Living In Skin

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Original Air Date: 
April 18, 2020

Skin is the living tissue that simultaneously protects us from the world, and lets us feel it. In this episode, the politics, biology, and inner life of your skin.

Products for skin

Living through a global pandemic is giving us all a whole new awareness of skin. Producer Angelo Bautista has been thinking a lot about his own skin — how to claim it, care for it, and all the ways he lives in it.

Daily touch is about moving your skin

What happens when an entire nation is social distancing and avoiding contact? Dr. Tiffany Field, founder and director of the Touch Research Institute at the University of Miami Medical School, tells Anne about the power of therapeutic touch. 

Alissa Waters in her shop.
Photo Gallery

In Madison, Wisconsin, there’s a place a lot of women with scars go. It’s a studio run by a tattoo artist — Alissa Waters — who specializes in the scars left from breast cancer surgery. Her tattoos help women reclaim their bodies.


Skin color is loaded with assumptions about race and identity, but skin itself has its own fascinating history. Steve Paulson spoke with anthropologist Nina Jablonski to find out more.

Show Details 📻
April 18, 2020
December 12, 2020
August 07, 2021
April 02, 2022
April 29, 2023
March 02, 2024
Full Transcript 📄

Anne Strainchamps (00:00):

It's To The Best of Our Knowledge. I'm Anne Strainchamps. Living through a global pandemic is giving us all a whole new awareness of skin. If you go out in public you have to constantly monitor it: stay six feet apart, think before you touch anything, wash your hands, in fact, sanitize them, and don't touch your face. It's all kind of exhausting. This hour, we want to reclaim our skin and all the different ways we live in it. Producer Angelo Bautista has been thinking a lot about his.

Angelo Bautista (00:41):

I fell down a skin care rabbit hole almost a year ago. I'm by no means an expert on skin care but I've learned a few things from watching hours of YouTube videos and lurking on the skin care addiction sub-Reddit.

Speaker 3 (00:56):

Aloha, everyone, and welcome to skin care [inaudible 00:00:57]. If you don't know who I am, my name is [inaudible 00:00:59] and I'm passionate about teaching you how to perfect your skin care routine, so make sure you subscribe to my channel and click on the notification so that you can see my videos.

Angelo Bautista (01:06):

I've spent almost 400 dollars on skin care products so far and I'm not really sure why I need it. I'm in my early 20s and this is probably the best my skin is ever going to look. I mean, I've gotten this far in life without a multi-step skin care routine. Why start now?

Speaker 4 (01:21):

I'm just so picky about my skin care that it never seems to be good enough.

Angelo Bautista (01:26):

Clearly I'm not alone. The skin care industry has been booming in recent years with global spending on skin care trending towards 18 billion in the next four years, not to mention that skin care consumers have never been more informed.

Speaker 5 (01:42):

I'm just exfoliated with a gentle 2% BHA face wash.

Angelo Bautista (01:44):

Look up hashtag skin care and you'll find influencers all over Instagram, YouTube, and TikTok disseminating the latest skin care know-how.

Speaker 6 (01:51):

Today we're going to be talking about toners, what they are, if you should use them, why you should use them.

Angelo Bautista (01:55):

There are videos all over the internet of people and celebrities sharing their skin care routines.

Speaker 7 (02:00):

You will really start to feel this tingle. Oh yeah.

Angelo Bautista (02:04):

In Korea, K beauty skin care routines can have 10 to 14 steps. People in the US are doing it too.

Speaker 8 (02:11):

This is a little weird but I always...

Angelo Bautista (02:12):

I saw one video that had 38 steps. 38!

Speaker 9 (02:17):

I take my time and if that means I have to take two extra hours in the morning, I'm going to do it.

Angelo Bautista (02:24):

I have five. Going through these steps twice a day, in the morning and at night, staring at myself in the mirror, gives me quite a bit of time to think about my skin and the person inside my skin. Step one: cleanser.

Angelo Bautista (02:49):

I think we all know how face wash works. Nothing fancy. Just a gentle cleanser that you can get from the drug store will do. But I do a little extra step: what's called a double cleanse. It comes from the 10 step K beauty craze. You take a cleansing oil to break up the oils and oil-based products on your face and then you follow up with a water-based cleanser to wash away what's left.

Angelo Bautista (03:17):

Some say it's too much. Some say it's too drying. Others say it's good practice. I don't know. I just like it. It makes me feel extra clean but also just extra. At the very least, everyone should be washing their face. Please.

Angelo Bautista (03:41):

Step two: toner.

Speaker 6 (03:46):

So let's get into it. What is a toner? Toners are liquids that penetrate very quickly into your skin, depending on the toner, delivering instant hydration, removing dead skin cells, picking up dirt.

Angelo Bautista (03:57):

My toner is the most expensive part of my routine and it's a step that's kind of hard to explain.

Speaker 6 (04:03):

They can also restore your pH balance if your cleanser wasn't pH balanced, and in general most of them plumper, brighter looking skin.

