My Odyssey Into Extreme Dermatology
To my utter disbelief, I, now 47, have since early January become embroiled in an age-related epidermal drama, which, though quite common to the north-of-forty population, is an affliction that not only lies below the beauty industry's radar, but was also previously unknown to me. What makes my ignorance remarkable is that 1) I consider myself a dermatological hobbyist whose favorite recreational reading material is "The International Cosmetic Ingredient Dictionary;" and 2) for the last fifteen years, I, on behalf of my face, have spearheaded a ruthless campaign against the ravages of time, fending off wrinkles, sun damage and sagging flesh.
My face looked as if a Hitchcockian crow had landed on my shoulder, pecking away at my flesh, drawing multiple droplets of blood.
Undeterred by the temporary bloody, bruising and stinging consequences, I have submitted to a surgical eyelift, quarterly Botox and wrinkle filler injections, bi-monthly chemical peels and/or laser treatments to tighten and even out my skin tone. In addition, twice-a-day, I apply no less than nine different creams, alternating and layering them to maximize their rejuvenating potential, never mind the aftermath of unevenly searing off my flesh, with swatches of desiccated skin flaking and peeling, briefly rendering me with the visage of a crypt keeper. In due course, my face emerges much refreshed and—if only to my eyes, which, let’s face it, are they only ones that count—abloom with the luster of youth.
That is, until my recent concession to ever-worsening presbyopia, the clinical term for declining eyesight due to age, which made it impossible for me to clearly see near objects, and worse, unable to properly apply makeup, failing to keep my eye and lip color within the lines. Consequently, I made the practical decision to invest in an illuminated, magnifying mirror for my bathroom.
But holy horrors! Why didn't the warranty come with a warning? The exaggerated reflection suddenly revealed that my pores were hardly as infinitesimal as my naked eye had led me to believe. I was aghast at the prominent peppering of blackheads on the end of my nose. But, they were nothing compared to the unsightly and unfamiliar-looking whitish-to-pale-yellowish bumps—some as sizeable as sesame seeds!—that were smattered across my forehead, cheeks and chin. Were these deformities a scourge of dreaded whiteheads? Yet, how could that be, given my diligence at exfoliation?
I had to call in the big guns, which meant putting in a call to Robin Hillary. A fifty-ish registered nurse and skin care expert who bears a vague resemblance to Calista Flockhart, Hillary is known as a miracle healer to a cadre of extremely discerning, high maintenance, appearance-fixated females who credit her laying on of hands with transforming the most blighted complexion to the comeliest one, an hour-long session of beautification costing $350. The only hitch: a three-month wait for an appointment. Nonetheless, being desperate, I gave it a shot and dialed her number anyway.
“Come over right this minute!” she ordered. “I’m on my lunch break. I’ll have to squeeze you in. But only to assess the problem. I can’t work on you today. I’m booked back-to-back.”
Dashing from my apartment in a state of near déshabillé, a coat messily tossed over the sweats in which I had slept the night before, a pair of ballet slippers on my bare feet, I braced the frigid winter air and ran the mercifully few blocks to the Park Avenue office of plastic surgeon Craig Foster where Hillary works.
Positioning a mega-watt medical lamp an unforgiving two inches above my mug, she peered through the magnifying lines and let out a small gasp. “Your skin happens to be beautiful from far away but close up, it’s covered with blackheads and here’s where you’re looking very dirty,” she said, swirling her finger above my right cheek.
“…But you have so many sebaceous hyperplasia, I don’t even know where to start,” she continued. “You’re a challenge. I have to clean out all the present ones. That will take 3-4 sessions, and then you’ll come back at least every three months for maintenance since you’ll keep getting new sebaceous hyperplasia. You can only treat them one-by-one. There’s no cure. Okay, I’m done. Book an appointment.”
Because of a cancellation, I lucked out and landed a time for the following week. Yet, walking home, instead of feeling relieved, I felt sideswiped by the foreign nature of the diagnosis. Why hadn’t I ever heard of “sebaceous hyperplasia?” Frankly, I felt more than a little letdown by the entire cosmetic megalith, from the beauty medical doctors to the mass purveyors of skin care products to the women’s magazines. I mean, where were the headlines decrying the rogue skin growths with tongue-twisting names, which were defiling cosmetically-altered-to-perfection faces?
