We Talked to Dr. Pimple Popper About the Joy of Watching Cyst-Popping Videos

Elena Sheppard
Popaholics unite.

Even if you’re not looking for them, it’s almost impossible to search for anything skin-care related online without running into one of Dr. Pimple Popper’s videos. Clearly, dermatologist Sandra Lee, M.D., FAAD, FAACS, has tapped directly into the deep, pus-filled heart of the strange-yet-satisfying video world.

Shortly after posting her first pimple popping video, Dr. Lee realized she’d found a gold mine—if such a thing could be said about bacteria and dead skin cells. Her fans, whom she lovingly refers to as “popaholics,” can’t get enough of her viral extraction videos, which have amassed more than 10 billion views on YouTube alone in less than a decade. With over three million followers on Instagram and a successful reality show on TLC, she has become one of the most famous dermatologists in the world.

Dr. Lee’s videos usually begin with close-ups of her patient’s skin, bearing recognizable conditions like blackheads, cysts, or pimples. It can be difficult to look away once Dr. Lee’s gloved fingers begin to massage the area around her patient’s blemish to coax whatever is stuck under the skin, out. Medical tools are commonly used, slicing sometimes occurs, and eventually whatever was under the skin comes to the surface. The entire procedure basically goes from zero to 60 in less than a minute.

We spoke with Dr. Lee about her new book, skin-care advice, and why the world is so fascinated by her work as a dermatologist.

SELF: Why do you think that your popping videos are so popular?

Dr. Lee: What it all comes down to is it makes people happy! Some people feel like it’s a cleansing thing, like you’re getting rid of something that shouldn’t be there. To some people, it’s like a roller coaster or watching a scary movie—there’s a rush of endorphins that you get watching something like this, and then watching it get resolved and being happy in the end—it makes you feel really good.

Also, people tell me that this is a level of ASMR—[they] hear the sound of my voice and it’s very relaxing to them.

There’s no way this would have lasted if this were just something truly gross and disgusting and negative.

Are there any downsides to uploading-pimple-popping-videos-fame? For instance, are people popping their own pimples more often and accidentally scarring themselves?

No, I actually think [my videos] help people [decide] to go in and get things looked at. People are going to pop their pimples no matter what. I try to educate people on how to do that the right way.

Or for instance, you don’t have to remove cysts. You don’t really have to remove everything that I’m treating here; it’s not medically necessary or they’re not life-threatening. But the fact is that if a cyst gets inflamed, it can be the most painful thing ever and it can leave a scar. I think some people are seeking to get their cysts removed before [it gets to] that, because they see [my] videos.

Now that your popping videos are so famous, what percentage of your patients come to you seeking extractions?

This has changed the demographics of my world. We’re definitely getting really big pops—things that I used to see once in a blue moon now happen on a weekly basis. We get a lot of people from around the world, which is amazing because there [are] thousands of dermatologists between me and where they live and they’re choosing me. I’m very humbled and flattered by it.

What is the consent process for patients appearing in your YouTube and social media videos?

We ask the patient if they are willing to allow a staff member to film a procedure, and we make all attempts to make the video/audio as anonymous as possible. Almost everyone agrees to this, and in fact, now people travel from far distances in the hopes that their procedure will be recorded and put on our social media.

They sign a consent form that gives us permission to use the video/photos on our social media etc.

How do you keep your videos from feeling too exploitative?

Our patients know and understand that we keep our videos as anonymous as possible and that identifying names are deleted from the audio. We also don’t show full face videos or photos and obscure identifying areas like the full face and even tattoos with surgical towels, etc.

I don’t feel they are exploitative because I post these videos for educational purposes and patients understand this and actually many request that we videotape them. If there is a growth in a private, sensitive, embarrassing area, if the patient is underage or very emotionally sensitive, or if I feel they will be embarrassed in any way about their condition being put on social media (anonymously), I won’t do it.

I’m very protective of my patients and I always want to maintain that I put them first, in safety and anonymity, before anything else. Also, patients understand if at any time in the future they decide they no longer want their videos on my social media or YouTube, that I’m happy to remove them.

I think the vast majority of people are pleased to have the opportunity to educate others and it’s important to show the world that there are many skin conditions that exist that are not contagious, that people shouldn’t be judged for having these conditions, and overall it probably increases tolerance and lowers the judgmental thoughts of others.

How has internet fame impacted your day-to-day life?

