Michelle Elman underwent 15 surgeries before the age of 20 due to a brain tumor, a punctured intestine, an obstructed bowel, a brain cyst, and a condition called hydrocephalus. After noticing the lack of representation for people with scars online, the UK-based body confidence coach decided to address the issue head-on in 2015, when she shared a photo of herself rocking a two-piece swimsuit on Instagram.

Part of Elman’s caption read: About a month ago, I finally faced up to wearing a bikini and although I love my body thoroughly and have for many years—this was one of the most difficult things I have ever done, yet once it was on, it was one of the most liberating feelings to know that I wasn’t letting two pieces of material stop me from being comfortable in my own body. My belief is that no one should have to feel ashamed of their body, whether you have stretch marks or a C-section scar so… THIS summer, let’s stand up and be proud of our scars and what they represent—a story!

Racking up thousands of likes on Instagram, the photo went viral—fast forward to 2018 and Elman is now the author of a thought-provoking memoir, titled Am I Ugly?, which details her decades-long journey to body positivity as it relates to overcoming multiple life-threatening health issues and how that takes a toll on one’s self-image.

I spoke with Michelle Elman about Am I Ugly?, inspiring strangers to love themselves, dealing with internet trolls, and more:

What’s your view toward the body-positivity movement as a whole? Do you like where it’s going, or is there room for improvement?

I still strongly believe in body positivity, and I believe the criticism around lack of inclusivity is going to make it stronger in the long run. I think we need to protect our movement and make sure it stands up for the people it was always intended for.

What do you want people to understand about body positivity?

I want people to realize that body positivity and body confidence are different and separate things. Body positivity is a political movement created to fight the oppression of people who live in marginalized bodies and end the stigma they face on a daily basis. Body confidence is your personal journey and relationship with your body. You can be body positive without being body confident, and you can be body confident without being body positive.

How do you handle negative comments on social media?

I am practically immune to comments about my appearance because I don’t base my worth on my looks, but it’s the comments about my character or personality that tend to affect me. On a good day, I don’t care at all, but on a bad day, every word hurts like it’s being said by my best friend, so I make sure to recognize that it has nothing to do with the comment, and it has much more to do with what is going on in my life at that moment.

When you first launched your platform, were you surprised by the overwhelming amount of positive feedback you received from strangers?

I’ve been running my account for four years, so it has been quite gradual. In the beginning, when I spoke about scars in particular, the feedback was rarely ever positive. At the time, a lot of people believe scars should not be seen and that it wasn’t “necessary” to be discussed, and I am proud to be part of the shift in attitudes toward scars.

Tell me about Am I Ugly. What motivated you to write this?

Am I Ugly? is my memoir, the story of me going through 15 surgeries and the impact it had on my body confidence. I believe illness is an important aspect of body positivity that isn’t discussed enough and my book really shines a light on that.

For people without illness, it gives them perspective and makes them realize the health that they take for granted every day. It focuses on setting the foundation of respecting and appreciating your body. What motivated me to sit down and write it was when I was in a hospital bed at 19, I was convinced I was going to die, and I was obsessed about leaving something permanent in this world. All I had done with my life so far was study, and I wanted my life to count for more—so I started writing.

Follow Michelle Elman on Instagram @scarrednotscared and @bodypositivememes.

Princess Gabbara is a multimedia journalist and storyteller. Follow her on Twitter and Instagram @PrincessGabbara. Visit her website at princessgabbara.com.