Angelo Bautista (04:14):

My toner looks like one of those fancy bottled waters that comes from some melting glacier in Norway. That's a lot. Okay. And I use these special Japanese cotton pads that I bought online. They look like tiny pillows and they feel so soft. Then I just take the little cotton pad and just swipe it on my face.

Angelo Bautista (04:47):

Not everyone in the skin care community agrees about toner.

Speaker 10 (04:51):

I know from past videos that I'm going to get some arguments on this one, but you don't necessarily need a toner. I'm sorry, but you do not necessarily need a toner.

Angelo Bautista (05:02):

Okay, maybe I might not need toner, but it does make me feel like a rich woman. Sometimes I just feel like I'm putting money into my face: like, liquid money. Sometimes I think, "Maybe it's all a scam sold under the guise of, quote unquote, self care." In 1988, the poet Audre Lorde wrote, "Caring for myself is not self indulgence. It is self preservation, and that is an act of political warfare." As an African American lesbian fighting cancer, she was saying that when your body exists under oppression self care is declaring yourself worthy of care: that you, in fact, matter. But I don't think she was telling us to buy expensive toner and use hundreds of cotton pads that will end up landfills because hashtag self care. Three decades after Audrey Lorde, when even healthcare is still unobtainable for many, the term self care has been co-opted by those who can afford it.

Speaker 11 (06:04):

Okay, I have a second to myself. I'm going to show you something. Okay. Goop glow overnight glow peel inspired by a chemical peel that I used to get at my dermatologist. I really want to...

Angelo Bautista (06:15):

Maybe you've heard of Gwyneth Paltrow's wellness lifestyle brand Goop. It's valued at 250 million dollars.

Speaker 11 (06:22):

Good morning. My skin is super soft. With our overnight glow peel I wake up feeling fresh and glowing and ready to start my day.

Angelo Bautista (06:31):

Goop sells a toner that costs 75 dollars for three ounces. My toner is 30 dollars for 11 ounces.

Angelo Bautista (06:38):

Don't forget the neck. The neck is so important.

Angelo Bautista (06:42):

And for those of you doing the math that's nine times as much per ounce.

Angelo Bautista (06:46):

Cleans up the leftover impurities, I guess. Cool.

Angelo Bautista (06:54):

I know I'm showing my privilege by complaining about the cost of luxury skin care products, but I can't help but wonder who benefits the most from skin care. Is it the person who can afford the 75 dollar toner or the one selling it?

Angelo Bautista (07:15):

Step three: serum. Serums are where skin care starts to feel like a science experiment, and it is science. This is biochemistry.

Angelo Bautista (07:30):

My serums are clear liquid goo in glass vials. The main ingredient I use is [nysinomine 00:07:36], which is just a sciencey term for vitamin B3. It's a superstar ingredient and it's good for a whole lot of things. They have these little eye droppers. You just squeeze them. It minimizes pores, softens fine lines and wrinkles.

Angelo Bautista (07:55):

Evens texture and skin tone. Skin tone. It helps with dryness. Moisturizing. It fights free radicals. Reduces sebum production. Redness. Pores. Winkles. Skin tone. Fine lines. Moisturizing. Radicals. [crosstalk 00:08:05]. Brightens and lightens the skin.

Angelo Bautista (08:12):

That last one though: brightens and lightens the skin. It doesn't sit right with me. When I was 13, I spent a whole summer in the Philippines visiting family and that's when I discovered papaya soap.

Speaker 12 (08:30):

(singing). Palm Olive Naturals white plus papaya.

Angelo Bautista (08:42):

Papaya contains an enzyme that's suppose to dissolve dead skin cells gradually revealing lighter skin underneath.

Speaker 12 (08:48):


Angelo Bautista (09:01):

Skin whitening products are incredibly popular in the Philippines. Whole store aisles are dedicated to them and you'll see celebrities selling them on TV. There's not just papaya soap. There's lightening creams and deodorants, kojic acid products, [glutathion 00:09:18] pills and injections. Some products may even contain mercury.

Angelo Bautista (09:23):

The link between skin color and cleanliness is as old as mass produced soap itself. In the late 19th century, the British soap company Pears published an advertisement featuring two young boys. In one cartoon you see a rosy-cheeked white boy giving a black boy a bath. In the second panel, the white boy holds up a mirror to the black boy and he's shocked by his reflection. His body is scrubbed white while his face remains stubbornly black. Another ad reads, "The first step towards lightening the white man's burden is through teaching him the virtues of cleanliness."

Angelo Bautista (10:05):

13 year old me wasn't thinking about soap as an allegory for imperialism: the cleansing of the unwashed savage. I wasn't thinking about the hundreds of years of Spanish and American colonization and what it did to our ideals of Filipino beauty. I didn't know skin lightening was a multi-billion dollar industry in Asia. I just thought, "It's just papaya. It wouldn't hurt to use every now and then. I mean, I don't want to get too dark."

