6) Not doing the recommended patch test on the hair color box

I know, it seems stupid and you don’t want to waste time with it. You have used that brand/color before. And it is just hair color not poison. I used to think that way too.

But here is why you should do it. Paraphenylenediamine (PPD) is a chemical substance that is widely used as a permanent hair dye. PPD hair dyes usually come as 2 bottles, one containing the PPD dye and the other containing the oxidizer, and are most commonly seen in that beautiful blue-black color. Acute allergic contact dermatitis to PPD can cause severe swelling, redness, blistering, weeping, oozing, itching and pain of the entire scalp. Eyelids can swell shut. Patients who experience this unfortunate reaction are quite uncomfortable and also quite unsightly. And if they have also used it on the eyebrows, like a recent patient, the reaction extends over the face.

There are methods to try to neutralize the reaction by completing the oxidation of the PPD, and they may be of some help. But it is not uncommon for the reaction to persist for some time, until the hair grows out. Some patients even shave their heads to remove the treated hair.

And just because you have used it before, you are not safe from this reaction. Allergic contact reactions occur on the second or subsequent time that you are exposed to the chemical. It takes one exposure to sensitize you to the chemical, and then at some later exposure, you react. So it could be the second time you use it, or the hundredth. And it could even be the first time, if you have come into contact with PPD from one of its other non-hair related uses.

So if severe redness, swelling, blistering, weeping, oozing, itching of the scalp and eyelids is not the look you are going for, do the patch test.

7) Picking—and picking, and picking, and picking…..

Some people can see a pimple on their cheek, pop it once, and leave it alone. Some will dig a hole down through the muscle—really. There is a spectrum of picking from—don’t even see it and leave it alone—pick at it once—keep picking when you know it won’t help—pick at it every day because it is dry and flaky and makeup won’t go on right—pick at it several times a day and feel guilty about it—pick at it and keep the same spot going for months to years—dig a hole to China.

In my experience, women are 99.95% of the pickers. I am one, that’s why I went into dermatology, so I could do it legally.

No comments from men, please. In my experience, 99.95% of the patients who say “I just took out my pocket knife and tried to cut it off, and then it started bleeding and got infected” are men.

Here is a secret—If you keep picking at it, it will never heal and may very well scar.

8) Not knowing when to stop with plastic surgery

Natural, subtle, expertly performed plastic surgery is great. Unnatural, obviously operated upon, poorly performed plastic surgery is not. And one of the problems with going too far with plastic surgery, is that just like some other decisions in life, it can be really hard to undo the effects.

There are many reasons that people just keep going with plastic surgery, having procedure after procedure and not stopping when most others are happy with much less. It may be an attempt to fix something else like a failing marriage, Body Dysmorphic Disorder (BDD), an attempt to fix previous unsatisfactory surgical results, unrealistic expectations, peer group norms, or just that they have forgotten what they really look like. And there are plastic surgeons who don’t discourage this, although the good ones will tell you—stop.

The problem is that patients who have had too much plastic surgery look less attractive, not more. Everything looks unnatural and alien-like. Stop before you reach this stage and start looking like poor Michael Jackson.

9) Letting a poorly trained individual do something like pour acid on your face

We are seeing more and more of this kind of problem, patients coming in with complications after a medical treatment by non-medical, poorly trained, or poorly supervised individuals. Things that change your skin, change your skin. And they can change it for the better, or for worse. These cosmetic treatments are specialized medical procedures. Medical procedures need to be done by well trained medical professionals. These treatments seem easy, and when done right, usually go well. But they can, and do, go wrong. A big part of cosmetic dermatology practice is knowing and preventing the risks, by knowing what not to do, and especially knowing who is at increased risk of complications. And you better know what to do about any complications, and do it in a timely fashion.

I have been told—it was cheaper, she is my friend, I won the raffle (hint—everyone wins), they were practicing (practicing??? on your face???) and on and on.

Be a responsible consumer and patient, do your research before you commit to having a procedure. Your face and body deserve at least as much research as a flat screen TV. Maybe even more.

10) Ordering fillers, Botox or chemical peels off the internet and doing them at home

When I first heard about this, I thought it must be a joke. But yes, people actually order compounds of unknown composition, unknown sterility, unknown reactions off the internet and take a needle and syringe, and try to figure out where, how, how much to inject and stick it in their face. Many times these are either counterfeit or a non-tested “special brand”.

And these people vehemently argue that it is their right to order the most potent toxin known to mankind, one that is being counterfeited and sold by terrorist groups, off of the internet and inject themselves, because the “greedy doctors charge too much”. Because the internet is a completely trustworthy, ethical and safe system, worldwide. We are the world.

I have just two words—Darwin Award