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Acne, doctors, and the value of a pretty face

I have a love-hate relationship with dermatologists. Scratch that — I have a hate-hate relationships with dermatologists except for one fine doctor who drastically improved my life. I’ve had acne on and off since I was about 15, and I’ve lost track of how many doctors I’ve seen about it. I’ve smeared countless lotions on my face, taken countless pills (including one that made me simultaneously ravenous and stomach-achey, which still seems impressively weird to me), and suffered frequent bouts of self-loathing about it. I did find one doctor when I lived in Seattle who was both kind and effective, and I had about two miraculous years of clear skin. Now I’m grudgingly back under dermatological care after watching that nice clear skin follow the pattern of redness, acne, and scarring that I know so well.

Acne is often extremely uncomfortable for all kinds of reasons beyond appearance: it itches, it makes your skin sensitive to the touch, it can come with dry skin OR oily skin (both of which are uncomfortable). It hurts! There are a lot of reasons to want to treat acne even without the social stigma, which is of course huge.

But here’s the thing about acne: it’s a medical condition whose most drastic effects are cosmetic. That word, “cosmetic,” is a troubled one. Here are its first three definitions from the OED:

1. a. Having power to adorn, embellish, or beautify (esp. the complexion)

b. Of surgery: improving or modifying the appearance. Of prosthetic devices: re-creating or imitating the normal appearance.

2. fig. That affects appearance only, superficial; spec., intended merely to improve appearances.

It’s the tension between definitions 1 and 2, hinged on that word “merely,” that gives me pause. On the one hand, as we know full well here, there is a lot of social power tied up in appearance, in looking “normal” for whatever your culture deems as normality. On the other hand, there is something so dismissive about that figurative link between “cosmetic” and “superficial” — the phrase “intended merely to improve appearances” drips with condescension. (I should note that I’m not attributing that condescension to the good lexicographers at the OED! I think the tone captures quite well the way “cosmetic” is used figuratively.) In fact, to me this definition perfectly distills one of the great rhetorical tricks of patriarchy, which is to define women’s value in terms of appearance, and simultaneously to define appearance as something so utterly trivial that only completely shallow and useless creatures — like, say, women! — would care about it.

Which is why I’m especially troubled by this NYT article about dermatologists who are turning their offices into mini-spas for “cosmetic” patients — i.e., those who come in for Botox and the like, and who pay out of pocket — while keeping the same style of brutal (in)efficiency for those pesky “medical” patients who come in with, say, acne, or, I don’t know, skin cancer. As with any medical trend story, there are some horror stories (like the woman whose first doctor recommended skin bleaching for a strange mole, and whose second doctor correctly diagnosed it as melanoma). But what I find most disturbing is the way the line between doctoring and beautifying is blurred: patients report doctors attempting to upsell them on beauty treatments when they come in for skin problems. At the same time, other doctors seem to have a bright line dividing “cosmetic” patients and “medical” patients:

In an interview, Dr. Susan H. Weinkle, a dermatologist in Bradenton, Fla., said that she typically spends more time with cosmetic patients because they come in wanting to look better, the kind of amorphous desire that takes longer to satisfy than defined medical problems. One of her staff members always calls a beauty client to follow up, she said.

“It is very rare that you would call an acne patient and say, ‘How are you doing with that new prescription?’ ” Dr. Weinkle said. “But with a cosmetic patient, the consultant calls them the next day.”

“Instead of laying on an exam table with a paper liner, you have them lay on a sheet,” said Deborah Bish, a former nurse who works as a practice consultant in Yardley, Pa. “You have to class it up for these patients.”

You have to class it up for these patients. Class is, of course, the not so hidden factor here. I’m willing to bet that it’s not just “cosmetic” patients who “come in wanting to look better” and would appreciate some information about how to care for their skin’s appearance as well as its ailment — but it’s only the cosmetic patients who are voluntarily spending their own money to look better. And, of course, “looking better” in our culture is a signifier of class status: clear skin, straight white teeth, smooth shiny hair (and, of course, a firmly sculpted figure) all indicate both the time and the money to devote to adornment, embellishment, and beautification. (Tangent: back in 2000, my friend and I met Al Gore at a political rally. We were both shocked — and I mean really shocked — to discover that he has crooked teeth. The Vice President! Whose dad was a Senator! Why wouldn’t they fix his teeth? I’ve been trying to unpack that reaction of ours ever since.)

So “cosmetic” is at once considered shallow (these rich women and their Botox spas!), as if it’s all about vanity rather than about classed, gendered, and racialized cultural mandates, and a jackpot — a never-ending demand that savvy dermatologists can milk for fabulous amounts of money.* If you’re unlucky enough to be one of the many people who depend on the bureaucratic nightmare that is health insurance for your dermatology treatment, you get the short end of every damn stick: you wait longer, you get less time with the doctor, you get the paper liner instead of the sheet, and you still get doctors trying to convince you to get microdermabrasion along with your acne lotion (and to do so, of course, they have to tell you what’s so much worse about your skin than you even thought).

I don’t know what the answer to this is apart from a revolution in the US health care system as well as an overthrowing of the beauty myth. Since both of these are a long time coming, I turn the floor over to you while we plan the uprising. A good part of our energy here at SP goes towards pointing out that what are touted as medical concerns about fat people are often aesthetic mandates in disguise. How does clear skin fit into this system? What are your experiences with acne and with dermatologists? How do your cosmetic practices fit in with your self acceptance?

*”According to a presentation for doctors from Allergan, the makers of Botox, a medical dermatology practice might have a net income of $387,198 annually, but a dermatologist who decreased focus on skin diseases while adding cosmetic medical procedures to a practice could net $695,850 annually.”

175 thoughts on “Acne, doctors, and the value of a pretty face”

  1. Medicine is evolving from a calling into a business decision. There is no shortage of derms now, but a coming shortage of family doctors. This is a recurring theme in the medical blogs, which I love.

    I’m surprised that in this article they forgot to list fertility doctors in the line up, because those folks can really rake it in and insurance seldom covers services.

  2. I’ve struggled for about 13 years with acne. I’ve had some success with dermatologists and have considered trying again soon.

    Something that bothers me about my acne and the few frown lines and furrowed brow that are finding there way to my face at all of 25 is that I am made to feel as though I am doing something wrong by not taking care of these issues. I have the money and therefore I have no excuse for continuing to have easily botoxed-away wrinkles or big pores my local laser clinic could “Blue Light” away…

    It’s similar to how I’ve felt about my weight in some ways – I have this deep down feeling that I can and thus SHOULD do something about these things. I think sometimes folks would have your Al Gore reaction to me – for example when I go to a professional convention or meeting, people must think it odd I don’t “take care” of my issues because I clearly could if I wanted to.

    I try to embrace this as a big “Fuck You” to the said beauty myth when I am feeling up to it. I can fix it, but I don’t, so bite me.

  3. “In fact, to me this definition perfectly distills one of the great rhetorical tricks of patriarchy, which is to define women’s value in terms of appearance, and simultaneously to define appearance as something so utterly trivial that only completely shallow and useless creatures — like, say, women! — would care about it.”

    THANK YOU FOR SAYING THIS! I have been trying to figure out how to articulate this for ages.

  4. Another recent feature in the Times had a chart of the average salaries of various medical professions. At the top dermatology and cosmetic surgeons. At the bottom: family practice, pediatrics and ob-gyn. That really said it all to me, right there.

  5. Oo!! I’ve had both really good and really bad dermatologist experiences. And some things in between.

    The bad: Right before I was going to go off my parents’ insurance, I finally realized that despite not being the worst skin I’d ever seen (that was my line of comparison, basically), maybe I had acne that deserved treatment. So I went to the dermatologist the family had been using for a while. I waited in the office for, oh, 40 minutes. Then the doctor walked in, glanced at my face from across the room, said, “Yeah, you have some scarring” dismissively, write three prescriptions, and walked out. The nurse had to come in and tell me what they were and how to use them. Then after 4 months, in which time my digestive illness had mysteriously flared back up after more than ten years of complete recession, I discovered that the topical was contraindicated with someone with my illness. Questioning my pharmacist revealed that the tetracyclines were not contraindicated, but they were known to be associated with problems. The doctor clearly hadn’t even opened my file. So I went off the meds, had to find treatment for my illness, and let the acne come back. I didn’t exactly feel like law suits, but seriously, this was probably malpractice.

    The weird: I followed up at the university health clinic. The doctor was a very nice (and hott!!!) resident who took me seriously and made me feel good about things. The non-resident doctor was a funny and ancient little man who pressed my fingers and demanded to know if I ate a lot of carrots and tomatoes! But the topicals didn’t clear things up. I gave up on meds for a while.

    The good: I finally gave up on OTC creams and washes and hippie treatments and went back to see a doctor at my current university. Being a university clinic, there was some turnover. The first dermatologist brushed off a lot of my concerns and just wanted to put me back on topicals that were too strong for me, even though I warned her my skin was sensitive. When I went back, though, I had a new doctor. She ANSWERED MY QUESTIONS, TOOK ME SERIOUSLY, and actually even treated my acne. This was so shocking that I was, like, in love with this woman. It’s so amazing to actually be treated!!

    So in my limited experience, doctors at colleges and universities seem to be better about these things. Maybe they just aren’t trying to turn a profit the same way. I mean, they’re still doctors and they still get kickbacks on their favorite regimens, and it’s not like I’ve liked all the doctors I’ve seen at school clinics. But the worst doctor, anecdatally, who barely seemed to care about the medical patients like me, was an asshole with a private practice. His careless practices hurt my body in very real ways. I hate that man.

    And fwiw, maybe it IS shallow, but it’s a lot easier to accept myself and my body now that my acne is gone. Just so much easier. I can even look at myself in the mirror WITH my glasses on and be okay with what I see.

  6. Also, I meant to include this in the post but couldn’t find a way to incorporate it: I get my acne from my dad’s side of the family. My older brother had it, my dad had it, my paternal grandmother had it. In fact, when my grandmother was a young’un, her acne treatment was X-ray therapy When she was in her 70s, she got skin cancer.

  7. Lynne, my nice dermatologist was also university-associated. In fact, every doctor I had through the UW Medical Center was competent, effective, and kind. I wonder.

  8. “In fact, to me this definition perfectly distills one of the great rhetorical tricks of patriarchy, which is to define women’s value in terms of appearance, and simultaneously to define appearance as something so utterly trivial that only completely shallow and useless creatures — like, say, women! — would care about it.”

    Yeah, that is really quite good!

  9. “Acne acceptance” was sort of a fat-acceptance warmup for me, probably because I’ve had the acne much longer than I’ve had the fat. (It started when I was 14 or so; I’m 36 now. It’s still here.) It was the Bane of my Existence through my teens and early 20’s – I was thin back then but I had those spots, and I was convinced that they were what stood between me and True Beauty. I had bigger friends that envied my metabolism; I would gladly have traded 50 pounds for perfect skin.

    Now that I think about, there are some big parallels between acne and fatness. I always assumed it was my own fault – maybe I wasn’t using the right skin care product, or my “regimen” was faulty – people would assume that it was because of poor diet or bad hygiene and inwardly I would agree, even though every other woman in my entire family had the same problem, regardless of personal habits. Everyone had advice. Nothing worked. Sound familiar?

    Eventually I got tired of caring about it and tired of trying a billion different remedies that didn’t work and cost too much money. I finally settled on a simple and inexpensive product that works reasonably well but not perfectly so, and decided that was that – I wasn’t going to beat myself up over my skin anymore. I don’t even think of “doing anything about it” any more.

  10. i’ve fought this too, and i don’t know how bad yours was at puberty, but i was borderline leper. not to insult any actual lepers, some of whom i’m sure weren’t as bad off as i was. it sure functioned the same, socially, as leprosy.

    i also found it very interesting that it was once common knowledge (early 1900’s) that dermatological disease (including acne) and low thyroid function overlap. once the low thyroid is addressed, the skin infections clear up on their own. of course, thyroid therapy is cheap and repeated trips to the dermatologists are not, so i can see why this would be an unpopular fact for the profit-driven health care industry to disseminate.

    low thyroid function results in low metabolism, hence decreased circulation, and susceptibility to infections … so scientifically, it makes total sense that your skin would suffer spectacularly when hypothyroid is a factor.

    now that i’m (finally) being treated for low thyroid, i have some hope that i will never have to see a dermatologist again. (i actually had one tell me that what i ate had *no impact* – not little, even, but NO impact – on my skin health. sure. the largest cleansing organ in your body is totally unaffected by whether you eat highly processed frankenfood or stuff from your own backyard garden. whatever, dude.)

    dermatologists as a whole operate like snake-oil salesmen/quacks. all they have to offer is one product after another that doesn’t address your general health. of course, i’m a firm believer that the natural tendency of the body is towards health, and when overall health isn’t present, no tinted sulfacet lotion is going to create it. get to the base of the problem, and your body will heal itself.

  11. One thing that seems to link the medical approaches to fat and acne is the blame on the patient. You’re fat because you eat too much/don’t exercise, and you have acne because you eat too much sugar/don’t wash your face/eat too much fat or oil. Never mind genetics, hormones, or PCOS.

  12. When I think about it, I’m really surprised that I was never referred to a dermatologist for my acne. Especially considering how concerned various doctors have been about getting me to do something about the facial hair thing (even though the acne has been around longer). The only thing that I’ve ever gotten is the occasional suggestion of trying a different kind of birth control.

  13. Victoria, I think that’s true in the general conception of both fat and acne, but I personally (despite my dislike for my past dermatologists) haven’t had any blame me in any way for my acne. YMMV, obviously, but I think there’s been more medical mythbusting done for acne in recent years.

  14. Hmm, I haven’t really been to a dermatologist since my teen years, so maybe things have changed. Plus I had the same experiences with a great university doc as you and Lynne mentioned above, so perhaps I should have another go at it…

  15. We were both shocked — and I mean really shocked — to discover that he has crooked teeth. The Vice President! Whose dad was a Senator! Why wouldn’t they fix his teeth? I’ve been trying to unpack that reaction of ours ever since.)

    Interestingly, I have had an experience with my teeth that parallels the one you have had with your acne.

    For my mother, cosmetic dentistry was just not something you did–if your teeth were ugly, you just lived with it, as long as it wasn’t causing you pain. My two front teeth are slightly discoloured from a childhood reaction to penicillin, and my teeth are all slightly crooked due to one lazy canine that was a bit late to the party.

    My mother used to take me to an extremely enterprising dentist who would always send me home with brochures about teeth bleaching and braces. But she held firm, and to this day I am a little self-conscious about my smile. I also hate going to the dentist.

    I often wonder if people look at my teeth and think the same things you did.

  16. Meg beat me to it, but I just have to repeat this passage:

    “In fact, to me this definition [of “cosmetic”] perfectly distills one of the great rhetorical tricks of patriarchy, which is to define women’s value in terms of appearance, and simultaneously to define appearance as something so utterly trivial that only completely shallow and useless creatures — like, say, women! — would care about it.”

