Does cosmetic surgery make you angry? Credit: Getty

January 26, 2023   5 mins

One of my closest friends is allergic to Botox, which was exactly as terrible a discovery as you might expect. It started while she was still at the doctor’s office, with a burning sensation at the injection site. (“That’s just your imagination,” the dermatologist said.) That sensation promptly turned into a bizarre, patchy rash. (The dermatologist: “I’ve never seen that before.”) Eventually, it gave way to spasms, which though infrequent were intense enough that her husband and kids could see them as they happened, her facial muscles jumping and writhing under her skin like something out of a horror film.

This experience was alarming, but fortunately short-lived. Botox, which smooths wrinkles on the skin by paralysing the muscles underneath it, is cleared from the body within three to six months — at which point the injectee, or the ones not allergic to Botox at least, return for another round. Indeed, it’s a built-in expectation of the whole Botox industry that women (who were the recipients of 95% of the 4 million Botox treatments performed in 2020) keep coming back for more; some proprietors have even begun to offer discounts or bundles for returning customers, not unlike those Subway sandwich punch cards that give you one free tuna melt for every ten you eat. There’s an entire dissertation to be written about the normalisation of non-surgical plastic surgeries, the endless drone-like march of women into clinics for their biannual dose of injectables, but the cultural conversation about these procedures often ignores the fundamental reality that Botox is popular — despite the cost, despite the risks, despite the horror stories of half-frozen faces and drooping eyelids — because it really, really works.

“I’m so angry,” my friend texted me, the week her face finally stopped twitching. “Because I really really liked the way it fixed my elevens.” And yet, there’s something enviable about my friend’s position — not the nightmarish months of uncontrollable twitching, but the paradoxical freedom she now enjoys of not having a choice. Imagine the serenity: never having to decide whether or not to do Botox, or, having done it, when or whether to stop.

That women will confront this decision is something of a foregone conclusion, as illustrated by the endless bombardment of Botox-related media stories, advertisements, personal essays, and gossip magazine features in which plastic surgeons debate which celebrities have what done to their faces. The reasons to get it done are simultaneously myriad and yet, at base, all the same. We want to look rejuvenated, which is to say, younger. Or to look less tired, or less angry — which is to say, again, younger. Botox erases the effects not just of time but the human experience: disappointment, grief, rage, joy, any emotional disturbance that causes expression that in turn puts lines on your face. If you inject a paralytic toxin early enough, often enough, maybe you can look like a person who hasn’t lived at all.

Indeed, the rise of injectables has changed the nature of the game from restoration to preservation. Gone are the days of waiting until things are dire enough to merit going under the knife, waking up bruised and battered but with the promise of looking 10 years younger after the bandages come off. Now, the thing is to simply never allow the effects of age to take hold at all. My own dermatologist assured me that the best time to get Botox was before you actually look like you need it. “If you can’t make that face, you won’t get these wrinkles,” she said, which gave me the disturbing sense that by getting Botox I would be not so much protecting my skin as changing my destiny. They say that smiling can be an instant mood-booster, because the movement tricks your brain into thinking you’re happy even when you’re not; what happens to the brain of a person who’s been physically unable to scowl for years? Is it as smooth as her forehead? Smoother?

It is tempting to put this new standard of beauty, one maintained at the tip of a needle, in the context of broader questions about feminism and empowerment. Objectively, certainly, it is better to be beautiful: attractive people are paid better, promoted more, received more warmly by society. But what of the patriarchal system that defines beauty to begin with? Is the woman who improves her appearance with injectables — or, rather more to the point with Botox, preserves whatever beauty and hence privilege she already possesses past its usual sell-by date — guilty of sustaining a paradigm that leaves women in general worse off? On the one hand, in some ways, maybe; on the other, surely this is a ridiculous burden to lay upon any one woman’s brow, no matter how unwrinkled.

And then, too, there are the women who never opt into that paradigm in the first place. Another friend, the novelist Leigh Stein, recently tweeted her relief at never having felt compelled to nip, tuck, or inject herself. “The benefit of never having been beautiful is that I don’t feel the pressure to maintain my face,” she told me. I will note here that various commenters disagreed vehemently with Stein’s assessment of her looks, but again, her peace of mind seems enviable. I have never been the kind of beautiful that stops traffic or entices modelling offers, but I am nevertheless aware of my face as an asset, one which has been periodically valuable to me but is now sliding inexorably toward the floor.

For this reason, I have had Botox: four times in all, starting at age 35, when I began receiving injections once a year, except for the one time when it was more like 18 months. The haphazardness of my commitment is not due to any great moral ambivalence about plastic surgery; I’m just lazy. And because I took the advice of the dermatologist who urged Botox as a wrinkle-preventing mechanism, the injections don’t actually make any measurable impact on my appearance. I look the same; what’s different is that I feel — bizarrely —like I’ve accomplished something.

Maybe I have. All cosmetic interventions — the Botox and the serums and the lip-plumping injections, the waxing and lasers and liposuction — somehow fall under the dubious banner of “self-care” rather than the comparatively unsavoury one of “egregious vanity”. Yet despite being dressed up as something almost altruistic, an act of caring for yourself the same way you’d care for an elderly parent or a potted plant, self-care often seems more a question of caring about how your self is perceived. (It is perhaps no coincidence that the pandemic saw a surge in patients seeking Botox injections, having been tormented for months by the sight of their own haggard faces while attending meetings on Zoom.) How much does it matter to you, to keep up the appearance of not being past your prime? How much are you willing to invest — in time, in money, in subjecting your face to routine maintenance, like a car?

The thing about Botox, of course, is that it’s a gateway drug. If you do it once, you’ll probably do it again — but you’ll probably do other things too, eventually, until you end up with a face that is perhaps more youthful than the one nature would’ve given you, but also no longer entirely yours. I see these women from time to time, the ones who decided long ago on the latter option, their cheeks so eerily smooth and plump that they seem like they’re peering out from behind a mask. There’s something fascinatingly remote about them, and not just in their apparent lack of concern for the way others view them, with voyeuristic judgment and ridicule. They no longer look anything like their younger selves. They don’t look like the mother or aunt or grandmother they might have grown to resemble. They don’t look entirely human, really. But they do look like each other, a strange sisterhood of choice.

I don’t intend to join them, but I wonder if anyone ever does.

Kat Rosenfield is an UnHerd columnist and co-host of the Feminine Chaos podcast. Her latest novel is You Must Remember This.