Michael Jackson's health and appearance
Michael Jackson (August 29, 1958 – June 25, 2009) was an American musician and entertainer who spent over forty years in the public eye, first as a child star with the Jackson 5, and later as a solo artist. Starting in the mid-1980s it became clear that Jackson's appearance was changing dramatically. The shape of his face, particularly his nose, triggered widespread speculation of extensive cosmetic surgery. His skin tone also changed, becoming much lighter. Although Jackson was diagnosed with the skin disorder vitiligo, it also widely speculated that the change was due to skin bleaching.
Jackson and some of his siblings said they had been physically and psychologically abused by their father. In 2003, his father admitted to whipping them as children. The experience deeply traumatized Jackson and may have led to the onset of further health issues later in his life. Physicians speculated that he suffered from body dysmorphic disorder.
At some point during the 1990s, it appeared that Jackson had become dependent on prescription drugs, mainly painkillers and strong sedatives. The drug use was later linked to second and third degree burns he had suffered years before. As more and more difficulty emerged in his life he gradually became dependent on these drugs and his health deteriorated. He went into rehabilitation in 1993 with the help of Elizabeth Taylor and Elton John.
While preparing for a series of comeback concerts scheduled to begin in July of 2009, Jackson died of acute propofol and benzodiazepine intoxication after suffering cardiac arrest on June 25, 2009. His personal physician was convicted of involuntary manslaughter in his death and sentenced to four years in prison.
Jackson's skin was a medium-brown color throughout his youth, but, starting in the mid 1980s, his skin gradually grew more pale through what was widely considered to be skin bleaching and changing of his features to appear European. According to Jackson biographer J. Randy Taraborrelli, Jackson began making his nose smaller around the same time his skin became very gradually lighter and that he was using the over-the-counter skin-bleaching cream called Porcelana to achieve the lighter skin. Taraborrelli reported that Jackson's sister Latoya used Porcelana too, and that they had crates of this cream stored at their family home Hayvenhurst, "hoarding it as the most valuable beauty product ever produced." Jackson's physical changes gained widespread media coverage, and provoked criticism from the public. African American psychologists argued Jackson was "a lousy role model for black youth". Dr. Dennis Chestnut said Jackson gave "black youth a feeling that they can achieve", but also may encourage some people to think they've got to be esoteric and idiosyncratic to be successful. It was also presumed that Jackson bleached his skin just to boost his career. Dr. Halford Fairchild stated Jackson and other African American celebrities would try "to look more like white people in order to get in films and on television". 
According to Taraborrelli, in 1986, Jackson was diagnosed with vitiligo, which Tarraborrelli noted was sometimes considered by doctors to be a consequence of damage done by bleaching chemicals over the years. However, skin bleaching is not the only suspected cause of vitiligo which is a rare non-contagious disease. The causes are not known, but a range of genetic, auto-immune, and environmental causes are suspected. Between 1% and 2% of the worldwide population are considered to be affected. The depigmentation occurs in patches, and affects all ethnic/racial groups equally. Yet the disorder cannot be cured, but the progression of the patches can be stopped.
New York plastic surgeon Dr. Pamela Lipkin, who has never treated Jackson or reviewed his medical records, said, "when you look at the other features, the skin bleaching sort of goes along with what I think was his quest for beauty, so I have to wonder what came first? Vitiligo or lighter skin?" Noting that Jackson had even skin tone when he was younger, Lipkin's interpretation was that "probably he's trying to look Caucasian: His skin is whiter. His nose is getting thinner every six months. His lips are getting thinner. His eyebrows are getting higher. His eyes are getting wider every time. His cheekbones are getting bigger."
When producer Quincy Jones who worked closely with Jackson at the time Jackson's skin transformation began, was asked about Jackson's facial transformation he stated: "It's ridiculous, man! Chemical peels and all of it. And I don't understand it. But he obviously didn't want to be black...You see his kids?"
According to the affidavit of Sergeant Deborah Linden found by Vanity Fair reporter Maureen Orth in the Santa Maria courthouse complex, Jackson told his maid Blanca Francia "that he bleaches his skin because he does not like being black and he feels that blacks are not liked as much as people of other races." Orth was also informed that Jackson referred to blacks using unique names like "spabooks."