    Absolutely brilliant. Thank you.

  17. hallie, a lot of that is really just not true for a lot of people. But I’m glad you found a remedy that worked well for you.

  18. Sorry, but:

    dermatologists. Scratch that.

    He he. Scratch that. Get it. I crack me up.

    Now please resume your serious feminist discussion of the intersection of beauty and medicine. Thank you.

  19. Eve, with Al Gore I think there was also an element of how tightly controlled the images of public figures are — it’s like when people see a movie star IRL and realize they’re actually short (or whatever). Seeing Gore in person was so different from seeing him on TV, and crooked teeth were one part of that. However, I do think the largest part of my reaction came from this connection of class, power, and beauty; I was really surprised that someone with the power to become Vice President wouldn’t have used some of that power to straighten his teeth, not because I particularly care about that, but because, to play off your phrase, it was just something you did.

  20. Yeah, SM, I had the same experience with not being blamed by doctors, so maybe that has come a little farther. There is certainly still a lot of blaming by non-doctors, though. It took me forever to convince my mom that because my skin was different from hers, I couldn’t get rid of my acne just by drying out my skin as much as humanly possible. When I do that, I just have acne AND dermatitis. Awesome! Also, this totally holds true for the diet thing. Most people just don’t get rid of their acne by changing diet.

  21. Here’s my unhappy dermatological experience story…I’ve had really bad acne since I was eleven or twelve and when I finally worked up the nerve to see my doctor (I hate doctors) he basically told me I obviously “wasn’t eating healthy” aka FAT! and that if I went on a diet that my acne would clear up. Pretty much destroyed myself esteem and I didn’t have the heart to tell him that I WAS on a diet AT THIRTEEN. Few years later, I went to a dermatologist who told me the same thing, but I told him that I wanted a prescription and he gave me a low dose antibiotic and told me if that didn’t work that I should try even harder to lose weight. I cried. They were both old men, so I guess that might have had something to do with it? Plus, I was devastated because I’m not even that fat. I’m 5’9″ and size 18/20. I felt the doctors shouldn’t have assumed that I was eating unhealthy because I don’t. Seems kind of prejudicial. Now I just wear good concealer and a lot of makeup. *sigh*

  22. He he. Scratch that. Get it. I crack me up.

    Fatadelic, I currently have about 5 dozen mosquito bites (curse you, weekend in NC) so I imagine my language is going to have an unusual amount of “scratch” and “itch” words in it for the next few days!

  23. There is certainly still a lot of blaming by non-doctors, though.

    Oh, TOTALLY. I’ve just been pleasantly surprised by a lack of blame even by the jerky doctors.

  24. get to the base of the problem, and your body will heal itself.

    Gee, hallie, the base of my allergy problem is that I AM ALLERGIC TO THINGS. This absofuckinglutely perfectly demonstrates the problem with traditional definitions of health – it isn’t one perfect state of having absolutely nothing wrong with you!

    If the base of your problem is genetic, there’s no way to fix that.

    I’ve never had to deal with acne, other than the stereotypical outbreaks during puberty. And, I can tell you, even then that what I ate had absolutely no impact on what my face was doing.

    SM, stellar post. I read that article this morning and just…. I have so little faith in the medical industry.

  25. SM, I didn’t mean my comment to be as maudlin as it sounded. But your discussion of cosmetic got me thinking about that aspect of the ‘beauty’ industry as well.

    Funny thing–one of the first things I noticed about Gore when I saw video of him was his crooked teeth. I liked that he wasn’t picture perfect; it gave the impression that he wasn’t focused on appearance. I imagine other people had that reaction as well, which leads me to wonder if there isn’t a reason why he never had them fixed.

    Then again, sometimes teeth are just for chewing.

  26. One thing that seems to link the medical approaches to fat and acne is the blame on the patient. You’re fat because you eat too much/don’t exercise, and you have acne because you eat too much sugar/don’t wash your face/eat too much fat or oil.

    I think that’s VERY true of the social response, but like SM, I haven’t had that experience with dermatologists. In fact, dermatologists were the ones who told me the problem wasn’t eating the wrong foods, and that I was probably washing my face too much. But the thing about acne is, it has a gazillion different causes, another gazillion different manifestations, and no actual cure. When I was 16, I had one blissful summer of clear skin, thanks to Retin-A and oral Erythromycin. But eventually, the Retin-A was too harsh, the Erythromycin blew out my immune system, and they stopped being so effective anyway. For years after that, I tried a shitload of other things that didn’t work, then went on the Pill and poof! Not perfectly clear skin, but much clearer skin, to the point where I could take acne off my Self-Hatred Checklist. Since then, I’ve gone off the Pill a few times, and it’s always come back — my acne is clearly VERY much hormonal. But that’s not true of other people I know, and things that didn’t work for me worked for them. And then, some people do grow out of it, but some people don’t… blah blah blah. It’s just so different for everybody that treating it is a major crapshoot, and a doctor would really have to give a shit to bother keeping up with the trial and error. And too many, it seems, just don’t give a shit.

  27. It’s just so different for everybody that treating it is a major crapshoot, and a doctor would really have to give a shit to bother keeping up with the trial and error. And too many, it seems, just don’t give a shit.

    Kate, that is sooooo true!!

  28. My parents and sister live in an area where cosmetic medical treatments of any kind just aren’t very common. It’s partly a cultural thing — the upper midwest has never been the hotbed of cosmetic medicine that California or the South have been — and partly that the small city they live in isn’t particularly wealthy. There’s been a lot of skin cancer in my family, and it’s really striking to me what a good quality of care they’ve gotten from their local dermatology practice, both in proactive monitoring and in follow-up after a procedure.

    I on the other hand live in a major city in California, where I routinely hear radio ads for chemical peels, fillers, laser sculpting, etc. I don’t get my skin checked as often as I ought to, and part of that is the dermatologists I’ve seen have been very focused on the cosmetic procedures and I feel very much like a charity case. For what I actually need (someone with a clue just looking me over) a physician extender would be just fine, so I have no quibble with that…but I think the practice that would even have such a person on staff would be more medically focused than any of the practices I’ve been referred to thus far.

  29. You know, the whole idea that what you eat causes you to break out seems akin to me to the “don’t eat that because you’ll get FAT” thing… it’s dubious at best in terms of fact, but hey it lets us blame people for the condition of their bodies/faces.

    In my experience, what I eat only causes me to break out if I RUB IT ON MY FACE.

    YMMV due to allergies/other conditions, but you can’t just assume that everyone breaks out due to “frankenfood”.

    I have mild adult acne that I can more or less manage on my own now, but in middle school I went to see a dermatologist who seemed to be of the old-school dermatologist persuasion in that he focused on the medical conditions and scheduled a follow up appointment to make sure I was doing okay on the regimen he prescribed (most of it was OTC stuff except for a cream).

    And SM, that paragraph after your first blockquote is brilliant, as usual. :D

  30. In my experience, what I eat only causes me to break out if I RUB IT ON MY FACE.

    HAHAHAHAHA that’s awesome.

    Especially since of all the hippie remedies I tried, some of which worked temporarily before the acne came right back, the one that made the MOST brief incremental progress was the acne treatment full of alpha and beta hydroxy acids. Most of those, especially the betas, come from foods like sugar. Rubbing that sugar on my face helped! For, you know, a couple months.

    But don’t eat it, it’s a frankenfood!!!

  31. Great post, SM!

    Personally, I’m not surprised by this trend, though I’m certainly disgusted by it. It’s sad that I can’t visit a doctor of any stripe, without being prepared to fend off elective procedures left, right, and center.

    Quite frankly, it’s shit like this that makes me such a strong supporter of socialized medicine. I think profit is a poor motivator for proper healthcare, and with medical personnel and facilities generally driven by the bottom line, I think it’s almost impossible to avoid this kind of trend, where the profitable business takes precedence over medical treatment.

    And I am so there on the “if you can, why on earth wouldn’t you” thing, as re: beauty treatments. I think there’s this expectation for women especially to do all that “girly maintenance” stuff – waxing, manis, pedis, facials, hair, teeth, blah blah blah. As much as I sometimes enjoy that kind of stuff, the expectation that that’s just “what you do” is riddled with classism.

    Plus, as recovering poor white trash who inherited a small jaw and crappy crooked teeth, never got braces or consistent dental care growing up, and has perfectly functional (if gnarly looking) teeth, I get really incensed by that particular beauty standard. So, you know, I’m biased on that one.

  32. Overall, I’ve had good experiences with my dermatologists- I’ve needed to, with 20 years of acne. I like to think it is because I am persistant and make sure they ‘make time’ for me as a patient. If I have questions, I’m gonna bug them and not let the doc scurry off. I go in with a checklist, I go in knowing what works for me, what doesn’t, and what I what to try; knowledgable without being a pest.*

    My derm’s office is connected to an aesthetic center and the patient rooms in the office all feature advertisements for the center. I’ve never been referred to the center save for the one time *I* asked about it. However, I don’t know if that will change as I get older and am expected to care more about ‘aging’ and fillers and such.

    *I’m not saying other people don’t do these things or haven’t encountered doctors who don’t give a shit- just what has worked for me.

  33. But the thing about acne is, it has a gazillion different causes, another gazillion different manifestations, and no actual cure.

    No kidding. :) And frequently the “cures” just make it worse. Recently, I stopped all my washes and creams for a couple of weeks and put nothing on my face but water — and my mother commented my face was looking clearer than it had in months!

    It’s just so different for everybody that treating it is a major crapshoot, and a doctor would really have to give a shit to bother keeping up with the trial and error. And too many, it seems, just don’t give a shit.

    Very true. I wonder if part of this may also come from the lack of continuity of care a lot of people get nowadays — lots of people upthread seem to be going to many different doctors over the course of a few years (myself included), and finding the right cure seems more like a case of landing with the right doctor.

  34. This is all beautifully worded criticism of something that has bothered me for quite some time – starting at the latest from when I was suffering from my own epidermal issues and the “cosmetic” medication wasn’t covered by my shoestring insurance.

    But since we’re talking skin, I also wanted to do a PSA for anyone who has suffered from an itchy, red-bumpy skin ailment that wasn’t acne:
    In my early 20s, I started getting a rash that began around my mouth and chin and slowly took over the entire lower half of my face. It looked red and bumpy, felt itchy and dry and raw, and got worse when I was stressed out. I saw my male GP* about it, and he gave me some steriod cream to treat it. I used this for a year and imagined it got a little better, but it didn’t.

    Then I went to a female dermatologist, who diagnosed my rash immediately as “perioral dermatitis – a sort of mysterious condition that affects women in their early twenties. She didn’t know what caused it, but she knew what aggravated it (artificial mint, some makeup, heat) and she knew how to fix it, because after two weeks of some pills (not steroids) and cream (also not steriods) I was rash-free.

    She said, “If you ever see anyone whose face looks like yours, tell her to quit using mint-flavored toothpaste and to see a doctor.” I’ve seen some women who look like I did, but I can’t get up the nerve to interrupt them, so I’m doing it here. Sorry for the possible thread derail – it is about cosmetic treatment! ::sheepish grin::

    *same GP who, when I was involuntarily puking and unable to eat, diagnosed me with an eating disorder and prescribed Paxil. Is there a First Do No Harm blog for sexism?

  35. Only Harding Brand Pure Baby Extract is suitable for external use. Those baby flavored oils are best used for cooking.

  36. Every, freaking, time I go in to my dermatologist for an annual skin check or to check-up on my skin conditions (roseacea & hidradenitis), she tries to get me to do laser treatments for my roseacea. It’s all about the looking better.

  37. I think you’re totally right that there is that expectation, Tari, but at the same time doing those things is looked down on as shallow and superficial. You can’t win!

  38. My endo, when I first started seeing her, had a practice in absolutely luxurious offices. She shared space with another endo, a nutritionist, a botox nurse (not an official title, but that’s what she did), and a massage therapist. She employed two assistants and a full-time phlebotomist (whom I love – only guy who can take my blood without hurting me). I got sales-pitch emails and brochures urging me to come to their botox open house (!!!!!) and consider microdermabrasion and other frightening things.

    Now that the economy has gone to hell, the other doctors have left and she shares a much smaller, homelier office with a dermatologist who actually removes moles and does skin exams and is down to one assistant and (thank goodness) the phlebotomist). I’m happier, but I’m sure she isn’t.

  39. “In fact, to me this definition perfectly distills one of the great rhetorical tricks of patriarchy, which is to define women’s value in terms of appearance, and simultaneously to define appearance as something so utterly trivial that only completely shallow and useless creatures — like, say, women! — would care about it.”

    This is SO well-put! I never would have been able to write that sentence, to put it so succinctly and well.

  40. “Harding Brand Pure Baby Extract. For baby soft skin, it’s gotta be baby!”

    LOL I just lost it.

  41. tanglethis, I have a similar skin condition! It might or might not be the same, but I find your experience very interesting because I’ve never encountered anyone with something like what I have going on. Untreated, it affects the skin around my mouth and it’s painful, raw, red, and itchy. It spreads, too, but it never spread farther than a clownlike perimeter around my mouth. I started getting it when I was 15 and tried treating it with lotions and creams, with no success. Went to the doctor, got a strong-ish steroid cream (Elocon), which works like a charm (though cortisone does nothing.) So it might or might not be the same thing you’re talking about, but maybe I’ll try cutting out the mint toothpaste. :)

  42. Lynn, it’s funny, too, because one of the remedies recommended my derm in middle school was a bar of soap by Aveeno that’s made with oatmeal. It worked like a charm. So I was rubbing oatmeal on my face, and at the same time my grandmother, if she saw me eating something “bad” (notice how fruits and veggies NEVER cause acne! no they don’t!) she’d yell, “don’t eat that it’s going to come out on your face!”

    I loved my grandmother, but… *headdesk*

  43. The lead OB/GYN at the ‘lady doctors for ladies’ office where I used to go closed up shop two years ago. Saw a recent ad featuring the lead lady doctor and was, momentarily, YAYYYYYY. Then I realized that her new practice focuses solely on botox and lasers and peels and the like. WTF!?

    So, so sad.

  44. Here we go… I think that you and I have “discussed” this a bit, already, but you have hit so many nails with this.

    I have some acne and a nasty case of rosacea. I feel SO GUILTY when I think about having my face lasered because it’s JUST COSMETIC. Of course, rosacea can be disfiguring if left untreated. For me, it is altering not only my skin texture (obviously), but the shape of my nose. When I was on meds, my skin looked so great. There were still marks and scars, of course, but I was SO comfortable with myself. People really do judge others on their skin. So many people think that if we just stop eating certain foods, or do activity x, or any number of things, we’d be “cured.” Sound familiar?