Stepping outside, I flipped open my cell, speed-dialing Fredric Brandt, a cosmetic dermatologist who practices in New York and Miami. "People aren't as obsessed with these things. Most times, I have to point it out and ask, 'Should I remove that?',” he confirmed. “The general population doesn't look at your face and say, 'The hyperplasia is due to aging.' People don't know that so these things don't have negative connotations, like wrinkles. Wrinkles are also more glamorous because they're are all sorts of new and exciting treatments. That's not the case with sebaceous hyperplasia."
Back home, I googled “sebaceous hyperplasia,” but my search only it got me thinking about a living will, along with pre-paying for a plot. Though common and benign, the bumps on my face were deemed a skin “disorder”—as in something that went wrong!—and yet, resulted from the natural—as in ordinary!—process of aging. But backing up, technically-speaking, sebaceous hyperplasia is an enlargement of pores, or sebaceous glands, which produce sebum, an oily substance that keeps the skin self-lubricated. Over time, the glands get stretched out, allowing for the build-up of cellular debris mixed with sebum, thus giving rise to the yellowish, soft, bumps corrupting the skin's surface. “Instead of having youthful DNA that creates long, beautiful collagen fibers, which gives your skin is suppleness and elasticity, the genetic control of your skin just doesn’t work as well as when you were younger,” says cosmetic dermatologist David Colbert. “It’s like having Alzheimer’s of the skin. Your skin starts to forget what it’s supposed to do.”
Adding insult to injury, the erstwhile name of the condition was “senile sebaceous hyperplasia” but the prefix—“senile”—has been dropped since the elderly are less likely to be stricken than adults who are in mid-life (now do you get my sudden morbid preoccupations?) Like senility, there is no way to stop sebaceous hyperplasia from advancing, either. The only option? To decimate the malformation, destroying the offending oil gland once it morphs into something with a head. Squeezing the bugger between your forefingers will only result in self-mutilation. As for the cause of the blight—hormones are an easy mark since their constant fluctuation monkeys around with the size, cellular activity and sebum-output of the sebaceous glands. Genetic predisposition provides a nice catch-all explanation, too, especially when latent sun damage—the skin’s indisputable and ubiquitous adversary—is added to the mix.
When finally the long week passed and the day of my appointment with Hillary arrived, I entered the examining room where she greeted me, holding in one hand a hyfrecator, an apparatus with a probe emitting low electrical pulses, and in the other, a razor sharp scalpel. Prostrating myself on the examining table, I tried not to flinch as she zapped my scores of clogged pores. Next, wielding the knife to perform “I & D”, the surgical acronym for “Incision and Drainage,” she painstakingly pricked and prodded my now enfeebled ducts, extracting miniscule, semi-solid, yellowy beads of sebum.
“Omigod! Did you see what just came out?” Hillary exclaimed, balancing the spoils of her small motor skills on the instrument’s delicate point, offering me a glimpse.
“How can I see anything with this lamp in my way,” I replied, my ghoulish curiosity stymied by the blinding medical light. “Also, I need my glasses. They’re in my bag somewhere.”
“Forget it. I can’t break my rhythm. This is so satisfying. I’m so OCD. It’s like needlepoint.”
Or a chimp picking out nits from a fellow primate’s fur, I thought.
The primal scene between Hillary and me culminated with her swabbing a Q-tip saturated in trichloroacetic acid over my freshly gored and gaping oil glands, the fiery solution prompting them to tighten, the contraction preventing any new gunk from moving in. Although an hour had passed, and my face looked as if a Hitchcockian crow had landed on my shoulder, pecking away at my flesh, drawing multiple droplets of blood, my ordeal was far from over. Every three weeks for the following three months, I have eagerly returned to Hillary’s lair where she fries off and flicks out the decrepit occupants that cling against hope to the wobbly walls of my pores that—God, how I hate to admit!—have past their prime.
My aversion to getting old, I must confess, has long been, and continues to be, teetering on the pathological. Hence, since I’ve already got the illuminated magnifying mirror and I’ve just pre-ordered from Amazon a well-regarded textbook due out in May, “Cosmetic Dermatology: Principles and Practice, Second Edition,” by Leslie Baumann, a Miami dermatologist, I’m now looking ahead and starting to save in order to buy a couple of cosmetic medical devices, starter equipment that doesn’t have too many dials, though eye goggles may be required. My dream for the future is to build my own practice for a patient of one who will treat herself in and to an at-home, self-service dermatologist’s office. Board certification: optional.
Elizabeth Hayt is a writer in New York, a former New York Post sex columnist, and the author of I'm No Saint: Memoir of a Wayward Wife.