However in 1993 Jackson told Oprah Winfrey "there, as I know of, there is no such thing as skin bleaching. I've never seen it, I don't know what it is." It was in this interview that Jackson stated he had a skin disorder (vitiligo) and also stated that the disorder was hereditary, rather than something he caused, though he also said he used makeup to even out the uneven skin tone. "It is something I cannot help," explained Jackson. "When people make up stories that I don't want to be who I am, it hurts me. It's a problem for me. I can't control it. But what about all the millions of people who sit in the sun to become darker, to become other than what they are. Nobody says nothing about that." Jackson had also publicly stated that he was proud to be black. Winfrey's interview of Jackson was watched by 62 million Americans. It also started a public discourse on the topic of vitiligo, a relatively unknown condition before then.
Taraborrelli also stated that Jackson was diagnosed with lupus, that the vitiligo partially lightened his skin and the lupus was in remission and both illnesses made him sensitive to sunlight, which could have caused his lupus condition to recur. Jackson's autopsy did not confirm or refute the claim that he had lupus, and with respect to vitiligo, his skin was found to have a reduced (though not absent) melanocytes, the cells active in skin pigmentation, something which may be consistent with vitiligo.
To treat these conditions, Jackson used Solaquin, Tretinoin, and Benoquin. On June 29, 2009, multiple tubes of Benoquin and hydroquinone were found in Jackson's home. Both creams are commonly used to treat vitiligo; Dr. David Sawcer said some patients with vitiligo get to the point where it makes more sense to remove the brown bits because so much of the skin is pale.  On the other hand getting depigmented skin to darken is extremely difficult. Jackson also had hydroxychloroquine injected directly into his scalp regularly. The treatments he used for his condition further lightened his skin tone, and with the application of pancake makeup to even out his skin tone, he could appear very pale. For example, Stevie Nicks recalled, in a Rolling Stone interview: "I remember before [we performed at Bill Clinton's 1993 inauguration], Michael sent somebody to find out if I had any foundation make-up he could borrow. I was using some light Chanel foundation at that time, and Michael sent back a note to say, thanks, but the foundation wasn't quite light enough for him."
Vitiligo occurs in three different patterns. Segmental Dipegmentation means only one side of the body is affected, Generalized Dipegmentation means many parts of the body are affected.  Jackson's autopsy report states a "focal depigmentation of the skin," i.e. the depigmentation occurs on one or a few areas of the body. In Jackson's case, there were 5 affected areas.
In 1996, during the Australian leg of the HIStory World Tour, Jackson married his dermatologist's nurse, Debbie Rowe. The pair first met in the mid-1980s, when Jackson was diagnosed with vitiligo. She spent many years treating his illness as well as providing emotional support, and they built a strong friendship before their marriage. The couple divorced in 1999 and remained friends thereafter.
Cosmetic procedures and diet
Over time, Jackson's facial structure changed as well. Surgeons speculated he also had a rhinoplasty, a forehead lift, cheekbone surgery, altered his lips, and had a cleft put in his chin. Those close to the singer estimated that, by 1990, he had undergone around ten procedures. According to biographer J. Randy Taraborrelli, Jackson had his first rhinoplasty after breaking his nose during a complex dance routine in 1979. However, the surgery was not a complete success, and he complained of breathing difficulties that would affect his career. He was referred to Steven Hoefflin, who performed his second rhinoplasty in 1981. Katherine Jackson, though, has said in a recent interview that Michael intentionally got his first nosejob from Steven Hoefflin. Taraborrelli stated Jackson had a third rhinoplasty three years later and a fourth in 1986. Jackson wrote in his 1988 autobiography Moonwalk that, in addition to the two rhinoplasties, he also had a dimple created in his chin. From 1986 onward he was a regular client of Arnold Klein, a dermatologist who specializes in dermal filler injection, a non-surgical cosmetic procedure.
