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yes, medical gaze is such a good term!! it helps explain a recent trip to the derm i’ve been grappling with. i went to get a mole checked and walked out with two prescriptions for my acne (one of them a retinoid) and advice to go buy it cosmetics CC cream since ~new science~ says tinted spf is better for sun protection. i explained my acne is hormonal and doesn’t bother me, and that i’ve been trying to wear less makeup. but she wasn’t phased and insisted these steps were necessary for the health of my skin !! wouldn’t balancing my hormones and wearing a hat be just as good? the whole experience was unsettling

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This doesn't surprise me but it does depress me!!

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Nov 15, 2022Liked by Jessica DeFino

Yup! My dermatologist who I see for skin cancer prevention sent me an email on "National Botox Day" with a special offer. There's no need for that crossover. I get that this is how those offices make money, but ew.

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Nov 16, 2022Liked by Jessica DeFino

‘There is no need for that crossover’ yes!!!!!! I am so sick and tired of Botox being lumped in with skincare and preventive skin care and even healthcare.

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100%!!

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Yes! It’s at my GP clinic, not even a skin specialist and they’re pushing this for ‘health’

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Such bullshit

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💯 spot on. Science is the new sexy. Even in his day, Einstein, was glamour-ized 🪄 and caused a sensation for his breakthroughs.

The grosser, larger problem you present is well taken.

Pushing an agendized beauty standard under the guise of medically approved "health" is repugnant.

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Agreed!

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Nov 16, 2022Liked by Jessica DeFino

I've been following your newsletter for a couple months now and have taken your advice- min cleanser, max hydration w/ jojoba, nothing else- and I got the exact glow all these ads rave about. It might have just been a good night's sleep (which you also unpacked well) but it felt amazing to know that it was my own body and not some scientific formula I'd have to replicate exactly every day. I'll take some redness over studying all of the ordinary's concoctions tbqh

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I love this so much!!

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Nov 15, 2022Liked by Jessica DeFino

Doesn't your average doctor make enough money just by providing actual medical procedures and advice, without having to also sell these cosmetic add-ons? Especially maddening considering the average income of the women who end up falling prey to their manipulations is often just a fraction of what a doctor makes, yet the docs act like they're doing us a favor by pushing all these extras.

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That's part of beauty culture conditioning: They truly *do* believe that they're doing us a favor. I really think that most doctors, influencers, editors, and brands that push tools that help us better adhere to beauty standards (skincare, makeup, surgery, etc) believe they are helping their customers/readers/patients.

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Nov 16, 2022Liked by Jessica DeFino

Going to the dermatologist can be so disheartening. I am very fair skinned and had a basal cell carcinoma removed from my forehead when I was only 25 and developed a dog eared scar. I decided to try a new dermatologist (see ya later, weird male derm!) and got a Kenalog injection to help flatten it. She recommended I come back several weeks later to see if that was enough and to see if another spot should be removed from my face. She said she was monitoring the spot on my face and injected a little more Kenalog, but I felt like it was just another way to get me into the office and bill for another appointment. It felt icky.

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Ugh, that's awful. It makes sense though — dermatologists are violating doctor-patient trust by pushing non-health-related aesthetic products/procedures/drugs, when then makes it harder to trust them when the issue at hand *is* health-related.

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Nov 15, 2022Liked by Jessica DeFino

Ugh, I often justify ways and means to improve my appearance by using logic along the lines of “I’m so lucky to be educated and smart enough to know how to do research on what will be most effective for [weight loss / skincare / etc].” 🥴🥴🥴

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Ah, beauty culture conditioning. It happens!!

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Jan 3, 2023Liked by Jessica DeFino

I stopped seeing a good ENT many years ago when he started pushing cosmetic Botox! Otoh, I can say I got Botox for TMJ in August -- my idea -- and to my surprise and delight it's eliminated my brutal Mohawk headaches: the muscles across the top of my head and down the back.

