Dermorexia: the ugly truth about our obsession with skincare

Photographs by Billie Scheepers

While dermorexia is not a diagnostic condition, the experiences it describes are similar to body dysmorphic disorder (BDD). Affecting around 2% of the population, BDD is a preoccupation with perceived flaws in appearance that can lead people to engage in repetitive behaviours to try to hide or “fix” their concerns, sometimes impairing themselves in the process. “Skin is in the top five parts of the body we see reported in BDD cases among young people,” says Dr Amita Jassi, consultant clinical psychologist and vice chair of the BDD Foundation.

Anxieties around appearance manifest across a spectrum: many of us experience low self-esteem or worry about the way we look. What constitutes BDD? “Like any mental health condition, it’s when it causes interference: spending lots of money, damaging the skin, taking up lots of time, when you can’t go out without worrying or become distressed if you can’t do your routine.”

Increasing awareness of BDD among aesthetics practitioners is important, says Jassi. Botox and fillers are increasingly widely available. Some practitioners are working from dental surgeries or living rooms. “The issue is, we’re not just talking about cosmetic settings. People can get very strong products on the high street. So how might they get information and support?”

Until recently I washed my face with a bar of soap, but in the last three years I have become invested in anti-ageing and skin treatments. First, there was the introduction of a “routine”: a mix of cleansers, toners, oils, moisturisers and SPF. Then came the expensive eye creams panic-bought after a particularly ageing hangover. This behaviour – what I jokingly refer to as the “collagen panic” – is partly due to age. In your early 30s, as collagen decreases, the signs of ageing become more apparent. But it is also the same timeframe in which spending on skincare has become more normalised, as has Botox, which is popular among my female friends. I’ve now paid for three rounds of it, at the expense of my overdraft.

When I first stumbled across the term dermorexia, I wondered to what extent my own new interest in skincare was costing me more than time and money. Am I buying into a potentially damaging culture?

Anti-ageing products grew in popularity in the 1980s. Botox and fillers became widely available in the 2000s. During this era the tabloid press sensationalised celebrity transformations, but just as it has become increasingly taboo for women’s magazines to flog diets or comment on a celebrity’s weight, it is now similarly culturally unacceptable to judge the aesthetic decisions of others. Celebrities like Gwyneth Paltrow and Kim Kardashian have talked about Botox openly. “Choice feminism” tells us cosmetics and plastic surgery can be empowering if they make you feel good.

According to DeFino, diet culture has been traded for skincare in women’s media. The pathological obsessions with thinness and health that can contribute to eating disorders such as anorexia are now focused on the face, with pressures displaced towards looking “snatched” or “glowing”. “As we were consuming content about loving your body, body positivity, fat activism, all of this, we were relocating those obsessions to our skin,” says DeFino. “The underlying obsession – control of the body and conformity – was relocated above the neck.”

Around mid-2020, as the pandemic set in, sales of skincare products and serums rose, alongside both invasive plastic surgery and non-invasive “tweakments”, as we found ourselves staring at our faces on video calls. “This growth of interest in skincare began partly as self-care,” explains the beauty entrepreneur Isamaya French, “when the pandemic gave people more time to focus on their wellbeing. There was a sense of not just looking after others but looking after yourself.”

The pandemic also confronted us with our mortality, something French links to the desire for youthful skin. “We’re hardwired to find things attractive if they signal good health. Our skin is our biggest organ, it’s the interface between vitals and the world, an indicator of health.”

The self-care ethos of the pandemic has since evolved into a more clinical approach. Orally ingested supplements such as NAD+ and collagen are growing in popularity. Elsewhere, FaceGym has built a brand on a fitness “workout for the face”, while popular London aesthetic studio Injectuals aims to “democratise medical aesthetics”. DeFino describes the shift as the “merging of medical care and aesthetic standards”.

While UK law bans Botox and fillers for under-18s, nearly half of all girls aged between 10 and 17 now worry more about their appearance as they age. “There is a genuine epidemic happening with young people who have been catalysed by these skincare-led aesthetic TikTok trending videos,” French says. “These are consumed by young people who want to look like older people, like Hayley Bieber and Selena Gomez.” On her BBC podcast, Miss Me?, Lily Allen recently spoke to this phenomenon: “My children are 12 and 13,” she said, “and every Christmas I get a list of active face creams, toners and moisturisers that are inappropriate to their type of skin.”