Angelo Bautista (10:39):

The shame of dark skin is subtle. A relative tells you not to play in the sun too long or else you'll get dark. Most Filipino celebrities you'd see on TV and in movies were fair-skinned and [foreign language 00:10:53], not [foreign language 00:10:54] or [foreign language 00:10:56].

Angelo Bautista (11:05):

I haven't touched papaya soap since.

Angelo Bautista (11:09):

Step four: moisturizer. Skin is the barrier between our inside world and the outside world. It's a porous surface like a sponge, and just like sponges we're all constantly in the process of drying out. The point of moisturizing isn't just to restore wetness but to seal in all the goodness from all the other stuff you've put on and to help keep out the bad stuff that can harm us: pollutants, irritants, weather.

Angelo Bautista (11:42):

There's something I find so satisfying about putting on a moisturizer. It makes me feel safe.

Alan Downs (11:59):

How do I find a lasting since of purpose in my life? Why am I never really satisfied?

Angelo Bautista (12:07):

As you can imagine, I spend a lot of time looking at myself in the mirror.

Alan Downs (12:12):

When will I finally be content with my accomplishments? Why do I eventually get dissatisfied with most all of my relationships?

Angelo Bautista (12:22):

Sometimes I'll just stand in the bathroom and look at myself.

Alan Downs (12:26):

How do I find the courage to be my own person?

Angelo Bautista (12:29):

And if I stand there long enough...

Alan Downs (12:31):

Why am I so sensitive to criticism?

Angelo Bautista (12:34):

Something inside me just bubbles up, like it's just bouncing around in my head and I feel it in my face and like it just wants to escape. Then I'll say, "I hate myself." I beat myself constantly, but only I can see the bruises.

Alan Downs (12:56):

There are some of the characteristics of shame-based trauma.

Angelo Bautista (12:59):

I recently picked up this book, The Velvet Rage: Overcoming the Pain of Growing Up Gay in a Straight Man's World, written in 2005 by psychotherapist Alan Downs.

Alan Downs (13:09):

When I wrote The Velvet Rage I wanted to cut to the core of what it's like to live with a secret: a secret that makes you believe that you're fundamentally unlovable. When you grow up with the secret of your own sexuality, there's this ingrained hardcore belief that there's something about me that is fundamentally flawed, and that I somehow need to compensate for that.

Angelo Bautista (13:34):

I somehow need to compensate for that. Compensate by being more muscular or more sexy or more successful or, I don't know, beautiful. Whatever brings us validation.

Alan Downs (13:48):

All of this is to bring us to this point because I want you to understand that when we feel shame the urge that we have within us is to hide. There are many ways in which we can hide.

Angelo Bautista (13:59):

It's only recently that I've realized the invisible ways avoiding shame has shaped my life, my relationships, even though I have a loving family and a loving partner.

Alan Downs (14:09):

When we feel shame we want to lie, we want to hide our bodies, we want to avoid the person. We may compartmentalize our lives. There are many ways. Humans are genius at finding ways to hide.

Angelo Bautista (14:26):

I've learned from being in therapy and from this book that from a young age one way we learn to cope with shame is through splitting. We split ourselves: compartmentalize. We hide the bad stuff, show the good stuff, and it becomes harder to recognize yourself. "Am I the good parts or the bad parts?" When we talk about skin we also fall into these types of binaries. There's good skin or bad skin, dark or light, perfect or imperfect.

Angelo Bautista (15:04):

Step five: mask.

Angelo Bautista (15:10):

This is an extra part of my routine that I'll do once a week. It's a little vial of what I call my blood mask, because it looks like blood. It makes me look menacing, like I'm performing a ritual sacrifice. It tingles and it stings and it feels like someone's poking your face with little needles.

Angelo Bautista (15:40):

Here's the question I've been struggling with: is skin care an act of self love or self loathing? Someone who cares for their skin this much must love themselves at least a little bit, right? But if part of the goal is to change something you don't like about yourself, isn't that self loathing? Or is it both? And, not or?

Angelo Bautista (16:06):

One day, a second grade substitute teacher as I walked into class. "You got some mud on you." "I do?" I asked, rubbing my face. "Yeah, right there." She pointed at my right jaw. "Oh, that's my birthmark." My birthmark is a dark brown oval splotch about an inch and a half long. Other kids thought it was weird and gross that it grew hair. My parents said that was a good thing because it meant it wasn't cancerous. I asked my parents if I could get rid of it. They said I could, but it would leave a scar. If you asked me today, "What's your favorite part of your body," I think it would be my birthmark. It's the part of me that feels the most free. It's a blemish I can never hide. No amount of skin care will change it and I'm okay with that. If I can love this part of me, this little piece of skin for what it is, what's stopping me from loving the rest?

