Resting bitch face: Disease-mongering plastic surgery news

The following is a guest blog post by Carolina Branson, PhD, an associate editor for As noted below, her graduate research was on women’s health issues in the media.

“Facial plastic surgery improves perception of femininity, personality, attractiveness.” When I saw this headline from a recent news release from JAMA Facial Plastic Surgery, it made me cringe. What it said to me was, “Women should get plastic surgery because it will make people like them more.” The conflation of beauty with health in the media is one of my pet peeves.

Predictably, this news release drew some journalists’ attention:

NBC News must have loved the “resting bitch face” phrase that came from the surgeon/author of the journal article because they reported it and hyperlinked from that phrase back to an earlier NBC story from two years ago, “TODAY anchors check if they have ‘bitchy resting face.’ ” And that story linked to a You Tube video on bitchy resting face that has drawn more than 6 million visits.

A simple web search shows many humorous take-offs on the theme of “resting bitch face” or “bitchy resting face.”

Bitch Face 1

Bitch Face 2

But we’re not laughing at the disease-mongering that has also occurred.  It’s one thing to talk about this label in the context of young women who are told they “need to smile more,” or even to describe the “supermodel pout,” that is not related to aging and is also not necessarily unattractive. It’s quite a different matter to frame a normal consequence of aging as a problem requiring a surgical fix.

We recently received a news release from a plastic surgeon who described how various facial features might be perceived by others, such as:

  • Thin lips = mean, older, strict/stern
  • Lines/folds around the mouth or down from the corners = mean, unapproachable, unfriendly, harsh, scowling
  • Beady, non-open looking eyes = shifty, tired, uninterested, apathetic, bored/boring
  • Deep folds/lines between the eyes  = angry, grouchy, stern, scolding
  • Low, flat arched eyebrows = tired, stressed, exhausted
  • Too high arched eyebrows = giddy, ditzy, hyper
  • Low eyebrows folded towards the center = judgmental
  • Large, non-refined or bottom heavy nose – looks masculine, non-feminine, rough, older

Lo and behold, that surgeon touts the ability to do “expression surgeries” meant to improve resting facial expressions. He wrote:

What can be done for each feature to combat Bitchy Resting Face?

Lips: Filler or fat injections to restore fullness and soften scowl lines/folds around the mouth or lips – look friendlier, happier.

Eyelids: Botox can make the eyes look more open and rested. An eyelid lift for the upper eyelids or chemical peel or laser for the lower eyelids is the more advanced version.

Nose: Rhinoplasty to feminize the nose.

Brows: Proper aesthetic brow waxing/shaping, or Botox to lift, better shape, better arch the brows or a browlift procedure – all  for a more open, awake and less stressed look

Forehead : Botox works best for smoothing out these classic frown lines.

So it seems that some plastic surgeons have been able to expand their business by performing these facial pick-me-up procedures.

In my dissertation, entitled, “The discursive construction of Complementary and Alternative Medicine (CAM) in women’s popular health media and medical journals,” I researched women’s aging as depicted in media representations. So when I saw the JAMA Facial Plastic Surgery journal news release and the subsequent media coverage I was eager to explore how this study was covered.

The authors in this particular study make the claim that likability, social skills, attractiveness and femininity all increased when raters compared preoperative and postoperative pictures of 30 white women who had plastic surgery. In all, the study was based on people rating 60 pictures.

Is this another example of disease-mongering? It makes claims about the benefits of an intervention (in this case facial plastic surgery) in terms of how it may affect others’ perceptions. This claim is particularly powerful for women who are self-conscious about aging or have low self-esteem. The two procedures which the study claimed had the most impact on other’s positive perceptions were face lift and lower eyelid surgery, which are by no means completely safe or inexpensive procedures. Any surgery including cosmetic, carries risks including infection, bleeding, scarring, nerve damage, or in some rare cases, anesthesia-related death.

