In a recent commentary on the Minnesota-based HealthNews Review.org website, one of the organization’s associate editors, Carolina Branson, does a great job of taking plastic surgeons — and the media — to task for disease-mongering about aging, specifically about facial aging.
Or, even more specifically, about the aging of women’s faces.
I must admit, until I read Branson’s article, I’d never heard the phrase “bitchy resting face” (also called “resting bitch face”), which apparently came to fame in a 2013 video spoof of medical PSAs by the creators of Broken People, a YouTube channel. But I do receive frequent press releases from plastic surgeons and other sources that try to, as Branson puts it, “frame a normal consequence of aging as a problem requiring a surgical fix.”
I ignore those releases. Some of them are incredibly offensive — and ludicrous. Branson quotes from one such release (which I had not seen before) in which a Philadelphia-area plastic surgeon makes the following warnings about how certain facial features (common to just about everybody) might be perceived by others (and thus why you should run out and get them corrected):
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
Incredibly, the press release actually refers to these features as elements of “bitchy resting face” — a “syndrome” made up by comedians.
A problematic study
That press release is so over the top, it’s hard to believe anybody would take it seriously. But other releases — ones associated with studies in peer-reviewed journals — have the appearance, at least, of gravitas and thus tend to be more influential, with both the public and the press.
One of these studies was published online in April in JAMA Facial Plastic Surgery. The press release that accompanied it is titled “Facial plastic surgery improves perception of femininity, personality, attractiveness.”
Branson explains her concerns with the study:
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 HealthNewsReview.org 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.”
Needed: caveats and context
Many media outlets, however, went ahead and reported the findings without these caveats — or without any context regarding societal stereotyping of attractiveness and aging.
One media story even quotes an author of the study as saying this: “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.”
Apparently, he will only make the effort to get to know such people if they first get their face “fixed.”
“The publication of this study and of the news stories that followed provide a classic example of disease-mongering,” writes Branson. “As presented, aging becomes a problem to be solved, because looking more youthful has these supposed social benefits.”
The older face as a problem to be solved: No wonder so few people are smiling.
You can read Branson’s entire commentary on the HealthNewsReview website.