Angelo Bautista (17:12):

I think skin care isn't about finding perfection. It's about finding balance, whatever that means for you: somewhere between good and bad that's just okay. Things can be just okay.

Anne Strainchamps (17:40):

That's producer Angelo Bautista.

Anne Strainchamps (17:45):

So we are all thinking a lot more about our skin these days now that there are so many things it's no longer safe to touch. Next up we'll share a few tips on how to handle skin hunger. It's To The Best of Our Knowledge from Wisconsin Public Radio and PRX.

Anne Strainchamps (18:09):

It is a strange new touchless world we're living in. How are you surviving?

Speaker 14 (18:16):

This is a CBS4 news special report.

Speaker 15 (18:20):

Take you out live now to Tallahassee where Governor Ron DeSantis is holding a news conference with the latest information on COVID-19.

Ron DeSantis (18:27):

And we urge all Floridians aged 65 plus and those with significant underlying medical conditions to stay at home. Obviously, if you need to get medicine, food, what-have-you, but you're safer at home and we want you to come out of this thing on the other side.

Tiffany Field (18:47):

I live in a little town called Coconut Grove. People are, everywhere, walking and riding bikes.

Speaker 18 (18:58):

My friend and I are here today to talk about common sense.

Tiffany Field (18:58):

I walk twice a day.

Speaker 19 (18:59):

Common sense to prevent coronavirus.

Tiffany Field (19:04):

And I run into people and they want to hug me and... My biggest worry is being run over by a bicycle. But people are finding other things to do, like I've seen a lot of people do artificial elbow bumps.

Speaker 18 (19:20):

We are both recommending you don't shake hands any more.

Tiffany Field (19:23):

I call them distance elbow bumps.

Speaker 18 (19:25):

You need to bump.

Speaker 19 (19:25):

Bump, don't shake.

Tiffany Field (19:27):

You don't know where that hand has been.

Tiffany Field (19:30):

As of today in Florida we're wearing face masks, so it's a little difficult to smile.

Speaker 18 (19:35):

Make your own DIY no-sewing-needed face mask.

Tiffany Field (19:38):

And there's so much sun that we have sunglasses on, so we sort of look like outer space men. We are using a lot of this stuff to say hi to people.

Speaker 19 (19:48):

Wash your hands frequently, 20 seconds, with soap and water or hand sanitizer.

Tiffany Field (19:52):

It is difficult. It's a very difficult time.

Ron DeSantis (19:56):

We instituted a 14 day self quarantine for everyone coming in from those airports in the New York City area. Every time they come they're now met by National Guard and Department of Health personnel.

Anne Strainchamps (20:10):

Handshakes are gone, possibly forever, according to Anthony Fauci. The friendly hug hello or goodbye? That's a thing of the past. You can't kiss a date, get a massage, hold someone else's baby, or high five a teammate, without risking everybody's health. What happens when an entire nation is touch deprived? I checked in with Dr. Tiffany Field. She's the founder and director of the Touch Research Institute at the University of Miami Medical School and she's a pioneer in the field of therapeutic touch.

Anne Strainchamps (20:45):

I'm thinking for somebody like you who studies touch this must be like a giant field experiment. I mean, have Americans ever been this touched deprived?

Tiffany Field (20:55):

Well, I think that we've been headed in this direction for a while of a no touch culture. We've actually been doing an airport gate study for the last year and a half and we don't see any touch in the airport gates. 98% of the time people are on cell phones and they're not talking. They're scrolling and texting and, I guess, gaming. I'm not sure that people are feeling that touch deprived. In fact, I think that we are a touch deprived culture, but I don't think we're moving in the direction of being less touch deprived.

Anne Strainchamps (21:34):

Is the US different from other countries in that way?

Tiffany Field (21:38):

It's different than Paris, I'll tell you that. The Parisians are very disturbed that they can't kiss each other on the cheeks at this point in time. I think they're probably feeling significantly more touch deprived than we are. There's been studies done years back in cafes where couples were observed to be touching each other and in Great Britain and the US it happened once every 30 minutes, whereas in Paris it happened 20 times every 30 minutes.

Anne Strainchamps (22:09):

That's a big difference.

Tiffany Field (22:11):

Yeah. Even with affectionate couples there is a direct relationship. We had a study where we compared adolescents with adolescents in Miami and the adolescents in Paris were all over each other, hugging each other, and giving each other back rubs. The Miami adolescents were hugging themselves and flipping their hair and cracking their knuckles. We actually found that the Parisian adolescents... These studies took place in McDonald's in both Paris and Miami and found that the adolescents over there were less verbally and less physically aggressive, so that was kind of a disturbing finding.

Anne Strainchamps (22:54):

Why do you think that is?

Tiffany Field (22:56):

The less touch you have, the more aggressive you are. There's a lot of studies in primitive cultures that suggest that the more physical affections infants receive from their parents the less aggressive they are as they're growing up. The studies that we did in Paris we also did with some preschoolers on playgrounds. The children were getting more physically affection from their parents and they were less verbally and physically aggressive towards their peers.

