When Your Skin Condition Becomes Viral Content

By Sarah Harris | November 28, 2017 | 8:35pm

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When Your Skin Condition Becomes Viral Content

A man waits in a dermatologist’s office, about to be rid of a beastly growth that’s been tormenting him for years. He sits, gowned, until the doctor—gloved, wielding an extractor and making incongruous small talk about take-out and the weather—starts in on his skin. She exerts increasing pressure on the stubborn pustule, pushing and pushing until—POP! Pus spurts forth like a geyser, dense orbs of dead skin are scooped and snipped from their confines, ribbons of pus and blood stream over otherwise even terrain. And then it’s all over: the wound is cleansed, the ooze is stemmed, and the grateful patient is pimple-free.

The pimple pop video is the perfect overshare: it allows us to indulge our armchair voyeurism, get just grossed out enough, and experience a satisfyingly pus-filled narrative climax.

Thanks to the power of the internet, minor dermatological procedures no longer simply unfold in the privacy of the exam room. Dermatologist Dr. Sandra Lee, perhaps better known as Dr. Pimple Popper and the founder of SLMD Skincare, has turned pimple popping into her digital stock and trade, broadcasting hundreds of videos in all their oozy glory on YouTube and Instagram. Lee’s videos are ostensibly educational, but her millions of followers don’t turn out in droves for how-tos on washing your face or applying sunscreen. They come for the pops. Lee has mastered pimple popping’s particular viral alchemy, and the internet shudders with collective disgust and delight when she goes to work on an extra-bulbous pimple—or cyst, or lipoma—and sets it free.

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When Lee first launched her Instagram account several years ago, she realized that her extraction videos got far more likes than the rest of her content. “Since then, it was like, I kept throwing logs in the fire, just to see what would happen,” Lee told Bustle earlier this year. It turns out there was an internet subculture just waiting for her: self-proclaimed popaholics who use pimple popping videos as a backdrop to study or fall asleep, and who take to Reddit to share their juiciest pops. Lee figured she was onto something. So she started her YouTube channel, and the Dr. Pimple Popper brand—and internet pimple popping phenomenon—was born.

But does turning patients’ bodies into content count as normalization?

Lee is different than other celebrity doctors—what she offers is noticeably more intimate, and noticeably grosser, too. The pimple pop video is the perfect overshare: it allows us to indulge our armchair voyeurism, get just grossed out enough, and experience a satisfyingly pus-filled narrative climax. Plus it’s easy to like Lee. She is perfectly coiffed and bronzed, noticeably wrinkle-free, and calm and steady in the face of volcanic zits. She makes easy small talk with her patients, checking in throughout the procedure and personifying their pustules with names like “the black hole” and “Momma Squishy.” She routinely breaks the fourth wall, talking to her patients about the fans who will see their videos (and once, even saying hi to her assistant’s mother). It all amounts to engrossing video—there’s something about a gaping pimple brought to resolution that makes it hard to look away.

But for me, something doesn’t feel quite right.

I have severe eczema. As a child, my mother schlepped me to doctors all over the country, trying the treatments they proffered (plus acupuncture, plus Chinese medicine, plus homeopathy) to no avail. Over the years, doctors have deemed my hands, feet, legs, back and breasts all dermatologically interesting enough to photograph. The pictures might end up in a paper or a text book, they said, or maybe displayed at a conference. My mom, a scientist, signed the consent forms. Later, I did too. I have no idea where any of those photographs went.

When I watch Lee’s videos (which on some level, I confess, I find weirdly captivating), I can’t help but feel a little skeezed out. And it’s not the pus or incisions that make me feel gross. It’s that Lee’s brand is built around her patients’ ick factor, and her audience’s desire to see something grotesque. Her collateral—those hundreds of procedures caught on video—relies on patients’ messed-up skin, and Lee’s capacity to restore it to something more palatable.

