My Odyssey Into Extreme Dermatology

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.