Sophie, 48, an author from London, shares a similar experience: “For her 12th birthday, my daughter asked to have her friends round and to go to SpaceNK. I said they could go and window shop. When they came home, they played hide and seek. I thought, ‘How can you be the right age for SpaceNK and hide and seek?’”

Despite her daughter not using TikTok, beauty influencer content seeped through. “I’m a scruffbag about these things, so I found it surprising that it had reached her. I will never forget when, aged 11, she looked at my face, sighed and said: ‘I wish I could persuade you to use a retinol.’”

I can relate. My Instagram algorithm constantly shows me products that claim to remove pores or make under-eye bags disappear. On TikTok I discover an endless scroll of skincare content: a six-year-old’s night-time skin care routine, kids getting ready for school with their beauty hauls from Sephora (the hashtag #KidsatSephora has more than 5m views). There are videos of parents surprising their kids, aged under 10, with products in bright and colourful packaging, and “smoothies” – a mixture of products, sometimes including vitamin C and retinol, which Dr Dhoat advises can be harmful for children. Another popular brand among young users markets an anti-ageing line for Gen Z under the slogan: “Getting old is getting old.”

In some ways, the skincare boom is benefiting our bodies from a health perspective: the adoption of SPF in regimes can prevent sun damage and skin cancer. Cleansing the face twice a day can protect the skin from bacteria and pollutants. But amidst a barrage of information – and misinformation – online, Dhoat believes the line between doing what’s right for your skin, and causing harm, can be thin. “Knowledge is power,” says Dhoat, urging young people to read up on what they’re using and to introduce products one by one, to isolate what’s effective and what might be causing harm.

Dhoat also reminds me that when it comes to our complexion, the internal is just as important as the external. She reiterates that there is no escaping genetics, environment and lifestyle choices. “Skincare and treatments are one small factor. Sleep and being active are important for skin appearance, more than what you put on it. Sleep especially, because cell repair happens at night.” An expensive cream or cosmetic procedure doesn’t guarantee results if you’re not “looking after your insides”.

She raises the million-dollar question: do I want to live like a monk to prevent ageing and drink six litres of water a day to glow? Or do I want to fork out for products and procedures that promise to transform me overnight? The possibly troubling answer, it transpires, is the latter, something I realise when, despite all these conversations, I find myself back in a London aesthetics clinic, sitting in a dentist-like chair under bright lights.

As my aesthetics doctor Dr Vy Nguyen watches I hold a mirror to my face. I study my reflection and share my current “concerns”: permanent lines under the eyes, which bother me a little, and around the smile, which don’t; sun damage and uneven skin tone. I’m 33, smoked for years and while I eat well and exercise, I stay up late and drink most weekends. The way I look probably reflects my age and my lifestyle – but I’m told it doesn’t have to.

Today, I am having a treatment called polynucleotides – DNA and RNA from salmon sperm, inserted into the skin under my eyes.

I told my friends about the treatment. One had also had it and was happy with the results; another looked at me with pity. Others talk about their relationship with skincare: a desire for control in an otherwise overwhelming world. Some see it as a smarter investment than makeup, a long-term rather than cover-up approach. Another notes that since many of us are getting married and having kids later, maybe we want to look younger for longer. Surely, I admit, it’s also… vanity.

When I told my stepmother about having Botox she was upset with me for contributing to a culture that demonises wrinkles and sees ageing naturally as something to be avoided at all costs. I shrugged the conversation off, as though we were talking about a problem bigger than me. I told her that, as with plastic surgery, or Ozempic, I believe everyone has the right to do what they want with their body. Only, as Vy Nguyen prepares the cannula, my mind is turning over: how can we know which beauty choices we are making for us and which we are making because society tells us to? Am I buying into the idea that ordinary imperfections ought to be fixed?

The procedure stings a little and there’s a bit of blood. I leave with a swollen face and, a week later, my under-eyes are puffier than before: I’ve had a strong reaction. Two weeks later I find myself looking fresher, but I weigh the recovery time and cost against the results: how long until I begin wondering what to “fix” next?