OK. I admit that I am a little envious of the fame, or should I say notoriety, of Dr. Sandra Siew Pin Lee Rebish, a board-certified dermatologist better known as Dr. Pimple Popper. It seems people just can’t get enough of her cable show by the same name. Fortunately, I am at a point in my career where retirement looms and I am not looking to build my practice or increase my volume of surgery, so I can comment without being accused of sour grapes (OK. So it is a little sour grapes, but not much).
I understand the fascination. I really do. If there is anything in medicine close to the satisfaction of draining pus from a nice juicy abscess or removing a large, disgusting cyst or mole, or a large lipoma (a benign fatty tumor), it is watching someone else do it. Dr. PP cashes in on this voyeuristic fascination and is undeniably the most recognizable dermatologist in the country. Plastic surgery has its own in-house celebrities, such as Michael Salzhaur, aka Dr. Miami, who will be the subject of a future post.
I can’t watch her show. My reasons extend beyond professional envy and the fact that I do all of these operations, albeit without the wide audience, fame, and fortune. No, it is the hyperbolic exaggeration of the complexity of most of what she does. Before I was ever a plastic surgeon, even as an intern in the US Navy, I removed cysts, drained abscesses, excised moles and skin cancers, removed lipomas, and even “popped” a few pimples. Some of these were even, dare I say, quite impressive. It isn’t rocket science, but she somehow manages to make it out to be.
When doctors become performance artists, much of the professionalism and seriousness of medicine is sacrificed for clicks and likes. The more the better, as any social media expert will tell you. This can result in dangerous extremes, such as Dr. Windell Davis-Boutte, the dermatologist whose online videos showed her dancing in the OR around patients who were under anesthesia. Her behavior was so egregious and her trail of injured patients, some permanently, so extensive that the State of Georgia stepped in and emergently suspended her license. On the other end are doctors like Dr. PP who make relatively simple things look incredibly complex. You would think that dermatologists are in the business of saving lives on a daily basis. They aren't. For that matter, neither are plastic surgeons. Our specialy is more life-changing than life-saving, with a few exceptions.
As I said, beyond a snippet now and then, I don’t watch her show, but I ran across season 7, episode 8, titled, “Once, Twice, Three Times a Keloid” (Cute. I can just hear the clicks.), which profiles a young black male with a very large, recurrent keloid of the back of his head. I have seen a number of these. Because of the very tightly curled skin in most black persons, ingrown hairs following haircuts and shaving are not uncommon and keloids often result. No one knows why keloid scars occur or why they are more common in persons with darker skin. While not life-threatening, they are very annoying to patients and can be uncomfortable.
Dr. PP finds this Keloid beyond her capabilities and refers the young man to another dermatologist, Dr. Sanusi Umar or Dr. "U". The consult of Dr. PP and Dr. Sanusi Umar with the patient and his wife is filled with the gravity usually associated with a life-threatening cancer. Umar proposes a plan to excise the keloid, inject it with the patient’s own stem cells for liposuction, injection of porcine (pig) dermal matrix into the surgical site, and post-excision radiation to the keloid site. This is gross overkill. Stem cell use for this has no data to support it, but many surgeons promote it because it sounds very state-of-the-art and drives patients to their practice. The dermal matrix use is unproven and probably unnecessary. He could have just excised the keloid and radiated the area three times in the next week with a success rate of over 90% in preventing recurrence. Of course, this does not make for compelling television.
I was appalled at the surgery, which I felt was incompetently done. Dr. "U" initially tried to salvage “skin” over the keloid to use to close the wound. This is absurd. There is no skin on a keloid; it is all scar. Not surprisingly, he eventually gave up on this, which was a good thing as this would have left the young man with a large hairless patch on the back of his head, not to mention residual keloid scar. Any competent plastic surgeon could have excised this keloid completely, mobilized the scalp as much as necessary, closed the wound with a fine suture line, and then sent the patient for three sessions of external beam radiation to the site. The surgery was done under local anesthesia with minimal sedation and the patient was clearly uncomfortable- keloids are difficult to numb with local anesthesia alone- and had a full bladder emergency. I would not have put this patient through such a trial and would have done this under general anesthesia in an outpatient ASC or hospital setting. Those are not options for dermatologists, very few of whom have surgical privileges in a hospital. I felt the entire procedure was an excellent tutorial on how not to treat a recurrent keloid.
Dermatologists are highly trained specialists in diseases of the largest organ of the body- the skin. They are trained to do limited skin surgery under local anesthesia, and very limited reconstruction. What they do is important and does not need embellishment, at least not of the theatrical type of shows like Dr. Pimple Popper, which misrepresent the specialty for ratings. Many, like Dr. PP and Dr. Umar apparently find routine dermatology too confining and/or boring and try to expand their surgical services into areas in which they are not well trained. This does a disservice to their patients.
Yes, you could say I am not a fan.
Richard T. Bosshardt, MD, FACS
