The trend is changing. Cosmetic surgery used to be the prerogative of the rich and famous and then it was something that whites opted to go in for. But now the color of the skin is not the main consideration for cosmetic surgery.

Washington’s Cultura Medical Spa has come up with the concept of ethnic cosmetic surgery. Founded six years ago by two African American physicians - cosmetic dermatologist Eliot F. Battle Jr., an expert in laser treatments, and Monte O. Harris, a board-certified otolaryngologist who specializes in rhinoplasty and other facial plastic surgery - Cultura is one of the first centers in the country to focus on the burgeoning field known as ``ethnic plastic surgery.\'\'

Cultura treats about 85 patients six days a week. They include former Miss America Ericka Dunlap, who flies in from Nashville for treatments of acne flare-ups and other skin care; tennis stars Venus and Serena Williams; and basketball stars Patrick Ewing and Alonzo Mourning. Some patients have come from as far as Turkey, Iran and Brazil.

Two-thirds of the center\'s patients are nonwhite, many of them black women who in increasing numbers are seeking such procedures as nose jobs and laser hair removal that until recently were largely the province of well-heeled white women. Many of these patients, doctors say, are also seeking treatments that seek to enhance - not obscure - their racial or ethnic characteristics.

Although white women continue to dominate the ranks of cosmetic medicine, the number of black, Hispanic and Asian patients has escalated dramatically in the past five years, according to officials at the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgery.

Surgeons say that minority women request many of the same procedures as whites, but there are some differences. Surgery to create a crease in the eyelid to give the eye a more open look is popular among Asian American women, while breast reduction, virtually the only cosmetic procedure that may be covered by insurance because it is usually considered functional, is popular among African Americans.

Some patients say minority physicians are more sensitive to their aesthetic concerns and have greater skill treating darker skin, which is more prone to scarring and pigment changes than white skin.