In his book, Jackson attributed the changes in the structure of his face to puberty, a strict vegetarian diet, weight loss, a change in hair style and stage lighting. Jackson denied allegations that he had altered his eyes. By 1990, the full extent of Jackson's surgery was widely debated; those close to him estimated he had undergone ten operations on his face up to this point. In June 1992, the Daily Mirror ran a full front-page picture, allegedly of Jackson's face, which they described as "hideously disfigured" by plastic surgery. Jackson sued the tabloid, and, in 1998, they agreed to an out-of-court settlement with Jackson. At the High Court, the paper's former editor acknowledged that after meeting Jackson in person, he believed that Jackson was neither hideously disfigured nor scarred at all. A Daily Mirror solicitor maintained that the publication did not tamper with the picture.
Media reports stated that Jackson's autopsy reported one scar beside each of his nostrils, one scar behind each of his ears, and two scars on his neck, "probably" from cosmetic surgery, plus cosmetic tattoos on his eyebrows, around his eyes and lips, and on his scalp (at his receding hairline).
In the unedited version of the documentary Living With Michael Jackson, which was shown in court in 2005, Jackson said he had two procedures on his nose so that he could breathe better. When he was asked about his cheeks, Jackson answered: "These cheekbones? No. My father has the same thing. We have Indian blood."
On the last day of the trial in 2005, the media used specific angles and lighting to accentuate Jackson's nose, as well as his cheeks and his skin tone.
In early 1984, Jackson was treated for scalp burns; his hair had caught fire during a shooting for a commercial.
On March 12, 1988, Jackson cancelled a show in St. Louis which was rescheduled for March 14; on March 13, Jackson performed in St. Louis although he was fighting a cold. The cold progressed to laryngitis; the show on March 14, was also cancelled. Three shows in Tacoma, scheduled from October 31 to November 2, 1988, had to be cancelled on his physicians' advice because Jackson had the flu. Two shows in Los Angeles were cancelled due to swollen vocal cords; three shows in Los Angeles scheduled for November 20, 21 and 22 were also cancelled; these five concerts were rescheduled for January 1989.
Among other things, laryngitis can be caused by an infection or an excessive use of voice. Treatment also includes voice rest. Jackson had been working with vocal trainer Seth Riggs for more than three decades. Riggs has developed a method which enables the artists to "sing safely."
In June 1990, Jackson was admitted to a Santa Monica hospital with chest pains. According to Dr. Mark Zatzkis "laboratory and X-ray tests of Jackson's heart and lungs revealed no abnormalities"; the pains "were caused by bruised ribs suffered during a vigorous dance practice".
In August 1992, a concert in London, England had to be postponed due to a viral infection. Four days later, Jackson performed in Cardiff, Wales. In September 1992, a concert in Gelsenkirchen, Germany was cancelled because Jackson was taken ill with the flu. In Lausanne, Switzerland, an ambulance took Jackson back to his hotel after the show held on September 8; another show in Basel, Switzerland, scheduled for September 11, was also cancelled. In October 1992, two concerts in Turkey, Istanbul and Izmir, and another one in Athens, Greece had to be cancelled due to loss of voice caused by a cold. His private doctor attended to Jackson in Istanbul. According to organisers Jackson's "vocal cords were irritated". These concerts were supposed to be the last three shows of the tour's European leg. Jackson attended to a throat specialist in London, and was advised to seek further treatment in Los Angeles.
In August 1993, two shows of Jackson's Dangerous Tour in Thailand had to be cancelled due to dehydration. On August 27, 1993, Jackson "returned to the concert stage". On August 30, 1993, a show in Singapore had to be cancelled due to nausea and a severe headache. In the opinion of his physician, Dr. David Forecast, Jackson "was in no condition to perform". A neurology specialist attended to Jackson. The specialist confirmed Forecast's diagnosis of "late-onset migraine", and medication was prescribed for Jackson who also underwent tests in a hospital in Singapore. The show was held two days later.
One cause for dehydration can be burns; the body loses fluids by water seeping into the damaged skin.