    As to those doctors who are providing cosmetic procedures… I live in a college town of 20,000 when school is not in session. We have a new OB/GYN office who claim to be all about the woman’s comfort. They have a very nice waiting room, high tech computers for the nurses, coffee, biscotti, etc. in the waiting room, and so on. The “enlightened” doctor there told me that due to my age (I was 30), blah blah blah and so on, when she diagnosed my fibroids. DUE TO MY AGE (this was about potential future pregnancies). Now they offer Botox, laser options (like hair removal, vein treatment), and other things I don’t know enough about. I know people who will not go there simply because of the fact that they are offering beauty treatments.

    It’s just such a difficult situation to be in. I want to go have my facial hair removed there because it is exceedingly inexpensive (relatively speaking – I have no insurance other than medicaid, so everything is expensive to me!), but I am conflicted. First, I received less than stellar care, a terrible incident with their billing/collections “person,” and the “beauty” angle.

    So, the dermatology angle that I so wonderfully forgot to focus on… mine is great, but my medicaid doesn’t cover it. I am in actual pain again from my acne/rosacea. After my last son’s birth, something happened to my face that I have never seen before. I got HUGE purple, crusty, oozy, horribly painful… things… on my face. It finally subsided, but it was the worst thing I’ve ever experienced on my face. Right now, I have an appointment in September to have a check-up again, even though they can’t do anything for me while I am breastfeeding. Since I am one of those moms who nurses for an extended period of time, I will be unable to go back on meds for a few years. This is very difficult for me because my bad skin bothers me so much. MUCH, much more than being fat. The facial hair I can remove, but the rosacea? Nothing. Make-up covers it, poorly, and when it starts to come off, it’s nasty looking. I have yet to find a good foundation. If I skip it, I have to worry about the typical mask effect (redness and bumps and veins around the middle of my face, with the white “normal” skin around my hair line and eyes glaring through).

    So my fantasy is being rosacea and acne free. I still subscribe to the Fantasy of Being Thin sometimes, though it is getting better. In cycles. But the skin… if only it were clear, my life would be so much better! Hahaha.

  45. i Lynne, on July 29th, 2008 at 5:09 pm Said:
    botox open house???? omg.

    I know! It’s bad enough that people at work are always inviting me to “parties” to buy makeup or jewelry (I never go), now my doctor wants me to come for… a free shot between the eyes?

  46. Okay, I started to post this a while ago, when there were only 5 comments. My sons needed me, so now we are at what, 50 comments? I am so sorry if I tackled things that other people already did. I swear I always read the comments before I post. :-)

  47. Sort of a tangent to this, but on the theme of the contamination of medical treatment and “cosmetic” treatment, I ran across a post at Sociological Images a few weeks ago about vaginoplasty that sort of turned my stomach, especially in the pitch for it being a women’s health issue.. in any third world country, this kind of thing is awfully close to female genital mutilation – which is considered by all kinds of national human rights organizations as a violation of human rights – but here it’s a privilege..? (And yes, I know that one major difference is the one of choice and consent, but when it comes to societal pressure on women to look a certain way.. you have to sort of question how much consent there really is.. it’s muddy..)

  48. I’ve no objection to doctors making as good a living as they’re able to. That’s what I try to do.

    And I don’t even object to their dealing with people who are spending their own money by offering them more time, amenities, and followup. They are competing for those people’s business and not — at least at the single-patient level — for your business or mine.

    With medical patients, less time per patient may mean more money, or, at the very least, it does not mean less money. With cosmetic patients, more time may well mean more money. It’s not a difficult business decision.

    Seems like the most obvious answer would be giving the rest of us the same choices as the self-paying people and rewarding doctors for treating people better. Fat chance, so to speak.

  49. Okay, I definitely think we need an old-timey apothecary label design for Harding Brand Pure Baby Extract.

    Oh gosh, between this and the Piggy Moo logo I’m really wishing I had a tablet and were better at graphic design. I may have to do them by hand and upload.

  50. Oh, I had a wonderful dermatologist experience when I lived in Philly.

    I had these crazy idiosyncratic hives, and sometimes my eyes/lips/tongue/throat would randomly swell up (or closed, in the case of the first and last one). Of course, I went to an allergist, who did a bunch of food allergy tests and pretty much dismissed me with an epi pen and the advice to take Benadryl if it kept happening. The hives didn’t go away for TEN MONTHS, and it was driving me nuts. The allergist, this whole time, was pretty much only worried about the times when I couldn’t breathe, and beyond that didn’t really seem that interested in figuring out what was going on.

    I was in Philly for a fairly rigorous academic program, so being doped up on Benadryl all the time? NOT HELPFUL. I needed to study, not sleep 16 hours a day. I needed to be alert in class. My stress levels went sky-high.

    I finally made an appointment with a dermatologist. She, unlike the allergist, took my case seriously. She did a biopsy(!), used that information to prescribe medication that helped (maybe a 50% improvement), and took the trouble to break down with me the fact that 1) it was probably environmental, and 2) she would test for what exactly it was if I wanted, but even if I found out it was a weird mold allergy or something, what would I do with that information, short of move (which I couldn’t do)? The answer to that was, of course, nothing, so she advised me to stop driving myself even more nuts about it and just accept that it was as it was. And she followed up with me in person and on the phone, and was generally wonderful.

    I eventually did move and the problem went away, but I will always remember her as being someone incredibly kind in a very difficult time of life.

    Of course, I was pretty lucky in that, since I was completely covered in nasty welts when I went in to see her, she couldn’t really see my skin to recommend other procedures… I doubt she would have, though.

  51. the upper midwest has never been the hotbed of cosmetic medicine that California or the South have been

    I’ve also found the upper midwest to be more sane when it comes to fat phobia. My mom’s doctor in Denver, CO told her she MUST stay toward the lower end of “normal weight” or she WOULD develop diabetes. She dieted constantly to keep her weight down (and got horrific bronchitis Every. Single. Winter.) while living there, then moved to Michigan and her doctor there called the whole theory nonsense.

    She’s been twenty pounds or more over the weight that “guaranteed diabetes” for over two decades, now, not a sign of diabetes… The Colorado doctor’s partner was the one who was positively horrified that I was taking in 2500-3000 calories per day as a teenager well within the normal weight range. *sigh*

    As a teen it did seem my diet had a bit to do with my acne, although not in the sense of clearing it up – I had acne no matter what I ate. But I sometimes speculated on a connection with diet and the type of pimples I developed. Never could decide if there was anything to it, though, because I wasn’t much for recording my diet so I was relying on memory. My acne was clearly more about the hormones than about diet; even a non-record-keeping person like myself could see it unmistakably cycled with my period.

  52. My parents didn’t believe in dermatologists, and the few GP’s I saw as a teen went for the “don’t eat french fries and chocolate” angle… when I had horrible, disfiguring, terrible acne that made my adolescent years a horror show. My parents could afford to have sent me, they just had these odd precepts (not religious or anything, “you can’t drive the car every day even though you have an afterschool job and it takes you two hours to get home and we have a third car” is another example of a weird thing).

    i finally went in my 30s. i asked a friend with amazing skin who she went to. i got lucky. it took me several tries in nyc to find a good one, and they offer both the fancy cosmetic work as well as the basic “i have tinea versicolor that i got from travelling in southeast asia, help”. they don’t push, they offer, and i think they have been very economical as well as genuinely HELPFUL.

    i know it wears us down to see multiple practicioners until we find the right one but i hope people try. because it can help your self esteem greatly, and in the case of someone who has rosacea, there can be huge physical risks.

    in seattle, dr. kendall wilske. she ROCKS. and is fat friendly. you’ll have to wait to get in but she’s so worth it.

  53. A few years ago, my husband convinced me to get a mole removed from my chin. It was smallish, on the underside of my chin, complete with big black hairs that would eventually make me look like a caricature of a witch. I agreed to get it removed for my hubby – it really bothered him, enough so that it bothered me. I went into an office and the doctor didn’t even make me wait; I paid my $100 and she cauterized it right off. Then she started pointing out other skin tags and moles on my neck/upper chest, asking if I wanted those off too! I said no, because I hadn’t even thought about them as a problem. She would have been happy to zap everything right off of me.

    I still feel like a “bad feminist” for having the mole removed – it shouldn’t matter! It was just a flap of skin! But it made my husband happy (why should I care, it’s my body)! In the end, it was just a flap of skin and $100, so I will live with the decision.

    The kicker? The mole grew back within a year. Not as big, but visible.

    The moles that DO bother me (under my arm and along my bra line – they get irritated from rubbing) would cost me three times the amount to be removed PER MOLE because the doctor only did “cosmetic” removal, and those weren’t “cosmetic”. Of course, those moles are also potential for cancer, so why would anyone want to get rid of them early?

    On another topic, like others above have said, I have fairly crooked teeth and am extremely self-conscious about them. I’ve even gone so far as to get a quote for how much it would be for veneers ($4000?!?). If I could fix one thing about myself, it wouldn’t be the moles or my weight, it would be my smile, because I think it gives a very bad first impression about me.

  54. When I was growing up everybody knew that acne was really all about sex. It was caused by thinking about sex, or by masturbating, or by eating chocolate. That and never washing your face.

    In my mid-twenties I was in the Peace Corps and I had a friend who was in medical school in the country where I was volunteering. He told me that I could get rid of my acne by boiling some water, taking the pan off the burner, making a little tent with a towel and steaming my face for as long as the water stayed hot enough to make steam, and then splashing my face with cold water. So I did that faithfully. And my acne never got better with that treatment. And my friend in training to be a doctor asked me when I was going to start following his advice so that I could have clear skin! And he didn’t believe me when I told him that I was doing his regimen twice a day! Because if I only would follow his advice obviously my acne would go away.

    Then, on a visit to the States, I went to a dermatologist who prescribed tetracycline, which I took everyday for oh, years? I now look on that as an irresponsible use of tetracycline and I wish I hadn’t done it, but boy did I like my clear skin.

  55. Some of you have mentioned the genetic component. Is anyone here the only one in their family (if not adopted, obviously) who has skin trouble? I am THE.ONLY.ONE. In fact, everyone else has gorgeous skin. EVERYONE. At least some of my grandma’s sisters were big farming women who look quite a bit like me. But skin? Gorgeous, every one.

  56. He told me that I could get rid of my acne by boiling some water, taking the pan off the burner, making a little tent with a towel and steaming my face for as long as the water stayed hot enough to make steam, and then splashing my face with cold water.

    That was the treatment my mom got from an actual dermatologist in Chicago circa 1950. Yikes.

  57. Emilymorgan, clown-mouth eh? That exactly describes what I had. Actually, a picture. Of the “good” side of my face that year.

    I’m glad the steriods seem to be helping you, although be warned – if you have what I had, you will probably build up a resistance to them and the itch will come back. Whatever it was that my dermatologist gave me, though – something to do with antihistamines? I can’t remember! – knocked that stuff of my face completely in two weeks, and it never came back.
    For awhile it would flare up when I used minty products – Burt’s Bees, for example – but I seem to have more or less grown out of it.
    I hope that helps you, or anyone. Good luck, and enjoy an itchless face!

  58. ooh, add me to the “fantasy of clear skin” and “love-hate with derms” lists. After years of an eating disorder, I finally got to a place where I love my body (Thanks, Kate!), but my skin… I’ve been breaking out since I was ten ( I’m 23 ), and it got terrible in high school. I’m talking giant, painful cysts 1 inch in diameter all over my face. I felt hideous and it hurt so bad I wanted to cry. After almost several years of this, the derms got it down to “normal” teenage acne (still broken out everywhere, but pimple-sized and not painful), but it’s never been eradicated. I made my peace with it more or less, but after trying a new “eco-friendly” cleanser last month, my face exploded. It was amazing what a hit my self-esteem took. I didn’t want to go out, didn’t want to see my boyfriend, didn’t want to subject people to my hideousness. All my confidence went out the window. My boyfriend still thought I was hot and told me as much but I was convinced I was disgusting. (I’m more or less back to the status quo btw- still broken out but only one painful bump).

    This has been sort of rambling, but I guess what I’m saying is that even though I feel better about my fat, my feelings about my looks still have the power to knock me flat, to prevent me from doing things I want to do. “Life would be so much better if I just had clear skin.” etc.

    In my experience, the docs just don’t listen.
    “Doc: Try clindamyacin and retin-A
    Me: I’ve tried them, they worked for a while but don’t anymore. Plus the retin-A is really irritating to my skin. (and increases my chance for skin cancer, which is already pretty high).
    Doc: try it anyway and come back in a couple of months”
    repeat every few months. I’ve given up trying for clear skin and merely aspire to mild, not in pain skin until I (presumably) age out of it when I hit my 30’s. (that’s when my mom finally got rid of hers).

    Oh, and if I had a dime for every time a friend said, “have you tried proactiv?”…

  59. And he didn’t believe me when I told him that I was doing his regimen twice a day! Because if I only would follow his advice obviously my acne would go away.

    Oh, for fuck’s sake. I’m sure he grew up to be a great doctor.

    Rolls eyes for an hour.

  60. I feel kind of rotten here, because my only problem has been a relatively minor one (though it was quite dreadful for me to live through). After going on meds for an underactive thyroid, my skin rebelled. I had perfectly clear skin through my adolescence, and through my twenties, but suddenly, my face was a welter of painful, deep-seated, bright red cysts that took days to subside. The marks remained for weeks on end, until my face was literally a spotted red mass. It was horrible. The one thing I could always count on as a fat girl — my “such a beautiful face” — had been taken from me. It hurt like I cannot even describe, both physically and emotionally.

    I went to my GP, pointed to my face, told him the deal, and he looked apologetic, told me that sometimes thyroid meds can do that, and promptly prescribed me Renova, which has worked like a charm.

    I have a hard time, though, shelling out that much money for a tube of face cream when it’s just for my “vanity” and I feel like I should not care. I feel that it’s anti-feminist of me to care if I have ugly zits. I shouldn’t care what others think about my appearance, as long as I am clean and know when to dress appropriately.

    But i keep paying for it, because it works when nothing else I had tried ever did, and because the pain is gone. My husband can touch my cheek and I don’t have to flinch because there are zits there that I can feel but he can’t see. I can let people take my picture again. I can smile without it hurting.

    My skin isn’t what it was, but it’s so much better.

    I can honestly say that being fat? That was EASY to accept, compared to my poor face. I have loads of sympathy for people with skin problems.

    I guess all I can say is that it really comes down to finding the right doctor and finding the right treatment. I don’t know that I have any wisdom to impart.

  61. Not only am I fat and get pussy pimple breakouts before my period, which started today, I also suffer from eczema. It is not attractive when your hands get big, red, bumpy, scaly blobs that pop up with no rhyme or reason. And boy can they itch!

    Eczema treatments are damn expensive too. I buy hydrocortizone to help with itching and use pine tar soap. All dermatologists say that using non-scented, clinical lotion cleaning products are best, but I like the smelly, girly stuff. I don’t want to smell like a doctor’s office 24/7.