Anne Strainchamps (23:23):

Tiffany, this is purely speculation, but could this have anything to do with why the coronavirus has hit place like Italy and France and Spain so hard? Because those are cultures were people are touching each other more?

Tiffany Field (23:35):

I would say that's true except for China. I think China is an exception. I don't think there is as much physical contact as Italy and France, but it's a very interesting speculation, or hypothesis, you just gave.

Anne Strainchamps (23:50):

I'm curious about what the affect of social isolation might be having on all of us. Just anecdotally, for instance, you and I are talking via video conference right now and that's how my entire production team has been working for the last several weeks. Everything is video conference. I don't usually touch my coworkers when we're meeting together, I don't think, so you wouldn't think meeting online would be all that different, but it does feel different. It seems exhausting, for one thing.

Tiffany Field (24:22):

Yeah. Just even doing the elbow bumping was better than nothing. But we know from our research that the critical thing is moving the skin and there's a lot of things we can do to move the skin. Granted, if you get a massage that's better than just moving your skin and if you get a massage from your partner that's better than getting a massage from a massage therapist. Yoga or stretching or sit-ups or every form of exercise, if you think about it-

Anne Strainchamps (24:51):

Wait, can I just ask... I thought that touch was about human to human touch. You're saying it's about moving your skin?

Tiffany Field (25:02):

Yep. Well, the positive effects, the healthy effects, come from moving the skin. What happens when you move the skin, you're stimulating the pressure receptors under the skin. Those send messages to the brain, mainly to the Vagus nerve. There's 12 cranial nerves in the brain. The Vagus nerve does a whole bunch of things. It has branches to virtually every part of our body. When that happens, you're slowing the nervous system down and when you slow the nervous system down, like a decrease in heart rate, a decrease in blood pressure, change in the brain waves to theta activity, which is relaxation waves, you get a decrease in stress hormones and you save natural killer cells.

Anne Strainchamps (25:48):

All of that happens just from moving your skin?

Tiffany Field (25:52):

Moving the skin. When you increase natural killer cells, they ward off viral cells, bacterial cells, and cancer cells. So ironically, at a time when we can't be touching each other, touching would be very good because the touching and moving the skin has a huge effect on the immune system. Just think about we're washing our hands all the time. When we're doing that we're moving the skin of our hands, at least if we're washing our hands correctly we're moving the skin. That itself is a stimulus. More than just keeping the virus off, it's going to help us because it's stimulating our pressure receptors.

Anne Strainchamps (26:27):

Wow. Are there symptoms of touch deprivation? Let's say you don't exercise a lot and you live alone. What would the symptoms be of having your... feeling touch deprived?

Tiffany Field (26:43):

People haven't actually studied that in moderate amounts of deprivation. We do, though, have a lot of things happening in our society, and this is happening all over the world, but mostly in English-speaking countries, which are cuddle groups.

Anne Strainchamps (26:58):

Cuddle groups?

Tiffany Field (26:59):

Cuddle groups, yes. You wear your pajamas and you lie on the floor in a big circle and you cuddle whoever's next to you. They turn the lights off. They have these rules that you can't get sexually intimate. They also have cuddle shops that are cropping up all over this country and Great Britain and Australia. You go and you pay a dollar a minute and someone cuddles you.

Anne Strainchamps (27:21):

I imagine that's another industry that's taking a hit during coronavirus.

Tiffany Field (27:24):


Anne Strainchamps (27:25):

What do you think... We've got months of social isolation ahead of us. Do you see anything good coming out of this?

Tiffany Field (27:34):

I think that with people being isolated at home, at least family members are touching each other more because they have more time with each other. What I hear from my friends who have kids, they're holding them on their laps a lot, they're giving them back rubs, they're hugging them a lot, and they know that if they hug or back rub they're going to calm down the kids and they'll calm down themselves because when you do touch someone else it calms you down. I'm saying to single people who don't have anybody touching them that they need to do self touch. They need to do yoga. They need to walk around their room: stimulating the pressure receptors on their feet is going to give them this kind of stimulation they need. Lying on the floor and doing crunches or sit-ups, all of that is going to contribute to very similar effects of just being hugged or shaking someone's hand. Yeah, just like exercise and diet, you need to have a daily dose of touch.

Anne Strainchamps (28:48):

That's Dr. Tiffany Field. She's the founder and director of the Touch Research Institute at the University of Miami Medical School.

Anne Strainchamps (28:57):

I've been thinking about how much personal history lives in our skin, for better or for worse. We all have certain touch memories that can make us happy: walking barefoot on a beach, holding your toddler's hand. But we also carry scars and there are different ways to come to terms with those. We'll touch on that next. It's To The Best of Our Knowledge from Wisconsin Public Radio and PRX.