The first concert in Santiago de Chile, scheduled for October 21, 1993, was cancelled due to lumbar problems; two days later, Jackson performed at Estadio Nacional. Another concert in Lima, Peru, scheduled for October 26, 1993, was cancelled due to a torn muscle suffered during a show in Brazil. Several concerts in Mexico City were cancelled due to tooth problems. Two abscessed molars were pulled. However, there were five shows in Mexico City. The last concert of the Dangerous Tour was held in Mexico City, on November 11, 1993.
In November 1993, Jackson announced the cancellation of the remaining Dangerous Tour due to an addiction to painkillers which had been prescribed after a recent constructive scalp surgery.
It was also reported, Jackson cancelled shows in Russia and Israel. However, these two concerts did take place. The rescheduling of the concert in Israel was not due to health problems.
According to Dr. Neil Ratner, Jackson suffered a back injury in July 1997; one of the stages collapsed during a concert in Munich, Germany. However, the History Tour continued; there was only one concert cancelled after the fatal accident of Princess Diana about two months later. In fact, such an incident happened during a charity concert in Munich, in 1999. Jackson was later taken to a hospital. Jackson's promoter Marcel Avram said he [Jackson] received abrasions and bruises. Jackson left the hospital the next morning.
On February 15, 2005, Jackson was admitted to the Marian Medical Center in Santa Maria with "flu-like symptoms." According to Dr. Chuck Merrill, Jackson was in stable condition and would recover within a few days. Jackson left the hospital on February 16, 2005; Dr. Todd Bailey said Jackson "continued to need care for some persistent viral symptoms, but otherwise he was in good spirits." One week later, the jury selection for the child molestation trial resumed, in Jackson's presence.
On March 10, 2005, Jackson appeared late in court after having received treatment in a hospital due to a back problem. During the trial, Jackson occasionally needed help to get to his seat. On June 5, 2005 Jackson was taken to the emergency room at the Santa Ynez Valley Cottage Hospital to seek treatment of a back pain. Jackson's spokeswoman, Raymone Bain, said "stress contributed to the back problem". During the trial Jackson had been briefly in hospital several times.
Dr. Christopher Rogers testified in the trial against Dr. Conrad Murray that, in his opinion, Jackson "was healthier than the average person of his age."  Rogers said the arteries around Jackson's heart were free of fat and cholesterol, which is unusual for a 50-year-old individual.
Childhood and mental health
Jackson and some of his siblings stated that they were physically and mentally abused by their father Joseph from a young age, through incessant rehearsals, whippings and the use of derogatory names such as "big nose" for Michael; this abuse had affected Michael throughout his life. In one altercation—later recalled by Marlon Jackson—Joseph held Michael upside down by one leg and "pummeled him over and over again with his hand, hitting him on his back and buttocks". Joseph would often trip the boys or push them into walls.
One night while Jackson was asleep, Joseph climbed into his room through the bedroom window. Wearing a fright mask, he entered the room screaming and shouting. Joseph said he wanted to teach his children not to leave the window open when they went to sleep. For a number of years afterward, Jackson suffered nightmares about being kidnapped from his bedroom. By the early 1980s, he was deeply unhappy; Jackson explained, "Even at home, I'm lonely. I sit in my room sometimes and cry. It's so hard to make friends... I sometimes walk around the neighborhood at night, just hoping to find someone to talk to. But I just end up coming home."
Although it had been reported for a number of years that Jackson had an abusive childhood, he first spoke openly about it in his 1993 interview with Oprah Winfrey. He grimaced when speaking of the childhood abuse at the hands of his father; he believed he had missed out on much of his childhood years, admitting that he often cried from loneliness. In the same interview, speaking of his father, Jackson said, "There were times when he'd come to see me, I'd get sick... I'd start to regurgitate. I'm sorry... Please don't be mad at me... But I do love him." In Jackson's other high profile interview Living with Michael Jackson (2003), the singer covered his face with his hand and began crying when talking about his childhood abuse.