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Nov 16, 2022Liked by Jessica DeFino

Ohhh Jessica, this!! As I’ve started critiquing my relationship with beauty culture more, I realized how much I prized certain forms of skincare and dermatological interventions because they seemed like the “smart, informed” choice. What I desired, ultimately, were the aesthetic rewards of skincare as I knew it– the poreless, “glass” skin, even tone – without any real regard to the true health of my skin, nor my body overall. I’ve learned so so much through your work and am excited to read this lengthier publication when she’s ready. :)

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Yup yup yup!! I can't wait to share it :)

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I was referred to a specialist to have spot on my lower eyelid removed. Before he even discussed the spot he told me he could take care of my puffy under eyes~for $5000.

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Whyyyyyyyy

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Jess, the medical gaze has always been the male gaze. Little has changed even with increasing numbers of female medical workers. Great post, as always.

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Well yes, for sure men rule the medical field and always have!! I was more touching on the OG term “male gaze” as a media/Hollywood/advertising concept. Thank you for reading!! ❤️🙏🏻

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Actually, Botox does have some important health applications. Seems to me using this fact to try to justify purely cosmetic uses is more obviously bad without the quote marks around “health.” Of course, the poor docs are just trying to earn a living - I wonder if they realize they are undermining their own authority when they promote not-medically-necessary treatment?

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Read the article! Some of the “health” effects cited are sketchy claims about Botox Cosmetic lifting depression, etc, which is why I phrased the way I did.

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besides being used for migraine headaches, and hyperhidrosis (excessive sweating), what are the important health implications?

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I think it's been used to relax jaw-clenching too. There are a few other examples. I linked to the full ELLE article in the text, which you may find helpful here!

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I was referred to an oral surgeon, who, after an examination and X-rays, said I do have TMJ. He said the best treatment his patients have found is Botox in the masseter muscle, but insurance does not cover it because Botox is only considered a cosmetic treatment (according to doc. I don’t know if it could be covered for excessive sweating. I haven’t fact-checked). So it’s like, oh so insurance is trying to fight the purity here?

It’s a weird blurring

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Hmm that's very strange. Because "Botox" as a medical treatment is a totally separate offering from "Botox Cosmetic" — the brand makes sure to trademark and market both differently. I bet you could argue this with insurance if you wanted to put the time and effort in (but you really shouldn't have to... this system is fucked)

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Did not realize that there are two distinct offerings! Maybe I’ll try to argue it. It’s $$$$ enough, I have that kinda time

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It can also help with managing urinary incontinence, drooling, and some other problems associated with Parkinson's.

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Relief of chronic pain (TBI victims, e.g., and it’s not addictive), and vocal cord dysphoria are two examples I have personal knowledge of.

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Recently walked around the high-end shopping area in Palo Alto, CA, across from Stanford, where lots of the retail and offices are science- and tech-related. Some sterile-looking high-end shop had signage about science-based “cryo” techniques to age... yeah, it was a medspa peddling fillers and Botox ugh

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I was distressed enough with facial redness that I finally asked my PCP about it last summer at my physical. Had a virtual appointment with a dermatologist at the Milwaukee VA clinic who diagnosed me with rosacea. I was then given the option to see a dermatologist locally to get treatment recommendations instead of driving 2 hours each way to the MKE site. The Community Care Network person said "Oh, hey, there's a dermatologist only a mile away, Forefront Dermatology. Would you like to go there?" Uh, sure, it's close. I like close.

I was "prescribed" a rosacea combination gel that was a proprietary blend, Rx-strength, but not FDA approved, so I had to pay fully out of pocket. Why she just didn't prescribe Soolantra was beyond me. The main ingredient in their concoction is 1% ivermectin, just like Soolantra, along with brimonidine tartrate, metronidazole, azelaic acid, and niacinamide. Guess there isn't as much profit in that. I didn't go back for my 3-month recheck. It felt icky and like my insecurity had been taken advantage of, especially after I saw the online storefront for all of their other "proprietary blends." It came across as the Aspen Dental of dermatology.

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