Anne Strainchamps (29:39):

There's a triangular mark on the side on my knee from where I was hit by a bus. It wasn't that terrible an accident and it's not that big a scar, but every time I see it, it reminds me to be grateful I'm here, and also to remember to look both ways before crossing the street. Across the town from me there's a place a lot of women with scars go. It's a studio run by a tattoo artist: Alissa Waters. She specializes in the scars left from breast cancer surgery. Her tattoos help women reclaim their bodies, and for a lot of them it's the last step after years of surgeries and reconstructions. Producer Shannon Henry Kleiber, who is herself a breast cancer survivor, paid her a visit.

Alissa Waters (30:33):

To set up a tattoo, I lay out my barriers that cover my surfaces and anything I'm going to touch during the tattoo. I then mix out my colors and pour them into ink caps. Get Vaseline so I'm able to soothe the tattoo as I go, and I go to set up my machine.

Alissa Waters (31:04):

When I'm doing placement for a tattoo, I would use an eyeliner pencil to draw on the patient and then I look at the shape and then the size of their breast to determine what would look best on them. Then I have them look in the mirror. Once we agree and we have a more permanent form of my stencil, we're ready to rock, starting the tattoo.

Alissa Waters (31:32):

I usually start with just a couple dots to get the person used to what they're going to feel for the next little bit. I've heard it feels like a cat scratch or like little bee stings, but I think that there's really honestly nothing that feels like it. Once you feel what a tattoo feels like you can say it feels like a tattoo.

Alissa Waters (32:03):

I use shading techniques to make it look like there is protrusion, so from a front view and from a three-quarter view it should look like the nipple protrudes out. It's an intimate spot and I do these tattoos not just for a mastectomy or a reconstruction but maybe a breast reduction can sometimes leave you with scarring or just a change in your areola size. It's nice to have somebody you trust doing it and then maybe have somebody here with you to support you.

Shannon Henry Kleiber (32:50):

Wow, that looks great. That looks real. Most people seeing that wouldn't know that that's a tattoo.

Alissa Waters (32:56):

Yeah, and that's definitely the goal.

Shannon Henry Kleiber (33:00):

These little dots can create a nipple.

Alissa Waters (33:02):

Yeah, it's cool. Using pointillism to create something super realistic-looking just works really well with skin because that's... your skin is essentially pointillism with all of these different colors mixed together.

Shannon Henry Kleiber (33:21):

I was going to ask if we can look at a few pictures together and tell me about some of your clients and people you've gotten to know.

Alissa Waters (33:28):

Yeah, absolutely.

Shannon Henry Kleiber (33:28):

Do you remember your first client?

Alissa Waters (33:31):

My first client, I remember. She had a unilateral mastectomy, so she just had one breast removed, and she had a significant difference in symmetry. One breast was a lot lower than the other one. We were able to change the entire appearance of this woman's chest by just moving her tattoo up. We did it so it actually tricks your eye a bit. It makes it seem like it's more symmetrical.

Shannon Henry Kleiber (33:58):

So there's a little illusion going on there.

Alissa Waters (34:00):

Yeah. You can see differences when I'm going through some of these pictures. I see a lot of different types of scarring. This is actually the most common. Has like a scar tissue that's kind of right through the center. This person has implants.

Shannon Henry Kleiber (34:16):

This is so artistic. How do you get the right color?

Alissa Waters (34:20):

When you look down at your skin you will notice that it's not just one solid color. It's a bunch of different flecks of color that make your skin look like that certain tone. If I were to just use one solid color it would look really odd and it would look too perfect, so using combinations of different colors that work well with someone's skin tone in tiny dots and putting them all together makes it look like it's real but not too perfect that it seems out of place.

Shannon Henry Kleiber (34:54):

You're kind of celebrating the imperfection of skin.

Alissa Waters (34:57):

Yeah, absolutely. I think that I'm not always trying to cover scars. I think sometimes working with them is the better way to go, honestly, or going through them with artwork instead of just trying to fully disguise the fact that they're there.

Shannon Henry Kleiber (35:15):

That's great. You have met women who are at a really vulnerable part of their lives. Do they ever have trouble showing you their scars? Or how do they feel when they come in?

Alissa Waters (35:27):

I think they come in nervous because it's kind of uncharted territory. A lot of the people that I see for this particular service have never been tattooed before. Some are almost numb to it and will immediately get undressed because they're very used to a lot of people looking at them in a very clinical way. I try to make my setting a bit more comfortable. There is art on the way. I'm playing music. It's just you, me, and whoever you decide to bring to your tattoo.

Shannon Henry Kleiber (36:00):

This is a tattoo that most people won't see. I mean, as you think about different places you could be tattooed. But it still makes women feel so much better about themselves.

Alissa Waters (36:11):

Yeah. I think it's important that other women are able to see that. It's kind of something that you don't see on the internet and print media just because of the nature of society's view of the female nipple is skewed and sexualized. There's been definitely some blocking of that type or imagery, so I think it's important that we make that more accessible for women to see other women who have gone through this.

