If you’ve got it, flaunt it.

By Boluwaji Ogunyemi, M.D.
Dermatology Resident, University of British Columbia
Vancouver, British Columbia
Email: b62baoATmun.ca

Conflicts of Interest: None declared

Keywords: vitiligo, beauty, disability, pigment disorders, models, impairment

Abstract: The ever-increasing availability (and arguably, acceptability) of aesthetic medicine procedures corresponds with the medicalization of the aging process. In this post, Bolu Ogunyemi speaks about the career of a model with vitiligo who accepts, and even embraces her disease. In contrast, many individuals, in regions such as Korea and Brazil, go to great lengths to alter their appearance. This essay also delineates the related concepts of disease, impairment, and disability and how and by whom these terms are defined.

Chantelle Brown-Young, aka Winnie Harlow, is a black Torontonian model whose appearance on America’s Next Top Model has propelled her to global fame.

Her success may come as a surprise since Brown-Young is afflicted with vitiligo, an autoimmune disease in which the body attacks its own pigment-producing cells. The distribution of her lesions is largely symmetrical, involving her mid-face, perioral region, abdomen, upper thighs, knees and ankles.

Brown-Young’s mass appeal invites reflection upon the concepts of health, impairment and disability vis-à-vis perceptions of beauty. Some individuals with vitiligo are uncomfortable with the phrase “suffering” as it relates to their condition. However, in the medical arena, anyone who has a disease is, by definition, said to suffer from it. For example, hypertension is asymptomatic and exceedingly common globally, yet if one’s blood pressure if persistently elevated, it is said that one suffers from hypertension whether or not it causes recognizable impairment.

Unlike the term disease, the concept of disability is less precise. The World Health Organization considers disability an umbrella term “covering impairments, activity limitations, and participation restrictions.” An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or actions. Brown may therefore have similar impairment from her disease but less activity limitation and therefore a different disability overall than many with identical disease. Since many societies have valued symmetry throughout human history, the symmetric nature of Brown-Young’s vitiligo is a disease characteristic that decreases Brown’s disability- a relationship moderated by the subjective aesthetic preferences of modeling agencies.

Indeed, vitiligo, like many other skin conditions, can cause significant psychosocial impairment among sufferers. Brown-Young seems to have taken disability into her own hands. In September of this year, she shared with The Sydney Morning Herald her resolve from a young age: “I just decided I’m going to tell myself that I am beautiful and this is how I may be for the rest of my life.”

Psychological distress caused by pigmentation disorders including vitiligo is an important consideration, especially for certain populations. In India, where leprosy is prevalent, many people with vitiligo are shunned and seen as outcasts; treated like lepers because leprosy can present as light patches on the skin similarly to vitiligo. Furthermore, as some people of color derive a sense of identity from their skin color, a sense of belonging to their communities and their heritage may be threatened by pigmentary disorders. Indeed, many people with vitiligo would not praise it as “symmetrical fantasticness [sic]” as espoused by Tyra Banks during Brown-Young’s first appearance on America’s Next Top Model. The primary medical consequence of vitiligo is that non-pigmented skin affords less protection from ultraviolet radiation than normal skin, thus increasing risk of photo-damage and premature aging.

Many dermatologists, plastic surgeons and other medical professions in the ever-growing field of aesthetic medicine are developing and performing new procedures to help to alleviate signs of aging. In this sense, people are now said to be “suffering” from natural aging. In a world that has historically valued youth and beauty, especially in women, cosmetic interventions are becoming more mainstream and more accepted with less stigma. In many parts of East Asia, the prevalence of skin lightening products and cosmetic procedures is much higher than it was just a few decades ago. In South Korea it is common for young women to seek surgical “correction” of their eyelids to approximate the appearance of individuals of European descent. Blepharoplasty in Korea has a similar level of social acceptability as providing orthodontics to youth in North America, Europe and other parts of the world. In a recently-aired feature National Public Radio (NPR), entitled Is Beauty In The Eye(Lid) Of The Beholder?, journalist Karen Chow investigates cosmetic blepharoplasty surgery to “correct” single eyelids to make them double eyelids. The first cosmetic blepharolasty was recorded in 1896 in Japan while the first reported procedure in North America in 1926 had a Japanese man as the patient. Blephaoplasty comprised over six percent of plastic surgery performed by Asians in 2013. This number may under represent the true impact as procedures performed overseas or by non-certified surgeons are not captured by this statistic. The history of cosmetic surgery to approximate the appearance of those of European descent is not limited to Asians. The makers of skin-lightening and hair straightening products have targeted the African Diaspora for some time.

In advocating skin cancer prevention to the public, dermatologists have taken advantage of society’s lionization of youth and beauty. Many young people receive excess recreational ultraviolet exposure from indoor and outdoor tanning. In addition to stating that improve sun safe practices will decrease the risk of skin cancer, public health messages aimed at youth emphasize that recreational ultraviolet exposure accelerates the development of wrinkles, unsightly pigment spots, and other signs of aging skin.

Brown-Young is an empowering voice for those diagnosed with vitiligo, regardless of their level of disability. In a world with an ever-increasing armamentarium of aesthetic treatments and procedures, her stance is refreshing. Brown-Young’s attitude is evidenced by a recent You Tube video about her vitiligo, in which she says “God chose me to be original…I’m Me.” It seems appropriate that she refers to herself as an “underdog” in these times when the medicalization of aging and increasing emphasis on the ability to “correct” people’s appearances worldwide. She remains a testament to, and a sign of hope for, the acceptance of woman and man’s natural and inherent beauty.

Her international success not with standing, Chantelle Brown-Young finds it imperative to help others in ameliorating the way the people appreciate each other physically on the stage of our daily lives. During her first appearance on America’s Next Top Model, Brown-Young imploringly asks “How can I show you the beauty in differences?”

Boluwaji Ogunyemi is a Physician-Writer and Dermatology Resident at the University of British Columbia in Vancouver, Canada.