I got in touch with Dr. Lee via email, who took umbrage at that characterization of her work. “I don’t think any of my patients are grotesque and I never treat them like I think they are gross or disgusting,” Lee wrote. “I never want them to feel embarrassed by the conditions that they have. In fact, I’m normalizing human skin issues, and creating dialogue around it.”

But does turning patients’ bodies into content count as normalization? And is it possible to normalize a person with a skin condition when you focus solely on a procedure intended to remedy whatever they (or their doctor, or our beauty-obsessed society) deem is amiss?

Some patients come to Lee’s practice expressly to have her address their pimples, cysts, and lipomas; others are there for unrelated skin issues. In either case, if you have a condition they deem social-media worthy, they will offer heavily discounted or free care if you sign a consent form allowing them to record and post a video of, the procedure—or, as Lee puts it, “often, the trade can be complementary care in exchange for sharing that popping goodness with the world!” By her account, it’s a win-win for patients, since time-consuming extraction procedures are elective, and not usually covered by insurance. But by NYU Langone bioethics professor Dr. Art Caplan’s standards, this arrangement “smacks of coercion and pressure. Put your weird boil on YouTube and you get free care—that’s not a deal that doctors professionally should strike,” Caplan says, “but it’s an offer that many patients can’t refuse.”

if you have a condition they deem social-media worthy, they will offer heavily discounted or free care if you sign a consent form allowing them to record and post a video of the procedure

The American Academy of Dermatology (of which Lee is a member) does not have an official position on social media ethics for dermatologists. But it stipulates in its general code of ethics that dermatologists should “not impose coercive conditions of treatment, including but not limited to requiring patients to…waive other basic rights, such as privacy or free speech, as a condition of treatment.”

Lee keeps her patients’ identities anonymous, and says she takes care to safeguard their privacy. But is patient privacy compromised when millions of people watch videos of their procedures online? Caplan say yes, even if they’ve consented to the agreement and remain anonymous.

Dr. Lee maintains that her channel is educational, and that her devoted viewers “now know the difference between a blackhead and a whitehead, a cyst and a lipoma, and when to seek the advice of a dermatologist if they have a suspicious mole.”

But Lee says she’s also realized that in order “to captivate and engage an audience on social media you have to entertain while you educate.” This, of course, is a fundamental tenet of good marketing. But using human bodies and their frailties as the source of that entertainment makes it easy for viewers to gawk, and you run the risk of turning the public practice of medicine into a 21st century freak show. “There’s a fine line,” ethicist Art Caplan notes, “between saying ‘I want to educate people about what doctors do’ and ‘holy crap, look at this!’”

Dr. Hassan Galadari, a cosmetic dermatologist in Dubai and author of a recent opinion piece on social media ethics for the International Journal of Dermatology, is more blunt.

“If you’re making these videos for shock value—making your viewers see all the ooze coming out—you’re not educating,” Galadari says flatly. “You’re not showcasing what dermatologists do. You’re self-promoting. And you’re sabotaging the specialty.”

“If you’re making these videos for shock value—making your viewers see all the ooze coming out—you’re not educating.”

Truly educational content, Galadari notes, would show patients with a wider variety of skin diseases, and Lee performing a broader array of procedures.

Galadari is no stranger to effective social media use. He has over 15,000 Instagram followers, and he usually shares photographs from conferences or his clinic, and adorable selfies with his curly-haired daughter and fluffy grey cat. But Galadari, too, is beginning to experiment with patient video. He recently polled his followers on whether or not they’d like to see an actual procedure. Several days later, a three-part series appeared on his account: in it, Galadari neatly slides a needle underneath a woman’s forehead, explaining to an audience how best to inject fillers and raise the patient’s eyebrows.