Shannon Henry Kleiber (36:42):

Do you have some pictures of other kinds of tattoos that women choose that are not the 3D nipples that we can look at?

Alissa Waters (36:54):

These two women decided to... instead of getting areola pigmentation they went for artwork and essentially two full chest pieces to cover the scar tissue from a mastectomy or reconstruction. This top woman, she's got sort of prairie and foliage and she wanted to feel like she was wrapped in flowers and I thought that that was the coolest idea.

Shannon Henry Kleiber (37:21):

Those are beautiful.

Alissa Waters (37:22):

Thank you. I think it comes down to how you maybe don't feel so much like yourself after this whole process. These two women chose to go with artwork. I think they picked it as almost like a new chapter in their life: that they wanted to do something celebratory.

Shannon Henry Kleiber (37:46):

You're really helping women reclaim their bodies in a lot of ways.

Alissa Waters (37:50):

Yeah. I think everybody is uncomfortable with their own body in way and I think throughout the process of getting a tattoo, whether it be a medical tattoo or it be artwork, I start to see that change a bit. Putting tattoos on your body is actually confidence boosting.

Shannon Henry Kleiber (38:12):

You have a mirror in there and so they look at the mirror and they see it. Are you behind them seeing the reaction in the mirror?

Alissa Waters (38:19):

Yeah. I usually stand off to the side so I can see their face, because I've been looking at what I did the whole time and I'm generally pretty confident in my ability, but I like to look at their reaction because it's them that's going to see it when they get out of the shower every day. I get a sense of relief out of most people because they've been looking at themselves in the mirror for sometimes years without seeing a part of their body that's just this small piece of skin but actually has a really big impact on what your body looks like and how you feel about it.

Shannon Henry Kleiber (38:55):

Do people cry sometimes?

Alissa Waters (38:56):

People definitely cry sometimes and I get a lot of hugs at the end of the procedure.

Shannon Henry Kleiber (39:03):

So Alissa, you are looking at nipples all the time. You are looking at women's bodies all the time. Do you go to art museums and see paintings differently or sculptures differently?

Alissa Waters (39:14):

I think other people, maybe, are a bit shocked by nipples and they are just such a normal part of my life at this part I almost don't even see them. But I almost use it as reference, to be honest.

Shannon Henry Kleiber (39:31):

It's research.

Alissa Waters (39:31):

Yeah, it's research when I'm creating a body part for somebody.

Shannon Henry Kleiber (39:35):

I mean, it really is like a public service, but art, but all these different things. Thank you. Alissa, this is wonderful. You're so... What you do is so interesting.

Anne Strainchamps (39:49):

That's Alissa Waters. She's the owner of Shade Medical and Creative Tattoo based in Madison, Wisconsin, and that was Shannon Henry Kleiber talking with her.

Anne Strainchamps (40:04):

If you walk down the street and you pass a stranger one of the first things you probably notice about them is their skin, specifically they're skin color. We make so many assumptions based on this one characteristic. What if they were all wrong? Anthropologist Nina Jablonski studies the history and biology of skin color and she told Steve Paulson that the earliest humans, our ancestors, all of them were darkly pigmented. Lighter skin colors evolved later. And that thing we call race? That's an illusion. The heritage we all share is dark skin going back to the very first naked ape.

Nina Jablonski (40:48):

We can estimate that humans firstly evolved naked skin probably around a million and a half years ago, and at the same time they mostly lost their coat of fur they evolved permanent dark pigmentation. Basically what that dark pigmentation did was take the place of fur as a UV sunscreen.

Steve Paulson (41:16):

So this was in Africa where this happened. The earliest humans evolved in African. Was the main problem that if we didn't have this melanin to protect us against the sun that we were going to develop skin cancer?

Nina Jablonski (41:28):

Probably that wasn't the main problem. Although certainly ultraviolet radiation can lead to skin cancer, this rarely occurs in individuals during their reproductive years. As I was struggling with this more than 20 years ago I realized that ultraviolet radiation has the ability to break down an essential B vitamin called folate, something that we get from green vegetables and citrus fruits and whole grains. Folate is really important for making DNA and new cells and it turns out that ultraviolet radiation has the ability to seriously damage folate. The key insight behind our research is that protective melanin pigmentation evolved primarily not to protect us from skin cancer but to preserve our folate so that we could reproduce successfully.

Steve Paulson (42:36):

Given all of these advantages of dark skin, why doesn't everyone has dark skin today?

Nina Jablonski (42:42):

For most of human history we did. What we see today is the product of the dispersal of a few human populations out of Africa around 60,000 to 70,000 years ago. These ancestors of modern Eurasians were beginning to disperse into parts of the world that had much lower UV levels. They run into problems if they have too much natural sunscreen and the reason is that some UV is absolutely essential to us for making vitamin D in the skin.

Steve Paulson (43:23):

Why do we need the vitamin D?

