‘You’re not a real doctor anymore’ is a comment I’ve received more than once on my Instagram. Look, I tried. When I started medical school as an enthusiastic 17 year old, I had every intention of dedicating my life to public hospital work. If it weren’t for burning out and being treated horribly by my superiors, I’d still be in the operating theatres treating burn victims and assisting with cancer reconstructions. Since getting my Autism + ADHD (=AuDHD) diagnosis at the start of the year, I’ve realised that it never would’ve worked out. With my newly tinted neurodivergent (ND) spectacles, I see that what I went through in 2018 was not just ‘typical’ burnout but ADHD- or Autistic-burnout. This is not to say it’s the ND person’s fault that they burnt out. I’ll always emphasise that burnout is an occupational phenomenon (the ICD-11 agrees) and institutions need to look at the systemic factors that drive workers to burnout. However, the vulnerability factors, prevention, and recovery are different.
The thing is, hospitals are still very old-fashioned. They use this device called pagers, which are small black boxes which you clip onto your body, that blast blaring noises whenever someone wants to contact you. If you’re a millennial who hates phone calls or perpetually keeps their phone on silent, you can appreciate it’s a bit of a nuisance. If you’re noise-sensitive like me, every time the pager goes off, you get a startle response, your heart rate accelerating as you rummage to find the ‘off’ button to make it S.T.F.U! Oh, and did I mention we were still using fax machines? The hospital does not accommodate those with Autism or ADHD. I mean, how can we expect them to when we haven’t even achieved gender equality?
Being able to run my own business now as a cosmetic physician is less an achievement and more of a necessity because I can cater to my own needs as an AuDHDer. However I occasionally still struggle with what I’m choosing to do. Is it a waste of my medical degree? Is it anti-feminist to be injecting people? Am I contributing to ageism in society? I don’t have polished answers for any of these but what I will say is that I’ve learned the importance of separating your job from your sense of identity. I had a conversation with a friend Victor last year who said, ‘sometimes it’s okay to just call a job a job.’ A lot of doctors see Medicine as a ‘calling’ and as noble as that sounds, there is something a little noxious about that. It’s like bosses who tell you that work is ‘family’. You can love working with your colleagues, but by calling them ‘family’ there’s a pressure and expectation for loyalty.
As for cosmetic medicine being an interest, the people who judge may have some unchecked misogyny. Why are ‘female’ interests and hobbies seen as vacuous or silly? Meanwhile men are allowed to spend an entire day walking around a field, hitting tiny white balls with a metal stick. I’ve always enjoyed skin care and treatments, and it’s not exclusive to women and gay men. There are plenty of cis-het men comfortable in their masculinity who find satisfaction in achieving and maintaining healthy, glowing skin. I don’t offer the service myself, but I work alongside a clinic that offers their (mostly male) clientele hair regrowth treatments and let me tell you - they are BOOKED. AND. BUSY. Tell me again how caring about appearance is a ‘female’ trait?
So is good skin genetics? Partly. I’m ‘lucky’ to be both Asian and have a connective tissue disorder called Ehlers Danlos syndrome (EDS) which means I am less likely to develop wrinkles. It’s honestly the one benefit of having a chronic illness that causes so many aches and pains. Asians have a thicker dermis (the middle layer of the skin) which is why a lot of us don’t have wrinkles. I think of skin a bit like paper - thick cardboard is hard to fold whereas crêpe paper crinkles easily. So a lot of anti-ageing skin treatments involve thickening and tightening the dermis by stimulating the production of collagen and elastin respectively.
A lot of patients these days want to look more ‘natural’, opting for treatments that encourage your own body to produce new collagen. These include:
Radiofrequency +/- microneedling
Lasers
Threads
Injectable stimulants - which I cannot name individually due to restrictions by the Therapeutic Goods Administration, with the exception of Rejuran which is made of polynucleotides (and is not a prescription drug like the other options)
When I was in Japan over Christmas and New Year, I observed that retinoids weren’t as popular as other skin care products. Maybe it’s that Japanese people don’t wrinkle as much, but we seem to care more about the appearance of pores (keana) and hyper-pigmentation. We call age spots shimi, which means ‘stain’. Even among ‘Western’ practitioners, many would agree that hyperpigmentation can age you more than wrinkles do. Unserious question (vote below):
Personally, I’ve always hated my age spots and I’ve been pre-occupied with getting rid of them since I quit my job. Years of driving long hours to hospitals meant that I had a lot of sun damage on the right side of my face (the driver’s side if you’re in Australia). Add to that the post-inflammatory hyperpigmentation I developed from acne after some incredibly stressful events, and my skin has turned into a blotchy, pigmented mess. I’ve always had slightly blemish prone skin but I’d never had those painfully deep, cystic pimples until last year. It was a palpable reminder of the impact stress has on skin health!
I’ve tried a multitude of treatments over the years and you may be wondering whether I might have an unhealthy obsession with my face (especially being in the industry). Could I develop facial dysmorphia? Definitely. There’s this thing called perception drift that cosmetic physicians are at risk of. Because we see so many faces that have had treatments, we lose sight of what a normal, unaltered face looks like. Those who spend a lot of time on social media are also at risk of perception drift due to the unfettered use of filters. Even the subtle ‘Retouch’ filter on TikTok can smooth skin texture enough to give us an unrealistic expectation of what skin looks like. I’d argue that the subtle ones are worse because you may not even realise you’re being exposed to filtered skin. At least with the Bold Glamour Filter, it’s obvious that it’s not real. I thankfully have my gay BFF who keeps me in my place. If I ever look over-filled, he’d be the first to say ‘Darl, you’re looking a bit weird.’ I guess he’s my Asian Auntie!
Lastly, it would be remiss of me not to mention sunscreen in an article about skin. It’s the best thing you can do to protect your skin from cancer, pigmentation, and wrinkles. Please wear SPF50+ sunscreen daily, even if it’s not sunny, and even if you’re indoors. Don’t forget to re-apply every 2 hours. I’ll have to do a future article on my sunscreen recommendations, because I have many!
Love,
Your Asian Auntie xx