Botox Nation: Changing the Face of America by Dana Berkowitz, and: The Ways Women Age: Using and Refusing Cosmetic Intervention by Abigail Brooks (review)

Interventions to reduce signs of aging are a highly gendered phenomenon. Women are much more likely than men to be penalized for looking older. Correspondingly, they are also more likely than men to engage in cosmetic interventions to reduce the signs of aging, particularly in the face – at a ratio of approximately 10 to 1.

Feminist sociologists Dana Berkowitz (Botox Nation: Changing the Face of America) and Abigail Brooks (The Ways Women Age: Using and Refusing Cosmetic Intervention) explore what it is like to age as a woman from different angles, yet reach similar conclusions. Botox Nation focuses on younger women mostly in their 20s, 30s, and 40s, whereas The Ways Women Age involves women ages 47 to 76. Berkowitz interviewed younger women who had had only Botox treatments and had it done for preventative reasons (i.e., they had been convinced that early use would prevent wrinkles from developing). Thus, her book focuses on women who feared looking older but were not yet likely at the point where they were seeing major age-related changes in their faces when their procedures were carried out. In contrast, Brooks’ interviewees were old enough to have experienced very noticeable changes in their faces and bodies (e.g., eyelid drooping and excess neck skin). Moreover, they had had a range of cosmetic surgeries (e.g., eye lifts, tummy tucks) and cosmetic non-surgical interventions (e.g., Botox, facial fillers). Brooks also interviewed women who actively resisted having such treatments. Berkowitz used data sources that Brooks did not: interviews with Botox providers and a few gay men, analysis of mass media reports and promotional material, and an autoethnographic component in which she describes her experiences with two Botox injections.

Botox Nation’s introduction provides the reader with an overview of Botox and biomedicalization, and of the anti-aging industry. The first chapter (of six) then describes how Botox has been marketed over the years, particularly its increasing promotion as preventative. Turf wars over Botox, such as between dermatologists and medi-spas, are the focus of chapter 2. The third chapter considers conditions that lead women to become and remain Botox users, such as getting a good deal (e.g., a Groupon), and having a social network with many users, which increasingly normalizes Botox and puts pressure on non-users. Chapter 4 explores how women grapple with the tensions and contradictions of having Botox treatments, arguing that a one-dimensional characterization of Botox users is undeserving. This chapter also examines how women justify Botox use (e.g., it helps them get ahead in the workforce; it’s a personal choice that helps them feel good about themselves). In describing what it is like to “be in a Botoxed body,” chapter 5’s focus is on physical and psychological impacts. Berkowitz identifies the connection between the expectation that women are socialized to never show negative emotions, and illustrates how Botox solves this problem, albeit temporarily, by getting rid of “bitchy face” (p. 143), which occurs when a woman’s face looks angry or upset, despite not having such feelings. The concluding chapter revisits the feminization of Botox and the marketing of it to certain women (White, middle class), and the “troubling” of the body – a situation in which people come to expect a “technologically enhanced” (p. 163) body.

Because Brooks interviewed older women who had actually undergone physical changes as a result of aging, her book is quite different from Berkowitz’s. These women’s stories demonstrate that age-related changes can “challenge a woman’s fundamental understanding of herself, of who she is” (p. 29). In the introduction, she provides an overview of how the development of profit-based medicine, the pharmaceutical industry, mass media, conspicuous consumption, and a “screen-saturated culture” (e.g., social media, cell phones with photo-taking...