Jackson recalled that Joseph sat in a chair as the group rehearsed, saying, "He had this belt in his hand. If you didn't do it the right way, he would tear you up, really get you. It was bad. Real bad." In 2003, the singer was accused of child sexual abuse and was acquitted two years later. During the investigation, Jackson's profile was examined by Stan Katz, a mental health professional, who spent several hours with the accuser as well. According to J. Randy Taraborrelli, the assessment made by Katz was that Jackson had become a regressed ten-year-old. Some medical professionals have publicly stated their belief that the singer also had body dysmorphic disorder, a psychological condition whereby the sufferer has no concept of how his or her physical appearance is perceived by others.
Weight and drug addiction
The changes to his face were, in part, due to periods of significant weight loss. Jackson became slimmer in the early 1980s because of a change in diet and a desire for "a dancer's body". By 1984, Jackson had lost 20 pounds (9.1 kg), bringing his weight to 105 pounds (48 kg) on a 5-foot 9 (1.75 m) frame, the slimmest he had ever been as an adult. Witnesses reported that Jackson was often dizzy and speculated that he was suffering from anorexia nervosa. Following accusations of child molestation in 1993, Jackson stopped eating, losing even more weight.
In late 1995, Jackson was rushed to a hospital after collapsing during rehearsals for a televised performance (which was subsequently cancelled); a non-related writer claims that the incident was caused by a stress-related panic attack, while medics cited irregular beats, gastro-intestinal inflammation, dehydration, and kidney and liver irregularities. In none of these hospitalizations, including this one, did medics find drugs in Jackson's system. The BBC reported that during his 2005 trial, the singer again suffered from stress-related illnesses and severe weight loss.
A biographer states that in 1993, the entertainer admitted taking Valium, Xanax and Ativan to deal with the stress of the child sexual abuse allegations made against him, while Jackson himself does not mention sedatives, he stated that painkillers actually were prescribed to soothe excruciating pain that he was suffering after recent reconstructive surgery on his scalp. A few months after the allegations became news, Jackson had lost approximately 10 pounds (4.5 kg) in weight and had stopped eating. In a court deposition unrelated to alleged child abuse, Jackson was visibly drowsy, lacked concentration and repeatedly slurred while speaking. He could not remember the dates of his prior album releases or names of people he had worked with. It took him several minutes to name some of his recent albums.
Jackson also stated during the 1993 interview that he first began taking painkiller medications regularly in 1984. In January 24 of that year, Jackson was filming a Pepsi commercial when his hair caught on fire from faulty pyrotechnics on stage that were intended to be part of one of many being filmed. He sustained second-degree burns to his scalp and never fully recovered from the injury or from the lingering pain. He reportedly began taking the painkillers after refusing at first in order to deal with the intense pain.
On November 8, and November 10, 1993, Jackson was questioned about a copyright matter. According to the sworn declaration from the plaintiffs' lawyer, he had been told that Jackson "was taking painkillers because of recent oral surgery."
In November 1993, Jackson announced that he was addicted to painkillers; he said he had recently undergone a scalp surgery, and the painkillers had been prescribed. Jackson said due to the pressure caused by the child molestation allegations, and the energy he needed for the Dangerous Tour he was "physically and emotionally exhausted". He said he had "become increasingly more dependent on painkillers", and would seek treatment. His lawyers said, Jackson would be treated for addiction overseas for one and a half months to two months. In December 1993, Jackson returned to the United States.
Jackson's health had deteriorated to the extent that he cancelled the remainder of his tour and flew with friends Elizabeth Taylor and her husband to London. When the singer arrived at the airport, he had to be held up by his two friends; he was then rushed to the home of Elton John's manager and then to a clinic. He was searched for drugs on entry; vials of medicine were found in a suitcase. He took over the fourth floor of the hospital and was put on Valium IV to wean him from painkillers. The singer's spokesperson then told reporters that Jackson was "barely able to function adequately on an intellectual level". While in the clinic, Jackson took part in group and one-on-one therapy sessions. According to Taraborrelli, in January 2004, as his trial approached, Jackson became dependent on morphine and Demerol and was being treated for this dependency by herbalist Alfredo Bowman in Colorado.