Australian writer and disability advocate Carly Findlay cautions that using patients’ bodies as public entertainment or educational material—or both—often results in a violation of dignity and privacy. Findlay has Netherton’s Syndrome and ichthyosis from erythroderma, which makes her skin red and scaly, and she knows what it’s like to have strangers on the internet gawk at her body. In 2013, a Reddit user came across a photograph of Findlay in a Google search and posted it on a ‘WTF’ forum. The callous comments immediately started rolling in. “She looks like a glazed donut,” wrote one commenter. “What does your vagina look like?” inquired another. Findlay took on the trolls directly, offering an explanation of her particular skin condition and linking readers to her blog.

Over the years, Findlay’s encountered lots of media featuring people with skin diseases or disabilities—everything from anxious parents oversharing graphic photos of their children on support groups, to the popular British television show Embarrassing Bodies, to tabloid and TV stories that Finley calls “inspiration porn—using disability for someone else’s benefit.” Those stories, she explains, often lack nuance and complexity, and distill a person down to their disease. When they’re shared, Findlay says, it’s usually “to make someone else feel good or comfortable. It’s never about the subject.”

Findlay sees that same quality in Dr. Pimple Popper’s videos: “it’s awareness raising for the benefit of others.” And it raises the question of precisely who the videos are made for. Are they for Lee’s patients, who want to document and share their procedures? In most cases, probably not. Are they for her viewers who are compulsive skin pickers, or those who experience an autonomous sensory meridian response while watching the videos? Perhaps. Are they out there for the general public to consume and comment on? Absolutely.

Dr. Lee declined to disclose how much revenue her social media channels generate per year, saying that “that’s really not what this is all about,” and noting that “many of our videos don’t monetize on YouTube and you can’t generate revenue on Instagram.”

According to a wry 2016 New York Magazine profile, “the majority of [Lee’s] income still comes from conventional procedures, but her YouTube channel could easily bring in hundreds of thousands of dollars this year.” And Lee isn’t shy about using her social media channels to shill her branded skincare line, special extractors, and Dr. Pimple Popper mugs, socks, totes, and other swag.

Dr. Hassan Galadari says offering a branded skin care line is common practice among dermatologists. And it’s ethical, because “you’re still sticking to your core principle of what you do.”

But with Lee’s YouTube videos, it gets trickier. The American Academy of Dermatology’s code of ethics states that “dermatologists should limit the source of their professional income to services actually rendered by them.”

While Lee is performing the procedures in the videos herself, she’s not making money on those particular services, since she’s given patients free or discounted care. Lee’s massive audience presents tremendous value to advertisers, who are likely the major source of any income she derives from pimple pops. Galadari sums up Lee’s business model this way: “She is taking money from outside sources and monetizing people watching these videos, and she’s using the specialty to do that. I don’t like this sort of practice.”

the pimple is the perfect symbol, the avatar for all we think is wrong with us, and all that we seek to fix.

The skin is our only external organ. And it is largely responsibility for signaling to society who we are—race, age, and beauty are all written onto the skin. Because we place high dollar value on those signifiers, ethicist Art Caplan says, “you can gin up demand in dermatology in a way that’s not so easy to do in other specialties. It lapses over into the cosmetic industry.” Botox, fillers, and other cosmetic procedures offered by dermatologists dangle the tantalizing possibility of looking younger, brighter, and blemish-free.

Few of us are immune to the industrial beauty complex and the body dysmorphia sown in its wake. Lee and her public pimple popping empire are part of that, and in many ways, the pimple is the perfect symbol, the avatar for all we think is wrong with us, and all that we seek to fix.

Remember back to late girlhood, to early adolescence, to a time when pimple pops weren’t broadcast on the internet, and instead resolved in front of the bathroom mirror? We frown, dissatisfied with what we see, and lean in closer. Our fingers close in on the throbbing blemish that stands as a reminder of just how corporeal we are. We squeeze hard. Pop! Pus arcs onto the mirror. It’s a tiny victory in our quest to tame the body, and for a moment we’re graced with grim satisfaction, and fleeting relief.