    My mom also used to pull that old chesnut of “you get pimples because you eat chocolate and greasy food.” And I’d tell her that is not the reason, it’s because of puberty and hormones. Yet she wanted me to wear cheap makeup, which broke me out even more. So even at 12 I knew not to use food as morality for the most part. I think defying my mother and not wearing all that stuff on my face was better in the long run, because I never struggled with acne and have pretty good face skin, except for the T-zone (my nose is oil city baby)! But, my mom is goofy, and she knows it.

    Every now and then she mentions Botox. Both her SIL and myself talk her out of it. I keep telling her that I don’t want The Joker for a mom, because half these people that abuse Botox look like they could have audtioned for The Dark Knight and not have money spent on makeup!

  62. I had very severe cystic acne that started at around 13, the cruelest age. Being fat and acne-scarred, well, I don’t have to tell you what life what like.

    It’s so long ago now (I’m 47) that I honestly can’t remember how old I was, or who the dermatologist was, when I was prescribed Accutane. I’m going to guess that I was in my early 20’s. I think the doctor was the only dermatologist I remember any more (there were so many, they’ve all blended into a blur), a REALLY weird cat with horn-rimmed glasses and a perpy bedside manner. I do remember him saying something about additional treatments I could do, but I was so jaded by then I was like ‘just give me the drugs and shut up.’

    I hate to be a shill, but that shit really worked. The side effects were pretty annoying, though I thankfully didn’t have any of the major ones, but after a three-month course, my acne was reduced to the occasional surface pimple or blackhead. No more of those big, painful cysts that left huge craters in my face and elsewhere. I dunno if it’s still prescribed, but here’s the Wiki on it:


    These days I have just minor acne, that’s easily controlled with topical treatment. I do have some pretty good scarring, though, and have considered having dermabrasion, but you know what? I’m old. It just seems stupid. This isn’t to say I’m not going to do it, mind you.

    So, on to why. For exactly the same reason I used to go on diets. Because I think that somehow, it will magically transform me into a siren that men can’t resist. The fact that I’m married has made no dent in this whatsoever. I think it’s genetically encoded in my female DNA. Must. Get. Man.

    I can’t help the urge, but I DO have control over whether I take it seriously or not. I think that the entities who sell the cosmetic improvements are simply capitalizing on a very basic human urge, and there seems to be this modern movement toward ‘Fulfilling your basic urges is OK! It’s healthy! It creates jobs!’ The sane response to that is, IMNSHO, Caveat Emptor. Start living with fulfilling your basic urges as your Prime Directive and you’ll end up in prison might fast.

    So, I dunno. I mean, looking ‘normal’ seems to me to be a fairly understandable desire — it means we won’t be rejected by our species and left to die in the wilderness. Unlike having varied levels of fatness, I think it could be argued that acne is an actual disorder (although it has it’s Haters, too — the ‘chocolate causes acne’ crowd), and that treating it isn’t necessarily giving in to the lock-step march straight to Hell.

    As for doctors who try to sell needless procedures to people who are actually sick, well, every culture has it’s bottom-feeders.

  63. Some of you have mentioned the genetic component. Is anyone here the only one in their family (if not adopted, obviously) who has skin trouble?

    I am the only one to have cysts on my scalp, big enough to see through my hair, some of them. Years after they freaked out my hubby (I’ve had three removed but one came back immediately and of course that was the one that makes it so it hurts to lie back on a padded surface while reading), my mother finally remembered hearing that my great-grandfather (died when she was a baby) had them. And my absolutely bald brother gets cysts, but only in his muscles, which detail he is Most Grateful for.

  64. OH. AND.

    I want to add something.

    When I met my husband, he had the worst acne I had ever seen. The infection had become confluent — his face was basically one big red scabby zit. It wasn’t pretty.

    Know what? I fell in love with him anyway in the space of a day and a half, even though he had the worst acne I had ever seen or have ever seen since, and we dated for four years and have been married for 13. And I’d love him even if he still had it. We’re an exception, not a rule, but the acne part? That was the smallest hurdle. Seriously. It was nothing to me. It meant nothing.

    So, you know, it’s ego-destroying to have it, and I completely and totally appreciate that, oh my god do I ever, but it doesn’t translate to unloveability. So the fantasy that you can only find twoo wuv if you have perfect skin? SO NOT TRUE. Y’all, y’all are amazing, and somewhere out there is someone who is smart enough to twig to that, and the next thing you know, you’re making out in a convention movie room during Evil Dead 2, and falling totally in love.

    It happens.

    Fix it if you want to or if you can, but please don’t tell yourself that it’s going to stop you from having the happiness you want. It doesn’t have to.

  65. Quite frankly, it’s shit like this that makes me such a strong supporter of socialized medicine. I think profit is a poor motivator for proper healthcare, and with medical personnel and facilities generally driven by the bottom line, I think it’s almost impossible to avoid this kind of trend, where the profitable business takes precedence over medical treatment.

    Oh yeah baby!

    Let us all write to our congresspersons.

  66. When I was a teenager, my folks took me to a dermatologist for my acne, who prescribed some kind of yucky lotion that always separated and tetracycline pills. I was on them for years, and while it probably helped keep the acne down to something I could deal with, it never really stopped it. I finally quit the tetracycline after the yeast infection from hell, but the long term use of antibiotics means that now any time I need an antibiotic I’m pretty much guaranteed a yeast infection to follow.

    It settled down to a small level after the teenage years, but now that the perimenopause fairy has given me an all-day pass to the hormone roller coaster (wait, haven’t I already DONE this?), the acne is getting more active again. My GP gave me a light topical that seems to help somewhat, but like 30 years ago, it’s still there.

    Which brings me to doctors. We moved about a year ago and I’m coming up on needing to find a new doctor (OB and GP) for the usual routine checks, and I don’t even know how to go about it. If doctors even have a website it never contains information about their practice’s precepts and values, which are very important to me. And I don’t have anyone I can ask. (And I tried the list on First Do No Harm, nothing in my area.)

    On the one hand, it helps to know that I’m not the only person who has had everything that’s ever been wrong with her blamed on her weight at one point or another, but on the other, it makes this process terrifying.

  67. One thing that seems to link the medical approaches to fat and acne is the blame on the patient. You’re fat because you eat too much/don’t exercise, and you have acne because you eat too much sugar/don’t wash your face/eat too much fat or oil.

    And that different things work for different people. I have three sisters. Two of them have horrible acne; my other sister and I lucked out. But for us clear-skinned two, anything pre-processed made with canola oil (basically, chips and Oreos) causes a nasty little break-out within 24-48 hours. We can almost set our watches by it, so to speak. And it’s easy to deal with: if we want clear skin, we avoid bad foods and drink water.

    My other two sisters? Any combination of diet, cream, and exercise just doesn’t work.

    I leave the analogy with fat as an exercise for the reader. ;-)

  68. I am the only one to have cysts on my scalp, big enough to see through my hair, some of them.

    I’ve got a couple that are small now, but my mom had big ones, so I’m sure I have that to look forward to. Maybe we’re related. :)

    Know what? I fell in love with him anyway in the space of a day and a half, even though he had the worst acne I had ever seen or have ever seen since

    Totally. Al doesn’t have bad acne, but he has the charmingly crooked teeth thing going on, and it’s instructive that he is SO sensitive about that, when I literally do not even notice. (Yeah, it registered on me when we started dating, but I didn’t give a rat’s ass, and I can’t remember the last time I actually noticed his teeth while talking to him.) Despite all the very real and painful judgment we do get for not looking perfect, it’s also good to remember that the things we’re most self-conscious about are often things a whole lot of decent people don’t care about or even fucking notice. It’s so easy to get hung up on one thing you believe everyone is staring at, and forget that you are a whole person with a face and body that are constantly moving and shifting and reflecting your level of happiness and interest when you’re talking to someone — you’re not actually one big zit (or one big thigh, or one big tooth, whatever).

  69. I’ve never needed to see a dermatologist. The genetics-gods gave that one to my sister (no worries… I have plenty of medical issues of my own!). But I will add to the discussion by noting that the gynecologist I was seeing for a while started offering Botox treatments in her practice! It felt like a really creepy bandwagon they’d jumped on… “Here… let me look up your vagina with my flashlight, and while I’ve got you in the stirrups, how about we fix those lines on your face?” Many women feel very vulnerable as it is at the gyn… then adding on the whole “your face isn’t good enough” speech? *shudder* I stopped going there.

    I know it’s a different issue entirely, but I do wonder how patients who receive Botox for medical reasons are treated… It’s used to treat certain tics and tremors, severe cases of bruxism, and hyperhidrosis….

  70. thanglethis, thanks! The steroid cream has been working fine for nearly a decade (I have to use it maybe once a month or so. I’ve never run out of a tiny tube of it before it expires), so I hope that it keeps going. And I can feel it before it’s visible at all, so it pretty much functions as prevention. But if it’s because of my toothpaste, that would be really good to be aware of!

  71. So much to say –

    First : All of these health and beauty medical treatments completely make me think of patent medicines from the 1800’s, which then make me think: If they would just put some morphine in those anti-cellulite creams, I would buy the hell out of them.

    Nextly: As to weird treatments for acne, my mother used to tell me that my grandfather had to eat sulfur to treat his acne, like by the spoonful. It made me really scared that if my skin didn’t get better I would also have to chow down some sulfur.

    Finally, and only tangentially related, as always: I got to work today and my boss had put a list of foods that trigger migraines on my desk, with the name and contact info for her “headache doctor”. As if I don’t know what triggers my migraines and haven’t been in treatment for them for 10 years. Bleh, thank you so much for your concern. please mind your own business.

  72. TropicalChrome. some kind of yucky lotion that always separated — was that Lotia Alba by any chance? White and chalky, to dry up your skin? I used that for years. I don’t really know if it worked or not because I didn’t want to stop using it in case things got worse. I actually don’t even remember when or why I did stop using it.

    My acne bothered me a lot but it was really pretty mild.

  73. My face has always been reasonably clear, but OMG, when I was a teenager I had bacne like nobody’s business. And chest-ne. My upper body is pretty scarred from it; luckily, no pitting, but if you see me in decent light (or when I’ve been sweating), I look like a leopard or something.

    It went away spontaneously when I hit about 22 or 23. Yes, I know, I’m lucky and I should shut up. But, ugh, it hurt and oozed and looked awful. No tank tops or swim suits for you! Unlike my brother and father (and fiance), though, it wasn’t on my face, so even my own mother rarely saw it and never thought it was worth treating. *shrug* So the vanity thing works a little strangely: if you don’t have horrible dermatological conditions where people can see them, they aren’t worth treating.

    On the flip side, I’ve got positively awful teeth. They work just fine, and the bunny-rabbit look is kind of endearing (I guess), but crooked/squished teeth + weak enamel = HELLO CAVITIES. *sigh* The orthodontist told me mom that the biggest reason I needed braces was so that people would like me better. No joke. Hence, no braces. (Then, when I was older and my mother was over that, we didn’t have the money.)

  74. Katia, it wasn’t white and chalky, it was definitely skin tone colored, but it was supposed to dry things out so it very well may have been that with some dye added. But like you, I never knew if it was doing any good but I kept using it anyway because it seemed like it was better than nothing, you know?

    That’s the main reason I’m still using this topical antibiotic gel right now, but I’ve been considering discontinuing it for awhile this fall just to see if it’s actually doing anything.

  75. Sweet Machine — I can’t believe your grandma had the same x-ray treatment my grandpa did! The guy that zapped him (for acne OR eczema, the story has gotten confused over time) as a young man gave him such long X-ray exposures that he *burned my grandpa’s epidermis off*. The skin cancer started only a few years later. And of course the doctor knew he was liable for malpractice, so he had everything he owned in a family member’s name. Arrgh.

    Mainly I only commented because I’d never heard of anyone else having that quack treatment. Skin has been a major frustration of mine over the years — my acne wasn’t horrible, and the Pill cleared me up except for once a month, like kate — but I have other conditions, including eczema, and most recently a lovely thing called pityriasis rosea that, blessedly, you can only get once a lifetime. (Swooping lines of itchy red bumps all over your chest, stomach and back, most likely to get in spring or autumn, most likely in your early twenties, main treatment is sunlight and/or Vitamin D, and waiting for it to go away. I bring this up because I know several people who have had it.)

    The thing that really strikes me is that your skin is a huge part of your day-to-day wellbeing. Yes, it’s your biggest organ, and it’s also the part of you that’s most in contact with the world. I have felt, struggling with some of these conditions, SO wretched. As if the itching would drive me insane, the way it never just gave me a day off, the worry that it would scar, or never end, and on top of it the guilt — it’s JUST a rash, toughen up!

    What I really want to say is, we should not feel guilty for wanting our skin to feel comfortable, soothed and non-painful. It’s not shallow to want your biggest organ not to hurt or itch, and we deserve to have someone help us to be comfortable in our skin.

    P.S. Great dermatologist in San Jose: Carson Kent

  76. Stephanie – I hear you on the weak enamel. My childhood dentist told me it was probably a combination of genetics and some prenatal deficiency – I even have, if you look really closely, tiny white spots where the calcium is deposited unevenly.

    And my teeth are just crooked enough that the dentist said they gave me character and that braces would really only serve cosmetic purposes. My husband and I were comparing bite profiles the other day on some apples we were eating and WOW, my teeth are a lot more crooked than I realized and, yet, they still work just fine.

  77. SM says:
    Okay, I definitely think we need an old-timey apothecary label design for Harding Brand Pure Baby Extract.

    So, anyone – what is this, and how many babies does it take to make up one jar/bottle, whatever?

  78. I got braces because I had my front teeth turned out to such a degree they were constantly slicing up my lip, so I never got any cosmetic orthodontia talk. However I have yellowy enamel, and got the teeth whitening offer from a dental assistant. I was irked enough to tell the dentist that I didn’t appreciate offers of anything not directly health related.
    Also, on the topic of the medical field trying to make the bucks, I just saw a trailer for a show sponsored by Menactra vaccine. Not even a medical drama. Freaky.

  79. Oh are you reading my mind or what? I’m dealing with a huge swollen spot breakout right now (which by the swollen ouch factor of it I know is an allergic reaction to something honey-related rather than just acne) and it just drives me crazy. As a teen, I had fairly average acne – nothing worth seeing a doctor about, except I used to have the most embarassing back acne (Stephanie, I feel you..my scarring has finally begun to disappear where I can wear backless stuff..). What ticks me off is to be 32 and still have flare-ups…usually hormonal from period, stress or as an allergic reaction to something (sensitive skin, gotta love it.) AAAAAAAAHHHHHHHHHHH!!!!!! And you know, of course, I have lots of presentations and meetings with clients this week. (And my mom is 58 and still has the occasional flareup so I have that to look forward to..)

  80. I should probably mention that I sort of got over the scars thing when I started working out. Eventually, the t-shirt was on the floor and I didn’t care how spotted I looked; I was on an elliptical, by golly. Now, as in this minute, I’m wearing a spaghetti-strap tank top because it’s frickin’ humid out and I had yoga class this noon. (And haven’t changed yet. Yes, I’m gross. :))

  81. I, too, have acne. I got it when went through puberty early at age 11. Since then I’ve always had it, tho it has sort of waxed and waned. I get the very deep, painful cysts that take forever to go away. Its definitely hormonal because it always flares up right before my period.