Nina Jablonski (43:25):

Vitamin D is essential for us to absorb calcium and phosphorus from our diet, so we need vitamin D to make a strong skeleton but we also need vitamin D to maintain a strong functioning immune system, and basically we have vitamin D receptors on every important organ of our bodies.

Steve Paulson (43:47):

There is also a whole racial component to this discussion. We tend to separate people by skin color into different races. You are a scientist. How should we understand race scientifically?

Nina Jablonski (44:03):

I think it's important to understand it from a few different perspectives. When we look at human genetic diversity we can see there are no clean breaks between human populations, so we see rough and ready kinds of biological groupings but there's tremendous amounts of overlap. There are no clear demarkation lines and this is the primary reason why geneticists decades ago said there are no human races from a biological perspective.

Steve Paulson (44:39):

So race is strictly a social construction.

Nina Jablonski (44:42):

Yes, but we have to recognize that doesn't make it any less real. It doesn't really matter about the philosophical status of the race concept. If people identify that they belong to a particular race it's real for them.

Steve Paulson (44:59):

But it would seem also that there are some physical differences between races. For instance, if we look at the world of sports, people of west African origin dominate the world class sprinting events.

Nina Jablonski (45:13):

This has a very interesting implication. Would you put west Africans in a separate race? Most people wouldn't because they have so much tremendous overlap of their biological characteristics with people from other parts of Africa, including east Africa where people have tremendous abilities in long distance running and marathon running and not in sprinting. Drawing a definite line of demarkation becomes impossible. Also, if you're just looking at a characteristic like running ability, sprinting ability, it also requires tremendous amounts of training. There's a huge cultural component to it.

Steve Paulson (45:57):

We should talk some about this cultural history because certainly one of the most disturbing developments throughout the course of human history is that blackness has been stigmatized around the world. For centuries, people of darker skin color have been seen as socially inferior. Can we date this as to when this started?

Nina Jablonski (46:18):

Yes we can. This becomes really potent in Europe beginning in the 16th, 17th, and then in a significant way in the 18th century. This isn't something that we can trace to very ancient times but rather mostly associated with the growth of the transatlantic slave trade. It becomes very important in the history of colonial mercantilism that we actually be able to have a workforce to help develop many colonial lands, so, "Let's get some slaves." Now, it's very important that if you're going to take slaves that you basically create slaves as an inferior class.

Steve Paulson (47:14):

Basically you have to dehumanize them to be able to enslave them.

Nina Jablonski (47:18):

Yes. You dehumanize them by saying they are inherently black, inherently immoral, inherently incapable of developing true human qualities. They are subhuman.

Steve Paulson (47:31):

There were some very influential thinkers you played up these racial differences. Linnaeus, the 18th century scientist who developed modern taxonomy, distinguished between four human races and attributed various temperaments to each. The philosopher Kant talked about the different races of humanity and, not surprisingly, he put the white Europeans at the top as the most talented race. These were among the people who laid the foundations for the modern world.

Nina Jablonski (47:59):

And the fact that Linnaeus was read by Kant and that many people read Kant, including Thomas Jefferson and many other thinkers who were important in the formation of our own country, read Kant and this becomes the most toxic combination in human history so that you have blackness associated with base qualities and subhuman status as less able to generate a complex civilization as Kant would have it.

Steve Paulson (48:35):

These days much has changed and pale skin is clearly not as prized as it once was. How do you see the politics of skin color in the world today?

Nina Jablonski (48:47):

We live in a very strange world where many light skinned people want to be darker, at least tanned, to look healthy and to look like they have just enjoyed a vacation on the Rivera. A lot of darkly pigmented people want to look lighter because lightness is associated with higher status. We have a very paradoxical situation. I think we need to recognize that humans are motivated to want an appearance that confers higher status. Once we recognize that that's a pretty stupid thing to do we can adjust our cultural sights and say, "Hey, let's just live with the skin color that we have. Let's cherish and protect it as it is."

Anne Strainchamps (49:45):

Nina Jablonski is an anthropologist at Penn State, and that was Steve Paulson talking with her.

Anne Strainchamps (49:55):

Cherish and protect your skin: that's the message we actually wanted to leave you with today because as we make our way through this global pandemic we all have skin in the game. Protect yours so it can keep you safe from disease and cherish what's written in it: your personal history plus the evolutionary history of our species. They're both worth celebrating.

Anne Strainchamps (50:23):

To The Best of Our Knowledge comes to you from Madison, Wisconsin. Angelo Bautista produced this hour. He had help from Shannon Henry Kleiber, Charles Monroe-Kane, and Mark Riechers. Our technical director is Joe Hardtke. Our executive producer is Steve Paulson. And I'm Anne Strainchamps. Thanks for listening. Be well.

Angelo Bautista (50:41):

And don't forget the neck. The neck is so important. Okay.

Speaker 24 (50:52):


Last modified: 
March 01, 2024