I grew up feeling more concerned about looking normal than looking pretty. The first makeup product I owned was this pot of cream concealer that my mom carefully applied to my cheek, covering the splotch of red with the skin I was supposed to have. Before my first day of 5th grade, I was handed a bottle of foundation to hide this shame from the other kids at my new school. The week before prom, I spent hours at the mall finding a concealer strong enough to cover it for photos. While the woman at the makeup counter prepped her brush to swipe a sample to my face, she cautiously asked, “Will this hurt?”
My port wine stain doesn’t hurt at all, but the bruise-like appearance often gets associated with pain. I can’t seem to pass by a skincare store without an eager employee offering to make my “problem” go away. One worker had a millisecond of hesitation in her face, her forehead creased and brows furrowed when I told her it was just a birthmark. “Oh,” she replied. “It’s very beautiful.” I laughed it off, attempting to dismiss the fact that she thought my “beautiful” birthmark was skin irritation.
I sometimes ask my friends what they thought my birthmark was when they first met me.
“I thought you were a burn victim or something.”
“Yeah, I was wondering what that was.”
“Honestly, when you first sat with us, I expected you to be weird. Like mentally.”
That was the first time I realized that looking broken on the outside could somehow mean I was broken on the inside. I thought back to all of the idealistic, well-meaning words of encouragement I heard as a kid: “It’s what’s on the inside that counts!” Can I not claim my body as a part of me? In this vision-dominated world, our appearance plays an unavoidable role in how we interact with others. We’re quick to make assumptions about one’s internal identity based on what we see on the outside. We’re drawn to faces specifically, peering deeply to catch a glimpse of the soul underneath. I’m scared that my face flashes like a warning sign that something in my soul isn’t quite right.
For a while, I thought this stigma was all in my head. Most people tell me they barely notice my birthmark. A study by Madera and Hebl seemed to prove otherwise.[1] When interviewing an applicant with a facial stigma – makeup mimicking a port wine stain – managers gave them lower rankings and remembered fewer details from the interview when compared to controls without a facial stigma. Another study by Ryan et al. provides evidence of an innate disease avoidance system – an instinctive repulsion towards any sign of physical ailment, regardless of whether the individual truly has a disease.[2] The researchers asked participants to imitate the use of different props by a confederate who was either a healthy control, had a port wine stain, or exhibited symptoms of influenza. As the level of contact with the prop increased (e.g., with the face, mouth), participants displayed more signs of disgust and contact avoidance with the prop used by confederates with a birthmark or influenza than the controls. Even when the participants reported knowing that the birthmark was non-contagious, their actions reflected an implicit bias against the facial stigma to a similar degree as a contagious disease.
Honestly, I forget most of the time that my birthmark is even there. I have never had a problem making friends and finding people who accept me as I am. It feels silly to be complaining. And yet, quietly in the depths of my being lies a constant need to prove myself. I greet each first impression with the biggest smile and a friendliness that says I am worthy of companionship. I strive for academic excellence to show the girl from my middle school that there is nothing wrong with me “mentally.” I make up for the assumptions I fear lurk in the back of people’s minds without them knowing. People are quick to reassure me that they barely even noticed it. They push it to the side or medicate me with compliments and affection. Doesn’t that imply that they think I’m broken anyways?
It’s hard to love something that medicine labels as a malformation. This is indeed a mistake. A glitch in my genetic code. I have seen images of hypertrophied port wine stains when left untreated, and I’m incredibly grateful for my dermatologist and the laser surgeries I underwent as a kid. Now that my birthmark is purely cosmetic, I’ve decided not to undergo any more treatments. I’ve also decided never to cover up my birthmark. There are many people with port wine stains who conceal them with makeup every day or seek to remove them as completely as possible, a choice that I absolutely understand and respect. I don’t know how to fix a stigma that seems rooted in generations of survival instinct. I have no answers to the bullying, the off-putting comments, the misconceptions, and the hesitancy of meeting someone new. But when I look at my reflection, my birthmark is there where it’s supposed to be. Perhaps the face staring back at me wasn’t meant to be mine, but it’s the only one I have ever known. So I adopt this abnormality as what’s normal to me.
[1] Madera, Juan M. and Hebl, Michelle R. 2012. “Discrimination against facially stigmatized applicants in interviews: an eye-tracking and face-to-face investigation.” The Journal of Applied Psychology 97 (2): 317–330. https://doi.org/10.1037/a0025799
[2] Ryan, Stephen, Oaten, Megan, Stevenson, Richard J., and Case, Trevor I. 2012. “Facial disfigurement is treated like an infectious disease.” Evolution and Human Behavior 33 (6): 639-646.
Esther Zhang is an MS1 at the Perelman School of Medicine.
Image by Grace Wu, an MS2 at the Perelman School of Medicine.