    Most stuff doctors prescribed for me did not work. The worst was my experience with retina-a. The first time I was about 13 and a doc my mom dragged me to prescribed it, along with this wacky regimen where I had to blow-dry my face with for 30 minutes plus some other stuff that I don’t remember, and then use the cream.

    I hate it when you have to do some long ritual in combo with some treatment – of course if it doesn’t work its because you aren’t doing it right. Then years later I went to my gp (I was on HMO and didn’t want to deal with trying to get a referral to a derm) and he gave me a higher percentage retina-a that gave my face a chemical burn. And then the doctor yelled at me when I told him that. Whatever.

    The things that worked for me was doxycycline, Differin, and birth control. I liked the Differin but its expensive, even with health insurance. The doxycydline worked but it only works as long as you take it, and I had some bad digestive problems while taking it.

    I wish I could take accutane and not have to deal with this. I actually just went back on BC just to control the acne (I don’t need it otherwise). I know a couple of women who have gone the accutane route but my acne is probably not bad enough for a doctor to prescribe it to me.

    Finally because I’ve seen some posts about teeth and cosmetic dentistry – I was never happy with my teeth and about 5 years ago spent the money to have a bunch of cosmetic dentistry done and it was totally worth it. I love my teeth and I wish I’d done it earlier.

    I really like the discussions regarding appearance things that have been coming up like the previous facial hair discussion. Thanks for posting these, I really like hearing about peoples experiences with the same stuff I have to deal with.

  82. Yes! I’ve been down Dermatologist Lane too many times to count. The cystic acne started when I was 14ish, and I’m still battling it here at the cusp of 30.

    It’s internal. Hormonal or something. I’ve learned this over the years. I’ve been fat with acne, thin with acne, a vegetarian with acne, a binge eater with acne, a no-frankenfoods purist with acne. It has nothing to do with food, but of course I’ve heard at least a dozen times that I must be eating the wrong things.

    It also has nothing to do with how or when I wash my face, though just plain water works the best because at least it won’t irritate or dry me out. But of course I’ve heard a dozen times, “what are you washing with?”

    I’ve gotten a few other “stupid little lady”directives. One dermatologist was *convinced* that the problem was caused by my long hair making contact with my skin. I actually shaved my head not long after that. And guess what? I became a baldie with acne. It wasn’t my hair. It wasn’t my detergent. It wasn’t my makeup; I didn’t wear any and I still don’t.

    What does help my acne? Getting rid of stress! We moved 1500 miles when I was 15, and my acne flared. I married an abusive man, and my acne flared. I had a job I couldn’t stand, and my acne flared. But when the bad marriage ended, when the job ended, when the stress disappeared – my skin cleared up as though by magic. With no changes on my part.

    The problem is, stress keeps happening. Right now, it’s my alcoholic, emotionally manipulative mother. And when she drinks herself to an early grave, something else will come up. I honestly feel my best acne treatment would be sessions with a therapist, you know?

    Despite the obvious – that the problem is all hormonal – I’ve had all the creams, all the antibiotics, even Accutane. I didn’t give Accutane much of a chance, because I was worried about birth defects if I got unexpectedly pregnant. Even though I was on birth control, I was nervous. Plus, I hated the regular blood draws just to test if the stuff was killing my liver. It seemed a drastic thing for “just acne.”

    But you know, it can really impact your life. I may well consider Accutane again once I’m done having kids. But I don’t know. Like I said, the problem seems like something a pill can’t really fix.

    At almost every dermatologist I’ve been to, I’ve been shuffled off to the Nurse Practitioner, with only a cursory glance from the doctor herself if necessary. But they all seem to advertise fancy treatments; I have no doubt that the doctor spends time with those patients. But why wouldn’t she? Economics are true incentives for people. Sigh.

  83. In fact, to me this definition perfectly distills one of the great rhetorical tricks of patriarchy, which is to define women’s value in terms of appearance, and simultaneously to define appearance as something so utterly trivial that only completely shallow and useless creatures — like, say, women! — would care about it.

    Can we move back to this for a mo? I couldn’t agree more with you, SM. But, here’s the thing about The Man. He’s got me, at least, coming and going.

    If we’re questioning the assumptions here, lets start with this:

    Is worrying about your “appearance” shallow or not?

    If it is, then I have to feel bad about the fact that I like looking nice…maybe not even in an overtly sexual way, but in the same way that wearing a smile does me more good than wearing a frown on those days when I’m feeling on the fence about life.

    However, if it isn’t shallow to worry about appearances, this gives latent support to the argument that appearances are the focus of good-and-proper femininity — which is obviously not the road we want to follow, as it is one of the assumptions that is at the root of a lot of the unhappiness we talk about here.

    I guess what I’m saying here is that so long as I feel like my appearance does matter to me, on whatever level, I’m either going to be perceived as shallow or shilling for The Man.

    So, I’m damned if I do, damned if I don’t unless I change my mind about the fact that it brightens my day when I wear a shirt that fits, or pants that fit, or a color that makes me look more awake than I really am. Now that I come to type this, though, these examples here, of course, are things that are actually in my control…maybe that’s the key. Anyone else see what I’m sayin’?

  84. Right now, I have an appointment in September to have a check-up again, even though they can’t do anything for me while I am breastfeeding.

    Some rosacea patients seem to do better with coal or pine tar soaps… I wouldn’t want to use it on my breasts if I were breast feeding, but on the face might be ok. It’s at least worth asking the doctor about it, since you can get it OTC and in theraputic doses. $4 for a bar of soap and $15 for shampoo is a good deal if it helps… especially compared to some of the other treatments.

    It’s also a psoriasis and eczema treatment… which is how I found out about it. My partner has severe psoriasis, and the side effects for many of the other approved treatments are pretty nasty. Coal tar shampoo and pine tar soap help keep him comfortable. Some kinds of lotions soothe his skin a bit… many others have ingredients that make matters worse.

    And I’m seconding whoever mentioned that pain means it’s not “just cosmetic”. And I’m adding itching… My partner will itch so badly that he won’t notice when he scratches his skin raw.

  85. I just sprouted a few huge zits on my chin (why now? I have no idea, I’ve outgrown the bad acne phase and I’m not PMS-ing) and dammit, they hurt.

  86. If the base of your problem is genetic, there’s no way to fix that.

    What?!?! You mean I can’t just go to the lab and change my DNA?

    Curses liberal arts degree.

    Baby doughnut oil is for internal use only.

    Are you sure? I was hoping it would be multi-purpose:

    Baby doughnut oil – the secret of health, beauty and vitality! Soften skin, whiten teeth, smooth away wrinkles and tone your digestion! Suitable for culinary and medicinal purposes.

  87. I’ve had lots of treatments for my acne, and the only one that works is severely impractical to maintain: being pregnant clears my skin up like magic.

  88. atiton, of course we’ve got basically no idea of what our attitudes towards personal appearance would look like minus patriarchy, but I suspect it would be something like “you get to care, and you get to not care.” Because aesthetics wouldn’t be cast as the primary concern of females (thus caring about your looks wouldn’t be of paramount importance), nor would they be cast as impossibly dumb and superficial because of being the primary concern of females (thus caring about your looks wouldn’t be anything to be ashamed of).

    So I mean, yeah, if you care about your appearance you’ll probably be perceived by The Man as either shallow or shilling for The Man. But if we’re trying to look with a non-patriarchal eye, you’d be perceived as someone who’s just doing whatever she feels like re: her own damn body.

  89. I also think in a post-patriarchal world, it would be acknolwedged, that women, too, are (gasp) sometimes attracted on a primarily physical level to certain people.

    Since my self-worth has improved, I’ve started to notice how many beautiful people there are in the world. Before, even though I thought everyone is more attractive than me, self-consciousness prevented me from really *seeing them.* Am I the only one who was well into adulthood before I really knew when I was attracted to someone because all I could think was, “but will he ever be attratice to me?”

  90. Am I the only one who was well into adulthood before I really knew when I was attracted to someone because all I could think was, “but will he ever be attracted to me?”

    Oh, hell no.

    Since my self-worth has improved, I’ve started to notice how many beautiful people there are in the world

    This is such an important point, and I think it goes both ways. Noticing beauty in others helps you see it in yourself and vice versa, ime.

  91. It’s so great to hear all your acne stories. I never really had a problem with it until a couple of years ago. As a teenager, I had perfect, clear, beautiful skin. Never wore makeup, because I didn’t need it. (and it was, and is, really hard to find a shade white enough for me. I am seriously pale.)

    Then, 3 years ago, pow! Horrible cystic acne everywhere. It came on along with the chin hairs and the round tummy, and the rest of the PCOS symptoms. (Hmmm, maybe around the time I switched to a non-estrogen birth control because of my migraines?) Huh. That’s when I gained a bunch of weight and started getting diabetic symptoms, too. Wonder if the artificial hormones might have been hiding problems that were already there? Nah, everyone knows you only get diabetes and PCOS because you’re fat, neither of those could possibly help you become fat. (/snark)

  92. Am I the only one who was well into adulthood before I really knew when I was attracted to someone because all I could think was, “but will he ever be attracted to me?”

    Gads, no. I was so grateful that someone, ANYONE would want to go out with me I didn’t think at all about how I felt about them. It took me years to realize that hey, you know, I did have some say in the whole matter and how I felt about them them did matter.

  93. (Long-time lurker, first-time poster…)

    And chest-ne. My upper body is pretty scarred from it; luckily, no pitting, but if you see me in decent light (or when I’ve been sweating), I look like a leopard or something.

    Oh, lord, yes. I worked at a Renaissance festival for several years–rack of doom+corset-emphasized cleavage+summer in the deep South=scars that I have to explain every year at my breast exam.

    I’m now a grad student, and we all get stress-induced breakouts at the end of every semester. So at least no one feels self-conscious when the whole department looks like we’re going through a second puberty. :)

  94. I actually think we can imagine what it would be like to care about your appearance for fun and your own satisfaction, not for how it pleased the patriarchy.

    Look at the rich white heterosexual men (the ones who aren’t actors, that is) at special events like the Oscars or whatever. Some of them dress in gorgeous formal wear with interesting touches, and some of them just wear whatever seems reasonably appropriate.

    If you want to dress in comfortable clothes and wear a baseball cap like Stephen Spielberg, go for it! If you want to be a wacky Victorian-style dandy like producer John Calley, cool!

    People can choose to express themselves through their clothing and grooming choices. Or not. It’s all good.

  95. I’ve been very very very lucky and never had major skin issues at all–even as a teen, my skin was clear 98 percent of the time. The one thing I had was after a trip to New Orleans, where I came home with a raging case of *something* on my face. Red, rashy, painful, and it would not go away no matter what I did. It did a number on my head for quite a while because one of my things was “well, I may be fat but at least I have super-clear, nice skin”. Once this red rash whatever cropped up, I was just…violently unhappy (more so than usual). I went to my sister’s dermo (my sister had terrible acne problems for years, including cystic acne) and he couldn’t have been a bigger jagload. He was interested in nothing but seeing as many people per hour as he possibly could, looked at my face from across the room and threw prescriptions at me, none of which worked. No effort was made to even attempt to diagnose what was going on, he just wanted to cash the check.

    I got sick of giving him my money and, well…I tried ProActiv and it worked for me. I try very hard not to be all “have you tried ProActiv”-y because seeing what my sister went through for so many years made it quite clear that what I had was nothing compared to what other people struggle with.

    Oh, and as for teeth: I had braces slapped on me at 13 and they weren’t removed until I was 18. My orthodontist was an old-school dude who used the wrap-around style of braces versus gluing the bracket onto the tooth itself, and said that I needed to have my jaw broken and reset because I had an underbite and if I didn’t have it fixed, I’d wind up not being able to eat at some point. Years later, I asked my dentist if I needed to have jaw surgery and he looked at me like I’d grown horns. Good old Dr. Bob. I give him credit–when I asked him if I could have a tooth in order to make it into an earring, he didn’t flinch at all.

  96. Oh, the teeth thing. I also have super soft enamel and have had a lot of non-cosmetic dental work done. I have some uneven coloration on a front tooth, but it’s never bothered me, and my teeth have yellowed a bit but that also wasn’t something I wanted to fix. If it was easy to fix, I might have tried it just for kicks, but it’s expensive and painful (don’t know if this is related to the soft enamel, but I also have the most sensitive teeth *ever*).

    So I wasn’t planning to do any whitening. THEN I needed a root canal and was having a crown put on #4, which is relatively close to the front of your mouth. They need to match the permanent color of the crown to the rest of your teeth, so I needed to basically pick the color I wanted for my teeth for the rest of my life (or at least for the life of the crown). This is inherently cosmetic, and I had been resisting paying any attention to cosmetic tooth questions until then. But I suddenly had to be able to come up with an answer for the shade of the crown. So I whitened. It hurt like hell. I got the crown… and since then I’ve been under a lot of stress and drinking a lot of coffee, so I kind of need to whiten if I want to match the crown again. But I’m afraid of the pain. :(

    Back to acne: I found almost all the topicals caused eczema and/or dermatitis, too, like a lot of you. My skin was just way too sensitive, even with months of trying to build up from treatment once every, oh, three days. No luck. But I tolerate the differin so I shelled out the $45 copay. Ick. Not like I was exactly made of money at the time, either. But I didn’t want the torture of the accutane to have been for nothing, and apparently for most people it’s important to keep up a mild topical regimen for maintenance for a year or so afterwards. See, now I have *invested* something (time, discomfort, money…) in this outward appearance of mine, and my stubborn side wants to make sure it was worth it, damnit.

  97. Back when I was trying to get a diagnosis for a whole bunch of weird shit, I found that doctors treated the symptoms piecemeal. Several GPs told me to lose weight – I was dieting and working out daily at the time. Then one decided that I need birth control pills – they made me crazy. The same doctor sent me to a dermatologist who gave me accutane – horrible side-effects. It took and a period that lasted more than two weeks before an ob-gyn suggested an ultra-sound – sure enough.

    The weird part is, most of the doctors treated my “cosmetic” concerns (Why have I gained 20 pounds while dieting? Where is this hair coming from? Why the sudden acne?) as silly. I wonder if they thought I was just trolling for drugs to make up for my horrible lifestyle choices. Not that I had horrible lifestyle choices, but I did have fat and acne, so I must have been doing something wrong.

    Honestly, there is such a horrid, puritanical streak in our culture, and doctors are part of it.

  98. I have really godawful acne. It’s excruciatingly painful, disfiguring, and often gets bad enough that the lymph nodes in my throat swell up. Once, my entire chin got infected and swollen.