In an interview with Aphrodite Jones, Patrick Treacy, a cosmetic surgeon who treated Jackson between July 2006 and early 2007, as well as shortly before his death, stated that he would have known if Jackson would have been also treated by another physician and that he never saw any drugs in the house. He also said that Jackson did not have insomnia and never asked him for narcotics. Treacy stated Jackson was in good physical health; he said Jackson always insisted on the presence of an anesthetist when Propofol was administered.
Jackson was 5 ft. 9in and weighed 136 lbs, which would be within a normal weight range, although he was thin, Dr. Rogers testified in court. According to his costumer Michael Bush, Jackson lost so much weight during a concert due to loss of water that the costumes Jackson wore at the end of the show had to be smaller than those he wore at the beginning of the show; usually, he was a 28-inch waist. According to Dr. Nader Kamangar, a sleeping expert at UCLA drugs such as Demerol can cause insomnia. In the case of Jackson, insomnia could have been caused by "anxiety for performing" as well.
Following Jackson's death, a police warrant issued against his attending physician, Conrad Murray, stated that Jackson's many doctors had used nineteen distinct aliases, such as "Omar Arnold," "Josephine Baker," "Fernand Diaz," "Paul Farance," "Peter Madonie," "Faheem Muhammad," "Roselyn Muhammad," "Blanca Nicholas," "Jimmy Nicholas," "Bryan Singleton," "Frank Tyson," and "Rob Kaufman" while prescribing medications for Jackson. He also took prescriptions as "Prince," "Michael Amir," and "Kai Chase," the names of one of his sons, his spokesperson, and his former personal chef, respectively. Police found a CD mentioning the "Omar Arnold" alias when they raided the Las Vegas, Nevada home and office of Conrad Murray, Jackson's personal physician. Use of pseudonyms by celebrities' doctors is common practice for maintaining the confidentiality of patients' medical history, and does not necessarily indicate addiction.
Following Jackson's death, reports of his use of pethidine (Demerol) surfaced. Cherilyn Lee, a nurse who provided nutritional counseling to Jackson, said that on April 12, 2009 he asked her for unspecified "products for sleep." On April 19, 2009 he told her the only medicine that would help was propofol. Lee refused, telling him, "Michael, the only problem with you taking this medication ... is you're going to take it and you're not going to wake up." Jackson dismissed the warning, telling her he had been given the drug before, by IV injection, and that his doctor told him it was safe. He did not name the doctor. An overdose of propofol can cause the patient to stop breathing, leading to a shortage of oxygen and a buildup of carbon dioxide in the body which can lead to arrhythmias and cardiac arrest. It was the last time they met.
Due to an enquiry about a cancellation insurance for the upcoming tour, insurance carriers demanded a medical exam by a doctor they trusted. In February 2009, Jackson had an examination performed by Dr. David Slavit of New York. Later, the broker told an AEG senior vice president Jackson had only slight hay fever and had passed the exam "with flying colors". A second medical exam was supposed to take place on July 6, 2009.
According to Lee, she received a frantic call on June 21, 2009 from an aide on Jackson's staff. The aide reported that Jackson was feeling ill. Lee reported overhearing Jackson complain that one side of his body was hot, the other side cold. She believed that somebody had given him something that affected his central nervous system. She advised the aide to take him to the hospital.
After his death, the autopsy report revealed that Jackson had a strong heart and was a "fairly healthy" 50-year-old. According to BBC, his weight was in the acceptable range for a man of his height, but he had punctured arms, and suffered from lung damage and some arthritis. The document shows that Jackson's most serious health problem was his chronically inflamed lungs, but this was not serious enough to be a contributing factor to his death. The post mortem did not uncover any physical problems that may have limited Jackson's ability to perform. "His overall health was fine," said Dr Zeev Kain of the University of California, who reviewed the report for AP but was not involved in the post-mortem examination, "The results are in normal limits." The autopsy also revealed that he was partially bald, and that his lips, eyebrows and scalp were tattooed.
In 2011 Dr. Rogers said in his testimony: "The theory that seems less reasonable to me is that Mr. Jackson woke up, and although he was under the influence of sedative medications, managed to give himself another dose." Toxicologist Dan Anderson testified that Demerol was not detected in Jackson's system.
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