Beauty Culture Is A Public Health Issue
On Linda Evangelista, CoolSculpting, and depression.
The Unpublishable: What the beauty industry won’t tell you, from a reporter on a mission to reform it.
Linda Evangelista has been “brutally disfigured” and “permanently deformed” by a CoolSculpting procedure, the ‘90s-era supermodel announced last week.
For Evangelista, the fat-freezing treatment resulted in a case of Paradoxical Adipose Hyperplasia — a known complication that increases rather than decreases fat cells and leaves patients with protruding masses of hardened tissue in treatment areas, usually in the shape of the CoolSculpting applicator. She attempted to reverse the rare side effect via multiple corrective surgeries over the past five years, all of which were unsuccessful. “[It] has not only destroyed my livelihood,” the 56-year-old model said of the situation, “it has sent me into a cycle of deep depression, profound sadness, and the lowest depths of self-loathing. In the process, I have become a recluse.”
Her story is familiar to me — and not only because I’ve heard hundreds of versions of it before while reporting on the mental and emotional aftereffects of plastic surgery, injectables, Instagram Face, prescription steroids, and plain old skincare products. Her story is familiar to me because it is my story, too.
In 2015, I developed chronic dermatitis around my eyes and mouth. Desperate to get rid of it — I was working for the Kardashians at the time, and dating someone new, and perhaps-subconsciously convinced that I’d lose both if I lost my “beauty” — I filled a prescription for symptom-suppressive topical steroids, and kept filling it for two years straight. I’m not sure how much you know about topical steroids (I knew next to nothing at the time, save for the fact that my dermatologist kept refilling my prescription, so, uh, it had to be safe, right?), but you are not supposed to be on topical steroids for two years. Two weeks is standard protocol. Anything longer than that puts patients at risk for the not-so-fun side effects I eventually experienced, including skin atrophy and a more dire case of dermatitis than before. As it turns out, steroids are both a dermatitis treatment and a dermatitis trigger — the “double-edged sword” of skincare, as one scientific paper says.
I stopped using the steroids when my dermatitis stopped responding to them, but my skin went into Topical Steroid Withdrawal. It was red and raw and in a permanent state of peeling. Cleanser stung. Moisturizer burned. And makeup? No way, not happening. A man in the elevator asked if I was contagious.
The pain lasted for months, and it wasn’t only physical. It was also — it was mostly — psychological.
When my TSW was at its worst, I checked out of my life. I called out sick from work and canceled plans with friends and refused sex with my boyfriend and was generally a miserable human being, crying and filling my Amazon cart with whatever online message boards told me to buy. I lost moments, I lost memories, I lost money. Any why? Because when I didn’t feel beautiful, I didn’t feel worthy of being seen or heard. I didn’t feel worthy of participating in life.
I felt the way I did, and Evangelista feels the way she does, because that is how beauty culture has conditioned us to feel.
I’ve had a hard time figuring out what to say about Evangelista’s revelation, or where to say it, or even how to say it. I feel the truth of the situation so deeply — deeply enough that it hasn’t yet alchemized into words, into an easy-to-articulate theory, into a coherent catchphrase that fully communicates what’s going on here. All I have so far is this: Beauty culture is a public health issue.
What is beauty culture, you ask? It’s basically diet culture’s fraternal twin.
Beauty culture is a system of beliefs that defines “beauty” as the adherence to current societal beauty standards — standards that are largely shaped by patriarchy, white supremacy, colonialism, and capitalism. It upholds beauty as a form of political, economic, and social capital. It reinforces racism, sexism, colorism, ableism, classism, ageism, fatphobia, and gender norms. It falsely equates beauty with health, wellness, worth, and moral goodness; and in this way, the pursuit of beauty is seen as the noble pursuit of “self-betterment” and “self-care”. Beauty culture positions normal features as “flaws” to be “fixed”. It systematically breaks down self-esteem and installs shame, so that it can then sell “confidence” back to you in the form of products, procedures, and practices. It rewards those who adhere to the current beauty ideal and oppresses those who don’t. It normalizes self-harm and self-mutilation as a means of achieving this ideal. It frames this achievement as “empowerment.” It siphons your time, money, and energy in the process. Beauty culture prioritizes appearance over physical, mental, and emotional wellbeing. It reinforces the idea that your beauty is the basis of your worth — that what you look like is more important than who you are — even through positive-sounding phrases like “Everybody is beautiful!” and “Because you’re worth it!”
Beauty culture doesn’t only affect those personally preoccupied with performing beauty. Beauty culture affects everyone. It is all around us — it is built into our political system, our economic system, our labor system, our school system, our relationships, our media (including social media), and even ourselves.
It hurts us, mentally and physically.
It holds us back, socially and spiritually.
It literally kills some of us.
Studies show that beauty culture contributes to anxiety, depression, disordered eating, body dysmorphia, self-harm, and even suicide. (Which is to say nothing of the physical harm often caused by skincare products, cosmetic procedures, injectables, and surgery, or the impact beauty culture has on the earth: the packaging, the plastic, the factory emissions, the industrial chemical waste — all for products no one actually needs — that contribute to the pollution that accelerates the very “signs of aging” we’re taught to treat with more products and procedures.)
I’ll say it again: Beauty culture is a public health issue — from the initial mental and emotional issues it causes (say, making a thin supermodel believe she should freeze her fat in the first place); to the physical issues that arise from products, practices and procedures (say, skin atrophy from a steroid prescription); to the mental and emotional fallout of said physical issues (anxiety, depression, withdrawal from the world).
Evangelista has since announced that she is suing the makers of CoolSculpting (ZELTIQ Aesthetics, a subsidiary of Allergan, the same company responsible for Botox and Juvéderm). And she should. CoolSculpting needs to be held accountable. But it’s important that we understand the issue here is not just CoolSculpting — it’s the culture that makes freezing one’s fat cells sound like a good idea.
It’s not just the steroids that can lead to skin atrophy — it’s the culture that cares more about eliminating superficial symptoms than addressing root causes.
It’s not just the skin-lightening creams that can lead to skin damage, kidney damage, and neurological damage — it’s the culture that glorifies whiteness and frames darker skin as less-than.
It’s not just the over-the-top skincare routines that can lead to sensitization — it’s the culture that colonizes the skin, devalues its inherent functions, and seeks to replace those functions with external products.
It’s not just the staggeringly high mortality rate of Brazilian butt lifts — it’s the culture that convinces us to risk our lives in pursuit of the “perfect” body.
It’s not just the potential carcinogens and endocrine disruptors in our beauty products — it’s the culture that makes us believe we need these products in order to be happy, well, and worthy.
Beauty culture needs to be held accountable for the harm it inflicts, too.
Jessica, thank you so much for this newsletter. I don't have the words to describe how much I believe in and support your philosophy and mission.
This post in particular feels incredibly important, and just sums it all up -- the pain, frustration, and futility of it all -- in such a compelling way.
Thank you for all that you're doing!
A brilliant analysis. I've read so many snarky comments about the Evangelista case, " boohoo poor supermodel getting old" etc etc. This is such an important perspective, and also an unusually kind one. Thank you for all that you do! If I had more money I would gift a subscription to everyone I know.