    Unfortunately — according to everyone I’ve talked to — acne is totally incurable and untreatable, so I have to just bear it. Besides, the scars are bad enough by now that even if it did go away, I’d still look like the Elephant Man.

  99. I’m 48 and have had pretty mild acne since I was 14. Actually, it was (I guess) kind of bad when I was a teen, because my pediatrician referred me to a dermo (we had Kaiser) and I got the antibiotic regimen along with shots of some kind and, as a bonus, a skin treatment that involved a cloth wrapped over dry ice and then dipped in acetone wiped over my face once a month. Anyone else had that one?

    My dental story is a pretty recent one; I had some old fillings in my front teeth replaced (along with the requisite matching of the filling material with my tooth color, which is brownish and always has been.) Immediately after, I was asked if I wanted to consider having my teeth whitened and, oh yeah, it wouldn’t work on the new fillings, so they’d have to be redone (!!) I don’t go to that dental practice anymore, needless to say…

  100. Kate,

    Do you get the cysts in your muscles, too? Those aren’t so visible, usually.

    Al doesn’t have bad acne, but he has the charmingly crooked teeth thing going on, and it’s instructive that he is SO sensitive about that, when I literally do not even notice.

    Hubby’s teeth are a little crooked, but he also got his two front teeth bashed in a bit in a fall, and he was really wound up about that. Totally beside the point as far as I’m concerned, don’t think I’d even noticed before he brought it up.

    The guy I’d dated before him wasn’t dealing with acne when I knew him, best I can recall, but he had major scarring all over his face – but I was hardly the only one who thought he was right fine looking. I think his incredible green eyes grabbed all your attention, so you’d decided he was stunner before you were consciously aware of the scars, I dunno…

    I guess what I’m saying here is that so long as I feel like my appearance does matter to me, on whatever level, I’m either going to be perceived as shallow or shilling for The Man.

    I think everyone has some awareness of their appearance and cares about it on some level, and that it’s quite natural. Even fairly young kids have favorite clothes and think they look good in this or that or whatever. IMHO there’s nothing shallow about some level of awareness; without that, where’s the fun of dressing up, after all.

    The problem isn’t the women care about their looks but that society has made looks the entire measure of a woman’s worth, so most women at some time end up obsessing on their looks. For a lot of us it isn’t so much about looking good in the natural sense of wanting to look your best, as it is about looking good enough according to society’s standards not to be shunned or shamed.

    Even that “survivalist” level of interest is going to be way higher than a natural awareness of looking good, but it’s artificial because the standard women are held to is artificial, so when people see glimpses of that attitude it can come across as shallow to those who deny the fact that society makes these demands of women. A further tragedy is that a lot of people dismissed for being shallow because they’re hung up on their appearance never experience the cheerful confidence of “I look good today” even normal people (let alone the arrogant “I look better than anybody else here” buzz of the truly shallow appearance-obsessed person), because the standard they’re using is impossible in real life.

    So they get the condemnation, but none of the benefits of what they’re being accused of!

    Ack. Was that as convoluted and confusing as I suspect it was?

    And it had already been quoted a number of times before my first post, but I, too, loved SM’s summation of the double bind of being condemned on the basis of appearance while being told worrying about it is shallow. Brilliant.

  101. atiton, this quote from Susan Bordo (which I posted in comments on the recent thread about her book) has been helpful to me:

    in my view, feminist cultural criticism is not a blueprint for the conduct of personal life (or political action, for that matter) and does not empower (or require) individuals to ‘rise above’ their culture or to become martyrs to feminist ideals. It does not tell us what to do […] — whether to lose weight or not, wear makeup or not, lift weights or not. Its goal is edification and understanding, enhanced consciousness of the power, complexity, and systemic nature of culture, the interconnected webs of its functioning. It is up to the reader to decide how, when, and where (or whether) to put that understanding to further use, in the particular, complicated, and ever-changing context that is his or her life and no one else’s.

    I think the “particular, complicated, and ever-changing context that is his or her life and no one else’s” echoes what FJ and JP are saying: if we could divorce these questions of aesthetics and appearance from their oppressive histories, then we’d all get to put as much time or effort into our looks as we felt like. It would be like (although this is not a great analogy because it also can have gender and class implications) whether or not you wanted a certain decoration scheme in your house: you might like ultra-modern, and your friend might like Victoriana, and your other friend might just have a futon and a TV. It would be a matter of taste and delight in a certain type of artistic expression.

    Is worrying about your “appearance” shallow or not?

    My answer to this is an emphatic no. In our current cultural context, even if you don’t worry about your appearance, there are plenty of people who try to worry for you. For me, I think what’s crucial is recognizing that the anxieties you have about your appearance do not come from your personal inadequacy, but rather from a systematic, oppressive cultural mandate to look a perfect way — a mandate that is drilled into you every single day of your life. If you don’t meet that ideal, it’s not because you’re a failure; it’s because the ideal is impossible. If you realize that, you get to choose, to some extent, how much you want to play that game, both for the sake of social acceptance and for the sake of personal enjoyment. Personally, I have found it much more enjoyable to occasionally make myself pretty since I’ve really learned that I don’t have to be pretty.

  102. I’ve never had acne or facial skin issues but most of high school I had absolutely horrible eczema all over my arms and legs. I went to a dermo who told me to use Eucerin on my skin and glycerin based soaps plus cool water in the shower. I never went back when that didn’t work. I took prenatal vitamins and flax seed oil (by mouth, 1 tablespoon a day, this is exceptionally gross) at the recommendation of a naturopath, that might have worked, I don’t know because I couldn’t stomach the flax seed oil. Then I went to my regular GP who noticed it during an exam and gave me a prescription for antibiotics (my arms and legs were a giant infection) and some prescription cream to put on after the infection cleared up (this was apparently crucial) and knock on wood it’s been 9 years since I’ve had any major eczema outbreaks. I do get a small patch in my elbows or the back of my knees once in a while, but I’m older now and able to resist scratching which is what really did me in the first time. I wouldn’t wish eczema on my worst enemy, it is so painful and uncomfortable not to mention ugly.

  103. Great post! I’m sure I’m not the only one freaked out by the fact that a medical doctor feels it is more important to do a timely follow-up on someone who came in for a purely cosmetic treatment than someone who came in for a medical treatment.

  104. The problem isn’t the women care about their looks but that society has made looks the entire measure of a woman’s worth, so most women at some time end up obsessing on their looks.

    That could not have been said more perfectly- thank you!

  105. (May I just state, as an introductory aside, that it was SM’s original post citing Bordo that got me to comment and participate in this community. Thanks, SM, for making my day that day.)

    I hear what you are all saying. I, too, firmly believe even today that it is my choice to pay attention to the parts of my appearance that I have control over (or not). The thing is, I find myself despairing that it will ever be the case that both those who do and don’t pay such attention will be treated equally. Oh, woe, is my dampened spirit.

    After all this, I also feel I should contribute my dermatologist story. I went to said dermatologist’s when I was about 15 because I believed that I had the most horrible case of acne ever to strike a teenager–like TWO zits…AT ONCE. The doctor took one look at my face, told me that I had beautiful skin and that whoever told me to show up there was mistaken. He did not charge me for the visit and sent me on my way. To this day, I think of that kindly old man with the fondest of thoughts. There are good folks out there. You’d think that would actually be a balm for my own cynicism.

  106. I got to have braces because my upper lateral incisors — the teeth on either side of your two front teeth — didn’t have any adult teeth, just baby teeth, so when they fell out, I had enormous gaps that my canines promptly shifted into. I look very vampiric in some of my middle school pictures.

    Also I have bad skin, partially because I’m a woman (yay, hormonal fluctuations) and partially because of genetics (my dad has rosacea). I struggled with it through middle and high school, trying Retin-A and benzoyl peroxide, both of which burned my skin. Surprisingly, my best resource for figuring out what worked, was Makeup Alley, where they talked about the need to be gentle with acne skin. Who knew?

    The thing that freaks me out the most is that the new OB/GYN I’m looking at going to does Botox injections in their office. I mean. What?

  107. I find really even teeth to be extremely creepy. Mostly straight and fairly white is nice, crooked and interesting is great, but that habit of getting pure white, totally even veneers (now spreading from the US to other countries) really scares me. It looks like everyone has false teeth, and I keep feeling like they’re lying to me from their smooth, perfect mouth. Irrational? Sure! But true.

  108. I come from a very acne-prone family, and while I frequently hate my skin and its unwillingness to obey, I have to admit that as far as family cases go, I probably got off reasonably lightly, and I just have to live with it. You’re right–it is painful, especially that deep cystic acne. I haven’t experienced what you have at the dermatologists, as I gave up on them years ago, but where I get it is at the gynecologist! I cannot believe how many pamphlet and displays for beauty products they are hawking in there. I find it unseemly and so off-point. It also seems like shooting fish in a barrel, because, gee, you’re not going to find any women concerned about their attractiveness and femininity among the pregnant and the concerned about their reproductive systems.

  109. It’s all about money. Dentists are also offering spa-like experiences with music, videos, pedicures/manicures, and massages alongside cleaning and drilling.

    And I hear you about the acne. I inherited appalling skin from both parents.

  110. My story about skin and food is minor, but it might be interesting because it doesn’t fit into any of the usual sin and punishment stories.

    When I was a teenager and in my twenties, the one thing that would give me a few extra pimples was eating chocolate if I hadn’t been eating it for a while. If I kept eating chocolate, my skin would acclimate and the pimples would go away.

  111. Some more thoughts:

    I have pretty bad scarring on my face (and back, and chest, and bottom) from my acne, but I remember my mother saying something about it once, along the lines of ‘did I want to have something done,’ and saying to her, ‘no, I kind of like it, it’s the face I’m used to.’

    Now, at 47, if my mother would pay for dermabrasion, I’d be there in a heartbeat. Or would I…?

    I have a chip in one of my front teeth, that I remember getting at 8 years old on the bottom of the bathtub. On my first visit to my current dentist (who I love) he asked me if I wanted to have it bonded. My response was similar – I’ve gotten so used to that chip being there, I wouldn’t be ‘me’ without it.

    I’m reminded of Richard Burton’s scarred face. Would be be Richard Burton without those scars? How about Ray Liotta?

    I resonated with the comment about finding perfect teeth sort of creepy. I live in a college town, where there are lots of 20-something girls with perfect everything, and — maybe this is just me — but they look so boring. There’s nothing unique about them. Perfect hair, perfect teeth, perfect figure, blah.

    My spouse has many ‘flaws’ like this, all of which make him who he is to my eyes (I should say, though, that I’m talking here about things that aren’t painful and/or unpleasant — that’s a different animal). I like people who look unique, so I guess I’ve learned over time to like the unique things about my own appearance.

    Oh, head rush! Maybe part of the trouble I have accepting my body is due to a reluctance to see it as unique. Because, you know, all fat is the same. If you’re fat, you’re just fat. Well, hell, man, I’ve seen a lot of fat people, and nobody is fat in exactly the same way. Everybody has their own unique shape. I’m going to have to go think about this…

  112. I’m a daily visitor here but a very infrequent commenter, however I would like to share a positive dermatologist story!

    I’ve had skin issues since my birth – my mum tells me that my skin was often covered in eczema as a child. A doctor friend (my mother is a registered nurse) recommended bathing me in warm water with a tablespoon or two of a mix of rolled oats (oatmeal? I’m Australian, so the name might be different) and safflower oil.

    That stuff is magic – I used it all while I was growing up to treat the horrific eczema I get on my toes. Our refrigerator always had a container of rolled-oats-and-safflower-oil in it.

    My acne cropped up when I was about thirteen, and I saw a wonderful dermatologist twice a year from then until when I moved to Japan twelve months ago. Dr. Belle Cominos, for anyone in Brisbane – she’s always got around a six-month waiting list or more for new patients, but it’s worth the weight. She’s also fat, which I admit made me feel a lot more comfortable when she was checking my moles out and I had to get essentially nekkid.

    Anyway, we tried topicals like Differin, but found they really only made it worse, then she prescribed the pill (Diane, IIRC – I’ve changed now), and bam. Cleared up in seriously less than a month. These days I just have super-oily t-zones and lots of blackheads on my boobs *shrug*

    She also recommended Clinique makeup and Neutrogena skincare. I liked the Neutrogena stuff but have switched to Lush for now. Clinique makeup is total love though, especially as I can get it here in Japan. :D

  113. she’s always got around a six-month waiting list or more for new patients, but it’s worth the weight.

    Lol Freudian-slip. Worth the wait.

  114. The best thing EVER that helped for my skin was eating fat. No kidding. After years of fat-free diet crap that was addled with sugar, cutting out oil and dressing, cooking without butter and trimming the fat off my meat, my doctor* suggested eliminating all carbohydrates and sugar and eating plenty of good quality fat. (This was largely in response to exacerbation of epileptic seizures that wouldn’t respond to medication and getting diagnosed with lipedema – to this day, she has never recommended that I lose weight at all.) The biggest thing I noticed was that it was just brilliant for my skin – it became softer all over my body, breakouts became reduced, and I lost a lot of general redness. WINNER.

    Also, whoever told you to thoroughly wash your face when you were younger is a jackass. Warm water and a washcloth can settle down your skin just fine if you’ve got sensitive skin.

    *I wish I could out myself just to recommend this doctor, because she is the most awesome human being ever. Rather than harping on about the ZOMGOBESITY when I put on 10kg in six months, she did a good run-up of tests to see if I had any thyroid/hormone problems while reassuring me that I was likely to be the same size as my mother, and it was nothing to be concerned about because my mum is in perfect health. SCORE.

  115. I’ve been doing a lot of research on the nonprofit sector for work lately, and often I can’t help but feel that in some areas–like pediatrics and social problem-solving–relatively low pay might almost be better. It makes it more likely that people in the profession–especially in these two sectors, where a pediatrician could have been a plastic surgeon instead, or a nonprofit leader could have (maybe has) had a lucrative corporate career–are incentivized by a calling and true love for the work rather than opportunism.

    I never want pediatrics to become the kind of moneymaking machine that attracts the kind of cowboys who go into finance these days.

  116. minerva:

    My father has a huge scar on his face from being in a knife fight as a punk kid, and my mother said it was the first thing that attracted her to him. She said that she was attracted to his imperfections because they made him human and real to her. But I remember her telling me about his scar when I was twelve or thirteen, and not knowing that he had one (and it’s pretty large and obvious) because it was just so a part of him that I never recognized it.

    I think that is how I am about my fat, I am in a process of constantly integrating and separating it from my “true” self, seeing it as part of me and foreign to me in different degrees.