The study also had additional flaws. According to Dr. Steven Miles, bioethicist at the University of Minnesota, the means of evaluation the raters used (a likert scale from an off-the-shelf online survey tool) is “not even remotely validated.” Miles notes, “There are scientifically validated scales for all of these parameters (trustworthiness, etc.). The ‘researchers’ decided real science was too hard.”

Dr. Susan Molchan MD, psychiatrist and contributor, also found fault with the statistical significance of the study. She notes the researchers did not correct for multiple comparisons. “I’m surprised they didn’t even address this, she said. In contrast, the study authors claim that “there was strong statistical significance to the data.”

But let’s return to the journalism about this journal article.  The Washington Post offered a fairly good summary of the research results. It included a quote from co-study author Michael J. Reilly, assistant professor of facial reconstructive surgery at Georgetown School of Medicine, in which he acknowledged the potential drawbacks of cosmetic surgery, “Each individual is taking on the potential risk of negative results…You might come out looking less likable, or less socially skilled, [as was the case for four of the women in the study] which can obviously have lots of impacts in someone’s daily life.”

But there was no independent expert perspective in the Washington Post story, something that was an important addition in a story on, even if it was simply quoting from an editorial that appeared in the same journal in which Reilly’s paper appeared.  TIME pointed out some of the limitations of the study, including making an important point that our society tends to have a negative view of aging, so that younger looking faces would be rated more positively. TIME asked, “Yet couldn’t aging also be seen in exactly the opposite light, as a factor that makes someone more adept and experienced at social interactions and therefore more likeable than a younger person who is more awkward and uncomfortable navigating among strangers?”

That NBC story I mentioned at the beginning had flaws.   It didn’t do a great job of reporting the study but instead emphasized the negative effects of aging and the great potential of plastic surgery to improve one’s social interactions. In addition, the article focused on an extremely negative characterization of older women. The piece quotes Reilly as saying, “My theory…it’s kind of, you know, basically resting bitch face. But some people, you just look at them and you think this person, they’re smart. They know what they’re talking about. I trust them. Or wow, I would love to get to know that person better.” To that, I would add my own “Wow.”  Shouldn’t NBC have found someone to counter this disease-mongering promotion of surgery?

The NBC story also holds up the experience of one woman from the study as representative of the findings. The woman in question, Donna Andersen, supports the “resting bitch face” theory, as she says she felt she was being treated differently because of her aging face and that people thought she was angry when she wasn’t. Donna comments, “I just feel like I am being treated differently [after the surgery]. I wasn’t looking for that so much. I just didn’t want to be perceived, when I am meeting somebody, as angry.”  The article ends: “The effects may look subtle in photographs, but Andersen says the $13,000 worth of surgery is worth it for her. “I am the talk of all my friends,” she said. We have no way of knowing if that is representative of all women in the study.

The publication of this study and of the news stories that followed provide a classic example of disease-mongering.  As presented, aging becomes a problem to be solved, because looking more youthful has these supposed social benefits. These messages reinforce the stigma of old age as a “problem” to be solved rather than a natural progression of life. News stories, that are supposed to independently vet claims, instead offered no independent perspectives and reinforced a narrative that suggests plastic surgery will enhance one’s life, without interrogating the social, financial, or ethical implications of this surgery and of this topic.

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Comments (4)

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Liz Scherer

May 19, 2015 at 10:38 am

As someone who spent years writing on menopause and aging, I cannot thank you enough for this sensitive and timely assessment. Disease mongering, indeed. And yet, it’s only the tip of the iceberg. Vaginal rejuvenation is another hot ticket item that deserves a gander.

    Carolina Branson

    May 19, 2015 at 3:57 pm

    Thanks for your response. I agree, there is a lot of ground to cover in the way the media covers women’s health in general, and aging in relation to women’s health, in particular.

Alina Fernandez

May 19, 2015 at 5:13 pm

Great article! I wish the word would get out more especially to young teens who also consider surgery to “fit in” more.


May 21, 2015 at 4:37 pm

Great read!
13 grand so that you think people won’t think you look like a bitch. ugh