What’s interesting to me is people recognize me by my voice. With [my show on] TLC, now they know my face, but before they recognized me by my voice. It’s hard for me to get used to, I don’t think I’m someone who should be treated like a celebrity by any means. You feel a little uncomfortable being out in the world, or having a drink with friends, or going to the beach, because you feel like you’re being watched.

But the nicest thing about it is there are so many future Dr. Pimple Poppers—and I love meeting young women especially, who may not know what they want to do in their life. But they see that I’m a surgeon, a doctor, and that I talk like them. They feel like they can do what I do, and I’m really proud that I can be a positive influence. I love the kid pimple poppers, too—they’re the cutest things ever.

So, let’s talk skin care: What are some of the most common types of pimples?

In terms of pimples, pretty much we all get them in our life. We get them mainly during our teenage years, and that’s because of our hormones—which is really the primary reason we get acne. Our hormones go a little wild at times and that increases the oil production in our face, and that’s when we tend to break out the most.

You could categorize pimples into three stages: First, blackheads and whiteheads, which are what we call comedones—[they] are the building blocks of acne. When those blackheads and whiteheads get clogged, bacteria gets involved and we can get what we call inflammatory papules, which we all know as the Mount Vesuvius we can have on our nose—that’s a pimple or even a pustule. The third stage, which is the most severe stage of acne, is when you can have cysts and nodules. When you get to that third stage, that’s the one we are most concerned about as dermatologists. It’s not life threatening, but if you’re in that third stage you have a higher risk of scarring that’s potentially permanent. Not everyone goes through all stages, thank goodness.

Which pimples can someone pop at home and which should we just leave alone?

I’m going to be like all dermatologists and say don’t pop anything! But the issue is [that] I still feel obligated to tell you how to do it because I know that many of us are going to do it anyway.

A blackhead is easier to pop—it’s not that you should pop it, but it is easier. It causes less trauma, and less risk of infection and scarring. It’s an open pore, that’s why it’s dark, it’s really open to the surface of the skin. So usually just a little pressure on the sides with a comedone extractor, or even with your fingers, can express a blackhead.

Whiteheads are a little different, because they have a thin coat of skin (which is why they’re white) and they’re exposed to air. That makes it a little more difficult, because you have to actually break the skin, and that’s when you get into that ‘No, don’t pop that!’ kind of thing. If you were really aggressive with your own skin, you could really damage it. The deeper that you traumatize your skin, the more risk you have of getting a scar too. (Editor’s note: Here’s what you should know before trying to pop a pimple at home.)

Since you already share so much medical knowledge through social media, what made you decide to write a book about your experiences?

I have always wanted to write a book. My father (who’s also a dermatologist) loves to read, which helped inspire me to do the same. He grew up poor and used to stare woefully at books in stores and say, ‘One day, I’m going to buy books.’ Growing up, I would go to bookstores every weekend and hang out there for hours.

I’ve always loved books, but the bigger reason [I wrote a book] is that the opportunity presented itself. I have this social media exposure and I get so many questions, which I try to answer in this book. [But] it was hard for me to write this, because I wanted it to be as complete as it could be.

I answer questions from people who want to be dermatologists about how to have a good bedside manner or how to get into dermatology. I answer questions from “popaholics,” people who just have questions about the things I pop out of the skin. I answer questions from people about how I got here, what happened, how I found myself in this position.

And I also answer questions as a dermatologist: What is this medical condition that I have? What is this skin condition? What is hidradenitis suppurativa? How do I treat my acne? I also do a lot of [cosmetic procedures], so people have questions about liposuction, or Botox, or filler. It was hard to [write] because I’m not naturally a writer, I’m a doctor—but I’m also a perfectionist.

You have such a large following—how do you determine the best ways to use it for educational purposes?

The most important thing—and why I wanted to do this in the beginning—is to bring dermatology to the masses. I think most people can’t see a dermatologist—they don’t have access to one, they don’t have the money, or [they have] insurance reasons. So people have a skin issue and they don’t know what it is.

There’s a lack of access to correct information and that’s what I’ve been trying to correct. Now people know the difference between a blackhead and a whitehead, or a cyst and a lipoma, or they know what those bumps are on their arms, or they see somebody with hidradenitis suppurativa, and now they can seek out treatment. Everything is attached to that—the TLC show, this book, the social media—all of that is connected to this goal. It’s hard, though! I have a lot of balls in the air. A lot of cysts in the air.

Put Your Best Face Forward: The Ultimate Guide to Skincare from Acne to Anti-Aging is on sale now.

This interview has been edited and condensed.

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Originally Appeared on Self