  117. Antipodean Teeth tangent: “American teeth” is a phrase I first heard ten years or so ago to describe a particular look – complete, even, bright white, symmetrical, and to my eye “large” – as is “she didn’t get the job because she doesn’t have “American teeth”. TV pretty faces seem to need it here, but radio not… got a feeling that may change. The phrase “American smile” to me summons up a quite wide mouth like Julie Roberts. “British teeth” are famously bad.
    I like gaps a lot. Gwen from Torchwood… *sigh* (I haven’t read the comments but I bet i’m not the first to swoon over her)

  118. Kristie, I completely respect your decision not to see a doctor about your acne. But fwiw, the fact that some family members had *far* worse acne than mine is what kept me from treating it (it’s not REAL acne like theirs!) for so many years. It also meant it was completely overlooked by my parents as a kid. So while it’s good to keep it in perspective like that, that the illness is milder for you than for some others doesn’t mean you don’t deserve treatment if you decide at some point that you want it. :)

  119. relatively low pay might almost be better. It makes it more likely that people in the profession–especially in these two sectors, where a pediatrician could have been a plastic surgeon instead, or a nonprofit leader could have (maybe has) had a lucrative corporate career–are incentivized by a calling and true love for the work rather than opportunism.

    In theory, I agree with that, but in practice, what that would likely mean is A) mostly women would go into those specialties, and B) they’d become devalued socially as well as financially. Look at nursing, teaching, social work — any of the “caring professions.” The work is incredibly important and should be more remunerative, but it’s not, because people go into those fields wanting to help — and the vast majority of those people are women. And the burnout rates are incredibly high.

    I hate to be such a cynic, but seriously, I bet that if pediatricians were paid a lot less than other specialists, the field would soon become female-dominated, and the cultural attitude toward pediatrics would soon become, “Oh, treating children isn’t even that hard. It’s all vaccinations, cough medicine, and lollipops. It’s not real medicine.” And then we’d all be taking our kids to burnt out, underpaid, demoralized doctors who really want to help but can barely keep their heads above water.

    So for me, it comes back to single-payer healthcare. If every patient is surrounded by the same number of cartoon dollar signs in a doctor’s eyes, then at least that level of discrimination is removed. (Racism, sexism, homophobia, fatphobia, etc., would still abound, naturally.)

  120. So for me, it comes back to single-payer healthcare. If every patient is surrounded by the same number of cartoon dollar signs in a doctor’s eyes, then at least that level of discrimination is removed. (Racism, sexism, homophobia, fatphobia, etc., would still abound, naturally.)

    Damn skippy. I’m a rampant anti-capitalist, of course, but that’s partly because money-making as the highest good only serves people who already have money. Public health and human rights just don’t turn a profit (more’s the pity)!

  121. I like gaps a lot. Gwen from Torchwood… *sigh* (I haven’t read the comments but I bet i’m not the first to swoon over her)

    Indeed, you’re not. :) And one of the things I love about British TV is that the actors so often have little flaws that would likely keep them from getting work (or at least lead roles) on American TV — which means they’re both more interesting and more “normal”-looking to me. Eve Myles is stone cold fucking gorgeous, no two ways about it, but she’s not Hollywood-perfect. And it’s not even that British actors have bad teeth, per the stereotype, but on British TV, you actually see normal-colored teeth, and slightly crooked or gappy ones — i.e., what a lot of Americans (myself included) look like even after years of orthodontia — not to mention weak chins and odd noses and receding hairlines and potbellies and for women, even occasionally hips and breasts that exceed the Hollywood limit. I’m always struck by how not perfect so many British actors are — despite their generally being far closer to “perfect” than me or most of the people I know personally — and I fucking love that. I am so sick of seeing American actors who all basically look exactly alike.

  122. I’m always struck by how not perfect so many British actors are — despite their generally being far closer to “perfect” than me or most of the people I know personally — and I fucking love that.

    I totally agree. Though I love David Tennant as Dr Who, one of my favorite things about having Christopher Eccleston as the Doctor is that he was this skinny, beaky guy with a non-posh accent and huge ears. And he was the hero! And the pretty girl falls in love with him (more or less)! I literally cannot imagine that happening on American TV.

  123. You mean the HOT skinny, beaky guy with a non-posh accent and huge ears . . . ahem. (What? No, my fiance doesn’t have big ears, but he’s definitely a skinny beaky guy . . .)

    Even David Tennant is a bit odd-looking, if you think about it. In the normal Hollywood market, he’d be the short, skinny, weird best friend/funny guy, rather than the OMG SEX SYMBOL he is over in England (and among people watching British TV here). Yay for mild diversity!

  124. Gah, torn between the Doctor Who and the original topic…

    On DW: anyone else notice when Donna realized she’d been living in a fake world and that those experiences never happened, and her response was “Oh, and I’d dieted!” in a way to imply that she was mad for putting herself through that? I found that interesting, especially given how happy she in general seems to be with her body.

    OT: A few years ago while working a summer job my (female) supervisor turned to me and said, “when I was younger I washed my face with soap and water everyday and never ate pizza or drank soda and *my* face was totally clear.” Thanks for the implications there, boss!

  125. My epilepsy meds fuck everything up–>hormonal BCPs become 50% effective (which, btw, makes it about as effective as pulling out, which means I’ve gone with condoms, sponges, and Plan B [once]); my skin becomes super-receptive to sunlight, meaning I can’t have Accutane; and the levels get screwed up by any of the -cycline antibiotics, so I can’t have those. I still have the acne I’ve had since fifth grade, and I just can’t seem to get rid of it.


  126. Oh, my dear Shapelings! What a wide-ranging, deeply intimate, and intellectually stimulating conversation…

    … to the extent that it’s hard to choose what to respond to, and whether it’s possible to add anything of value to the discussion…

    So, an observation: I am the proprietor of a small shop in a tourist destination. I see people all day everyday – and people see me. Literally, over the course of some twenty five years, the numbers of daily interactions must be in the millions by now.

    The kicker is – I have been both complimented on my complection and been slipped business cards for plastic surgery in the same half hour.

    As CHECK OUT GIRL, da…dadaDUM!!! I seem to be a blank wall upon which
    all sorts of assumptions are sprayed large, which have nothing to do with my “true” self. I have been treated dismissively on the basis of appearance, sex, weight, intelligence, class, experience, age, reproductive status, and so on. I can tell you, my “imperfections” are as varied as the people who notice and feel free to comment upon them.

    teh effrontery of being a fat, female, fiftyish grey haired shopkeeper who greets the world with barefaced aplomb!

    End ramble.

  127. Dr. Something, HAAAAAAAAAAAAAAA!

    Seriously. Very funny. Have people clicked that link up there?

  128. The silver lining is, I think that having hideous skin since early elementary school probably helped (although perhaps not as much as having an accepting family did) me avoid the temptation to get on the diet roller coaster, because although I never questioned the effectiveness of dieting, I figured there was no hope that I would ever look good anyway, so why suffer? (And it probably didn’t increase my social outcast-ness that much, because I’m a weird introverted geek, not a bad thing but I really suck at fitting in, and mostly I was happy if the other kids would leave me alone so I could read. Sure I have no self-esteem, but there is a whole rainbow of reasons for that.)

  129. Ajay – that addition was useful to me!

    Re: British TV – I really enjoyed the brit-com “Spaced” with Jessica Hynes and Simon Pegg, in part because everybody was funny, and no one was meant to be superhuman. These were people I know — the shock of recognition was really cool.

  130. (Okay, rephrase: “Spaced” featured loving lampoons of people I might know… it is, after all, comedy.)

  131. >In fact, to me this definition perfectly distills one of the great rhetorical tricks of patriarchy, which is to define women’s value in terms of appearance, and simultaneously to define appearance as something so utterly trivial that only completely shallow and useless creatures — like, say, women! — would care about it.<

    Actually, I just thought “merely” in definition #2 meant “as opposed to addressing the underlying issue.” Like claiming a car is fixed ‘cuz you hammered out the dents and gave it a new paint job yet neglected the faulty engine. Maybe it’s just me, but I saw no “patriarchal rhetorical trick.”

  132. I love that after stepping away from this thread, I return to find a Doctor Who lovefest. Ah, Shapely Prose, I’ve found my true home!

    (Also: Christopher Eccleston = hot like burning.)

    And Dr. Something, that’s hilarious!

  133. I have had acne since i started puberty in 5th grade. It has come and gone to varying degrees. In the past two years (I’m 24) gotten much worst. So i went to a dermatologist for the first time 3 weeks ago.

    My Mom came with me because she said she didn’t want me to yell at the Dr. (I have no idea why she would think i would yell at a Dr. I think she just wanted to come)

    The guy was a bit on the cold side. Inspected my face in a Sherlock Homes kind of way for a minute, and then tried to talk me into Birth Control. After explaining my body complete disdain for BC, he gave me some antibiotics and cream. So far some days the meds make me feel like I’m going to die from poisoning, and some days they have no effect on me at all. My face has cleared up a bit, but I’m not sure if it is enough to keep spending money and time on the meds.

    I also asked him about my visibly thinning hair (my mom has it also, but she is in her late 50’s, so sorry for the whinyness it’s just not fair for my hair to fall out at 24 … end pity party ) He told me it was probably anemia (Although i told him I had been repeatedly tested and always came out in the normal levels) and I asked about Thyroid or PCOS? He tells me that they will do a blood test for the anemia and thyroid, but when i push the PCOS he takes a very slow bottom up look at me and says “people with PCOS are generally ……… larger than you” so apparently having lots of other symptoms that do point to PCOS is negated by the fact that I’m not fat enough for him to consider that even an option to look into. OK, my weight is in normal range, but i managed to gain a lot of weigh in a very short amount of time.

    They haven’t called me to say that the blood tests came back with anything out of the ordinary, and I cant call from work, so looks like finding out will have to wait.

    Side note – My mother was super pissed when we left because the doctor had been so dismissive and acted completely uninterested in all of my concerns and questions. He was definitely trying to get me in and out in as short a time as possible. I wasn’t so angry because I wasn’t expecting anything different. I just kept assertively asking questions and drawing the conversation back to what I wanted to talk about until I got the information I wanted. As a paying patient you shouldn’t have to work that hard to get the Dr. to work for you, but it is becoming more and more common.

  134. Actually, I just thought “merely” in definition #2 meant “as opposed to addressing the underlying issue.”

    fuzzilla, I think “cosmetic” is often used that way (making “cosmetic changes” to something), but I don’t think that contradicts the tension I’ve described. The idea that by paying attention to the cosmetic you’re missing what’s more important underneath (i.e., the depth/shallowness metaphor) is part of the gender dynamic I’m describing.

  135. My face has cleared up a bit, but I’m not sure if it is enough to keep spending money and time on the meds.

    moonlight0806, my understanding is that it often takes 6-8 weeks for acne treatments to really kick in. On my most successful round of meds, my skin got a little better after a couple weeks and a LOT better after a couple months.

  136. OK, my weight is in normal range, but i managed to gain a lot of weigh in a very short amount of time.

    So was mine when I first started experiencing symptoms. It took years to get a PCOS diagnosis and now I weight nearly 100 pounds more than I did when I first started seeing doctors about the problems. You might want to see an endocrinologist if that’s possible. They tend to know more about this than other doctors.

  137. Thanks Sweet Machine –

    My main question, those of you who have been through this may know, how can it be healthy to take antibiotics for such extended amounts of time? Aren’t we going to create super bugs or kill our immune systems? I want a clear face that doesn’t itch and not that is not all scared up. But I want my immune system more.

    My Conversation with my mom about going to the Dr. kinda went like this:

    Me- He is just going to try to put me on Birth Control
    Mom – No, But whats so wrong with that anyway.
    Me: It makes me depressed and angry and makes my body hate itself more than normal. (yes all of it, I have tried nearly every form of Hormonal BC trying to treat various health issues) And I don’t want to spend money just to have to convince another Dr. that I actually know how the BC is going to effect me badly. And that I’m not overreacting to the side effects.
    Mom: He isn’t going to try to put you on BC, they try other stuff first.
    Me: I bet you the first thing he says will be “Want to take BC?”

    Long story short. I was right, the first thing out of the guys mouth after looking at my face was “have you ever considered BC” It took about 20 minutes of back and forth before he accepted my choice about avoiding BC because of its horrible side effects and moved on to talking about other treatment methods. We then revisited the conversation several times more before I left his office. All in all, I won the bet. It is funny how other people are so willing to tell you that you have no idea what is going on with your own body and that symptoms are just in your head.

    Tangent – I was talking to an old friend the other day that works at Planned Parenthood. She told me that one of their male doctors repeatedly used a more painful type of Pap smear method because he said that the cervix did not feel pain. Now, I know my cervix and it hurts when it is bumped and scrapped (makes me want to pump out of my own skin) I wonder why a man (without a cervix, so no personal experience) would continue to argue with females (that have cervix’s and know that they do indeed feel pain because of personal experience) I would never say that I understood what It felt like to get kicked in the Balls, why would a man assume he knew what it would feel like to be poked in the cervix?

  138. Sniper – thank you so much for posting that. It feels nice to have someone who doesn’t act like I’m crazy just because I’m not yet “fat enough” to be a problem.

  139. Moonlight0806: Like probably a good deal of the women reading this, I feel the need to say to your friend’s coworker/doctor, “BULLSHIT. How many Pap smears have you personally HAD? On your cervix?”

    Ugh. Can I blame the patriarchy?

  140. moonlight0806: On the antibiotic front, I honestly DON’T think it’s great to take them for so long. I was on a tetracycline, Minocin, for about a year and it caused problems (yeast infections anyone?) and I had to stop. Then I did the clindamycin (sp?) topical which did nothing but smell funky…

  141. Moonlight, try your gynecologist the next time you go in for a pap smear, and see if (s)he’ll do the tests for PCOS. One warning, though, the first treatment for PCOS (and the only one mentioned to me so far for the thinning hair thing…)? You guessed it, Birth Control Pills.

  142. The thing that freaks me out the most is that the new OB/GYN I’m looking at going to does Botox injections in their office. I mean. What?

    YIKES. I don’t even want to think about WHERE she wants to inject that stuff…

  143. Yes, Moonlight, a lot of people have very negative side effects when they take tetracyclines for so long. Immune issues, recurring yeast infections during and afterwards for many years, higher likelihood of developing some nasty GI bugs, etc. BUT. Not everyone has these problems, by any means, and I think some varieties of the antibiotics are better than others if you are developing certain side effects.

    I didn’t come across any oral meds for acne that left me side-effect free. Minocycline: IBD flare-up, years of recurring yeast infections to follow; BC: exacerbated those yeast infection problems and didn’t help with the cystic acne; Spiro: always lightheaded and only sort of worked a little; Accutane: ridiculous government regulations that were really difficult with my insurance situation (okay, this isn’t a side effect per se…), super dried-out, nosebleeds, chapped lips, different sleep patterns, extra sensitive skin even for me. But topicals didn’t work for me and I wanted treatment. So I went through the whole list until I found a med that a) worked and b) had side effects I could at least *tolerate*. Colitis flare or two yeast infections a month? Not so much. Chapped lips and nosebleeds? Not fun but I could deal.

    This stuff can be miserable trial-and-error. But I hope you can find a doctor that will *help out* with that, intelligently and compassionately, instead of treating you like an idiot. I vote for new doctor time!

