SKIN July 2019 Volume 3 Issue 4 Copyright 2019 The National Society for Cutaneous Medicine 284 COMPELLING COMMENTS Dermatoethics in the “Selfie” Era Jeanette R Zambito, M.S. Ed1, Skylar N Travis, MD1 1University of Rochester School of Medicine and Dentistry “Please”, her mother implored. “The other kids make fun of her.” Here with her thirteen- year-old daughter, Mrs. H was requesting that we remove numerous milia from around her daughter’s eyes. Her daughter was conspicuously quiet. Perhaps she was shy. Maybe she felt like she didn’t need to weigh in since her mother was taking care of it. Or, maybe, it just wasn’t that important to her. As we discussed the benign nature of the patient’s milia, explaining that removal was not necessary or recommended, the mother’s eyes welled up and she whispered “I just don’t want her to be bullied anymore.” Bullying is an issue that has received increasing attention in our culture, particularly with the rise of cyberbullying on social media sites such as Facebook and Snapchat. Recent research demonstrates a link between cyberbullying and self-harm and suicidal behavior.1 Nationwide, there are discussions in every sector, from education, to technology and law enforcement, on how to make kids feel more accepted. Cyberbullying goes hand in hand with the rise of social media, the “selfie”, and increased pressure on children to present a perfect version of themselves at all times. This phenomenon will undoubtedly lead to pediatric dermatology patients requesting procedures that are purely cosmetic in nature at increasingly frequent rates. This poses many difficult questions for clinicians. What is considered a legitimate reason for a cosmetic procedure? Who should the primary decision-maker be—the parent or the child? And where should we draw the line? Acne, for example, can be considered largely a cosmetic issue. Yet it is one that has a large enough impact on daily life and self-esteem that we regularly and routinely treat it. But how should we respond when faced with a child who is being bullied due to milia around the eyelids? What about the patient who insists that their lips aren’t plump enough? Kylie Jenner, younger sister of Kim Kardashian and co-star of the show Keeping Up with The Kardashians, admitted during a 2015 episode that she had received lip augmentation with Juvederm injections at the age of 17.2 (She had previously denied allegations that she had artificially enhanced her lips, claiming that it was the effect of lip liner). Her full lips became a pop culture phenomenon, spawning the #KylieJenner Challenge in which young girls attempted to recreate the star’s full-lips look with dermatologic consequences including edema, petechiae, ecchymoses, and scarring.3 As these issues spill over into the doctor’s office, we will need to ask ourselves: where do we draw the line with the proverbial lip liner? Conflict of Interest Disclosures: None. SKIN July 2019 Volume 3 Issue 4 Copyright 2019 The National Society for Cutaneous Medicine 285 Funding: None. Corresponding Author: Skylar N Travis, MD Dermatology Resident, PGY4 University of Rochester Medical Center Skylar_travis@urmc.rochester.edu References: 1. John A, Glendenning AC, Marchant A, et al. Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review. J Med Internet Res. 2018; 20(4):e129. 2. New York Times. (2015). Kylie Jenner’s Beauty Routine: How She Keeps It Real. [online] Available at: https://www.nytimes.com/2015/09/1 0/fashion/kylie-jenner-beauty- regimen.html?_r=1. [Accessed 28 Nov. 2018]. 3. Washington Post. (2015). Kylie Jenner Lip Challenge: The dangers of ‘plumping that pout’. [online] Available at: https://www.washingtonpost.com/ne ws/morning- mix/wp/2015/04/21/kylie-jenner- challenge-the-dangers-of-plumping- that- pout/?noredirect=on&utm_term=.b0a6 4a85dc58 [Accessed 28 Nov. 2018].