.

Even though doctors are improving procedures to maintain ethnic identity, and more blacks now can afford plastic surgery through credit and personal loans, many people face criticism from family and friends who say they are betraying their heritage by changing their appearance.

Hart-Cooper, for instance, faced resistance from her oldest son. He did not want her to have breast-reduction surgery because larger women often are celebrated in the African-American community for their voluptuous figures.

Still, Hart-Cooper said her self-esteem has gone up, and now she cannot wait to wear a sundress. She wears a 40 B bra, and her blouses look better on her, she added. Her plastic surgeon took six pounds off each breast.

"I was very pleased," Hart-Cooper said.

Number of procedures soars

Between 1997 and 2002, the number of cosmetic procedures performed on people of color quadrupled to about 1.3 million, according to the New York-based ASAPS. Of the 19 percent of plastic surgeries performed on minorities last year, 7.9 percent -- or 544,276 -- were performed on Latinos; 5.2 percent -- 358,235 -- on African-Americans; and 3.9 percent -- 268,170 -- on Asian Americans. The remaining 81 percent of surgeries were performed on Caucasians.

The top five surgical procedures in 2002 for the general population were liposuction, 372, 831 (up 111 percent since 1997); breast augmentation, 249,641 (up 147 percent); eyelid surgery, 229,092 (44 percent); nose reshaping, 156,973 (15 percent); and breast reduction, 125,614 (162 percent).

Generally, more women have plastic surgery than men, with women accounting for 88 percent of the 6.9 million people nationwide who had procedures in 2002, the ASAPS said, compared with 12 percent for men.

The top three procedures for women are liposuction, breast augmentation and eyelid surgery. For men, they are liposuction, nose reshaping and, also, eyelid surgery, according to the ASAPS.

More broadly, the United States led the world in plastic surgery procedures in 2001, according to the most recent statistics available from the International Society for Aesthetic Plastic Surgery.

According to a survey of 30 countries, the United States accounted for 21 percent of all plastic surgeries worldwide. Brazil was second. with 14 percent, followed by Mexico, with 8 percent.

Statistics on the types of procedures performed in the United States last year were not compiled by the ASAPS.

But -- according to Dr. Leo McCafferty, chairman of ASAPS's public education committee and a consultant to the Pittsburgh Steelers football team -- minorities are following the national trend regarding the types of surgeries they are receiving.