  144. Also, if you stay on the antibiotics and they are working for your skin but you begin to have yeast issues, seriously, ask about prescription level anti-fungals if you want to stay on the antibiotics. There are some that aren’t all that strong but you still need a prescription for them.

    You can also try the probiotic route, but chances are you’ll be killing those as you’re taking them, so I’m not convinced it makes much sense to take them right when you’re doing antibiotics (right after stopping the meds, on the other hand, it might make more sense).

  145. moonlight, on the offchance you’re still reading the thread, push for that PCOS diagnosis. It seems like not enough doctors take it seriously, and it really does need to be managed, before it gets worse, and you get the really bad effects. I got diagnosed PCOS with insulin resistance a little too late, and may be developing diabetes, which could have been avoided with earlier treatment.

    And you can manage it without BC. But, some of the other meds are pretty bad things to be taking if you were to get pregnant, so you have to be vigilant with non-hormonal methods. There’s a really great, supportive message board at http://www.soulcysters.net that was really helpful to me in researching the symptoms and talking to my doctor.

    Good luck!

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  147. Thanks, Lynne. I’m managing pretty well with tea tree oil and minimal makeup.

    Related to the dermatology/gynecology/weight overlap that moonlight0806 talked about, that was a ride and a half for me. I’d been on the pill all through college, but when I was wedding planning, my skin was totally out of control. (Ya think it was stress???) So I went on tetracycline, but of course then my BC was jeopardized, so I made the switch to Depo-Provera, which I was told might result in a “mild” weight gain of 2-3, maybe 8 pounds, which seemed manageable. I managed to have semi-decent-looking skin for the wedding, then a cross-country move plus new job fresh out of college made my face explode. There wasn’t enough tetracycline in the world. To add insult to injury, the “mild” weight gain from the Depo ratcheted up to 65 lbs. So none of it helped. Eventually, I walked away from all of it, got the hubby snipped, and while I have to deal with the dreaded PMZ (pre-menstrual zit), overall, my body is happier sans antibiotics and hormones. I’m a free-range human!

  148. I’m sorry – the cervix doesn’t feel pain?! What the holy fuck? I just had my second baby and my cervix didn’t dilate evenly, which is quite common. I had a lip on it and the midwife asked if I wanted her to push it back while I pushed the baby (to finish the dilation). OUCH OUCH OUCH. My cervix is super sensitive, as I would imagine many women’s are. God that shit pisses me off. Like someone said, I will never know what it’s like to get kicked in the nads (thank god!), and no man will ever know what it feels like to have his cervix scraped. Jesus H.

  149. i sense i have offended.

    my problem with dermatologists, since it isn’t clear, is that they weren’t equal to the task before them when i went in. i had a health problem, and they saw a skin problem. without doing a bit of digging, how could anyone get to the bottom of it? if i’m going to be treated like a ford truck that can be dismantled and examined as parts, i had better operate like one. living systems do not behave like bunsen burners, right? so obviously, this piecemeal approach was doomed to fail.

    we non-medical professionals are not the only people with prejudices. most doctors are people underneath too, and they come to work with every socially-conditioned disadvantage that we do, plus a medical degree. a degree which is earned by slaving through schools with are driven by a pharmaceutical industry more and more every day. the art of looking at living systems as whole beings has disintegrated right along with the rise of industrialism.

    what this means is, it doesn’t do any more good for my dermatologist to tell me that what i eat has *nothing* to do with my health than it does for yours to tell you that what you eat is the *only* thing affecting your health. both are arrogant pronouncements made during a ten minute office visit during which no actual scientific evidence is gathered.

    if you have a strep infection, they swab your throat. if you have a skin infection that looks like acne, they tell you you’re eating too much crap. *or* (as in my case) that what you eat has nothing to do with anything, when neither statement has any merit. how would they know? did my dermatologist test me for allergies, or rule out environmental factors, or take a blood draw and send it to a lab to analyze my hormone balance? no. he looked me over for five minutes, spoke mostly to my mother, and sent me off with a pill. of course it didn’t work; he didn’t bother to exercise any scientific curiosity.

    f he had, he might have learned (like i did later) that a combination of hormonal imbalances (a couple different ones, i’m finding: thyroid and estrogen, one feeding the other) and environmental factors (preservatives and chemical additives i couldn’t tolerate in food; chemicals in dryer sheets, fire-retardant-sprayed mattresses, and carpeting) had to be addressed before my health could improve.

    something this dermatologist didn’t learn, because he didn’t check any of it out, is that i’m chemically sensitive, and i had a (genetic, yes) hormone imbalance – like practically everyone else on my mum’s side of the family. but because i got no actual help from the doctors on any of it, i continued to suffer. they are peddling pills, not acting in any scientific capacity.

    now my mum – who was forever on a diet! to improve her health! – was convinced that cool whip was more healthy than whipped cream, that *fat-free* ham (-like product) with 1,000 chemicals in it was more healthy than just eating a damn slice of bacon, and that vegetables that had been processed for 10 minutes and 25 pounds pressure for canning, then revived by microwave, were a salubrious side dish. she also surrounds herself with perfumed dryer sheets and scented soaps, and is forever updating the carpeting, paintwork, and wallpaper in the house – meaning i was continually exposed to wave after wave of environmental toxins that me and my skin would have been a lot better off without. my health suffered.

    why are some people born with chemical sensitivities and hormonal imbalances and others not? i have no idea. why is acne a passing phase for some pubescent sufferers and a livelong struggle for others? i can’t say. why are some people born with a high metabolic set-point and others a low one? who knows. but i can see by reading these comments that listening to the latest fad-phrases pour out of the mouth of someone holding a medical certificate is not comforting to anyone.

    i don’t go in to doctor’s offices because it’s fun, i go in there because i want help getting well. if the person in that office can’t help me by maintaining some scientific curiosity and actually *looking* for a fucking problem to solve, i have no use for them. all the catch-phrases and pop-science i need i can read in ladies home journal and reader’s digest for chrissake. no one should have to live with an infection for decades (or crippling allergies, or PCOS, or low thyroid function) because of a sexist discrimination on what health care is worth spending research hours on. sweet machine got it spot-on when she pegged the patriarchy to the wall there.

    no one should have to live with poor health just because their doctors are too fucking lazy to do the work we’re supposedly paying them to do.

  150. Has that gyno ever had sex with a real live female? WTF? A gentle bump makes me feel like kicking some nads, let alone a painful pap!!!

  151. Amen, Bekbek! I’m sure that it doesn’t happen to all women, and I recently found out that my cervix is low (meaning that my vagina is short?), which may contribute to my pain more so than someone with a “high” cervix. I guess? But regardless, nobody gets to make sweeping generalizations about people like that doctor did. Every time I think about it, my cervix gets angry at him. And of all places – a Planned Parenthood. I guess I just assumed that someone working in such a place would be more attuned to their patients. I live in a bubble of hope too much, I think…

  152. Hallie, I don’t think many of us would disagree with you that doctors need to look at the whole picture and that they treat far too many patients like boxes to be checked off on an insurance form (in fact, that’s one of the things this post is about). But what you said was problematic was this:

    dermatologists as a whole operate like snake-oil salesmen/quacks. all they have to offer is one product after another that doesn’t address your general health. of course, i’m a firm believer that the natural tendency of the body is towards health, and when overall health isn’t present, no tinted sulfacet lotion is going to create it. get to the base of the problem, and your body will heal itself.

    A couple of things that are ruffling feathers here:

    1) Some people, myself included, have actually had great success with dermatologists (despite the many whose treatments didn’t work). It sounds like a lot of us have been told (by family members, other doctors, whoever) that our acne is hopeless and we just have to suck it up, when in fact an appropriate-to-us treatment has cleared up what we thought was basically a lifelong curse (one that is popularly thought to be our own damn fault for being greasy pizza-eaters). Sometimes acne is caused by something that actually *is* straightforward and can be treated as such.

    2) Not every body “tends toward health” in the way you described. The Rotund mentioned her numerous food allergies. Lynne mentioned her IBD. You yourself mentioned chronic health problems. I’m not saying you can’t be healthy with a body with chronic conditions — on the contrary, that’s what HAES is partly about — but this often requires careful management and a great deal of knowledge. TR’s body is not going to “heal itself” from allergies, and the way you phrased your comment, it sounds like you’re saying she can’t (for instance) ever have clear skin unless it does.

  153. Apparently the Shaplings are my lucky charm (thanks, Dr’s never seem to call me back). The doctor himself called me on my way home yesterday about my blood work. He said that my thyroid tested in the normal range but that my iron levels were “extremely low” (his words). I had already started taking prenatal vitamins after the Dr. visit (he told me to take vitamins just in case) because I had heard that they are good for iron deficiencies. He said something about females eat a lot less red meat than they used to, so the iron does not get replenished after your rag. That is probably true for me somewhat because I hardly eat any red meat, but I try to eat more dark green veggies to make up for it. I still need to do a little research about other things that cause such “extremely low” levels of iron, he sounded like he was surprised that I had levels that were so low. Until then I will keep taking those vitamins.

    Anyone else have any opinions on this one? Opinions are welcome. I also think I need to call them back and ask what the level was exactly, maybe that would help in the research.

    My dad had told me a few weeks ago that I did not know what I was talking about with PCOS and said something along the lines of “well, why do you think you have it” my answer being that I know exactly where my ovaries are because once a month they hurt like crazy.

    I am in desperate need of a good Gynecologist, I recently switched from a horrible one that did not listen about the BC issues to one that didn’t bother showing up at my appointment and then would not call me back. She had her nurse inform me that I was close to Breeding age and they would put an IUD in after I had my baby. I shit you not, this is after I had explicitly explained that I was not having children EVER. I really would like you to have heard the nurse. She stated that I would be having a baby soon enough so just wait it out. So anyone in Tulsa OK, know of a good Gyno?

  154. OK, so Breeding Age are my words, so no she didn’t actually say that. What she did actually say (in her words) “Since you are at that age and will be having a baby soon” (she actually said it like a statement, that they were damn sure I would pregnant in the next few months). So either they know something I don’t, or they were not listening to me at all when I explained my absolute certainty that I did not want children. I suppose it is possible that they are psychic and can see into the future, or perhaps they regularly impregnate their clients during examinations…….. with the way they behaved it could be either.

    They were an hour late for my appointment, and I was the required 15 minutes early, so I sat for 1 hour and 15 minutes before they informed me that my scheduled Dr. had double scheduled and would not be showing up. Then I sat for another 30 minutes in a hospital gown in the room waiting for the fill in doctor to show up. She made my cervix bleed and then acted like it was no big deal when I asked her why there was blood everywhere. The regular doctor never called me back, the nurse didn’t know the difference between IUD products ( i had to explain to her which ones had hormones and which ones didn’t). And the nurse told me that my doctor had a very hard time getting IUD’s to not reject. So i figure in the long run they did me a favor by showing their colors early. I don’t want an incompetent inconsiderate Dr. working on me.

  155. (@ sweetmachine) oh. okay, well then i’d be pissed, too.

    for whatever it’s worth, i don’t see allopathic medical practitioners taking those things seriously, either: allergies, PCOS, IBD. they often observe the diseases, break them down into individual symptoms, and treat each symptom with a different pill – all of which have side effects and many of which don’t do a great job of addressing the symptom they’re prescribed to treat.

    i don’t think my doctor, even if he was a magician, would be able to heal my thyroid gland and get it to work properly -any more than i’d think a diabetic could get a replacement endocrine system like you were installing a new fuel injection system in a car. chronic conditions require a different touch than passing infections. my body *is* working towards health – it’s just not getting there because of a low-powered thyroid gland. before we got down to that level, though, it was a nightmare of symptom-chasing and me not getting any better. it was frustrating, and i’m still pretty pissed off about it. why didn’t they try harder to look at the whole picture rather than farming me out to a specialist? if i’d gotten some treatment that actually worked, like you did, maybe i’d have been less bitter.

    it was once the professional habit to look at the system as a whole and treat the base imbalance in order to *support the body* in healing *the symptoms of the imbalance* for itself – in my case, the thyroid imbalance has proven to be the base of all the smaller symptoms i complained of, fruitlessly, to people like that worthless dermatologist, for years. so once my thyroid gland is supported, it can go back to running the engines that heal my skin normally (for one example) on its own. i don’t mean that my body can heal the base imbalance – it’s proven that i can’t. but that is what needs to be treated, and not the superficial infection. (is it dangerous to use the word superficial there?)

    low thyroid function has a long, long history of being written off as ‘hysteria’, ‘hypochondria’, etc. etc., much like fibromyalgia and chronic fatigue are today. ‘if we don’t know what your disease is, you don’t have one.’ and like acne is written off as just something adolescents have to suffer. there’s no reason, other than medical prejudice, why these things shouldn’t be researched and treated from the root, and until the sufferer feels well. it pisses me off, and hat makes me a bad writer, i see.

    this is way off topic, but i really admire the way kate can write coherently, scathingly, and comprehensively when totally pissed off. it is a real talent; i’m more of a sputterer.

  156. First: Am I seriously the only one who noticed that the dermatologist quoted in that article is just one easy typo away from being Dr. Wrinkle? Too funny…

    Second: between my dad’s odd health problems and my own, I have come to view doctors not as the caretakers of my health, but as (paid) consultants in my own healthcare, of which I am the primary caregiver. Usually, when I have a health problem, I do a lot of research via WebMD and other sites, such that by the time I go to the doc, I have a pretty damn good idea of what’s wrong with me. My last two major diagnoses (SAD and IBS) were ones that I called well in advance; for the latter, it was jut a matter of eliminating all of the other usual culprits it could be.

  157. Moonlight, I am 48 and never wanted (and indeed, don’t have) children. Let me tell you that you will have a hard time getting almost anyone to pay attention to you when you say you don’t want children, especially if you’re “breeding” age!

    I made the mistake of trying to get my tubes tied at the age of 22. No one would touch me unless I was married and had the *permission* of my husband. I didn’t even GET married until I hit 41.

    Unbelievably, I STILL have people tell me that I’ll probably change my mind about having kids, even if it’s just to regret that I never did. Ha!

  158. Wow. Thanks for linking me to this post! This is EXACTLY what I’ve been trying to express since high school. I’m sick of my doctors refusing to biopsy any more moles/suspicious skin problems and continuing to insist, and I quote, “that’s probably fine.” They do it because they are afraid of causing more keloid scars on my body for what might be no reason at all, if the biopsies come back fine.
    The thing is, as someone with a history of melanoma, I would much rather have scars for no reason than suddenly find out that cancer has spread throughout my body and I didn’t catch it in time out of fear of Teh Ugliez.

  159. Sweaty Armpits, if you have not yet had success in your dealings with doctors, have you talked to them about the possible use of botox in dealing with hyperhidrosis? It is my understanding (second-hand) from talking with doctors who treat hyperhidrosis that botox can be very helpful. (Apologies if you read this and growl, “Of COURSE I looked into this! YEARS ago!”)

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