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 capabilities, tablets, and laptops) have influenced women’s views of aging. The first chapter focuses on women who engaged in cosmetic interventions, and the second and third chapters describe “naturally aging women” and those who reject cosmetic interventions. The final three chapters broaden out to the larger context. Chapter 4 focuses on the “cosmetic anti-aging-product-saturated culture” (p. 28). Chapters 5 and 6 distinguish between the networks of women who have aesthetic work done (e.g., encouraged by friends; male partners rarely consulted or involved in their decision making) and those who do not (e.g., they bond with friends in their resistance to anti-aging messages).
The concepts of invisibility and beauty privilege permeate both books, but in different ways. I read Berkowitz’s book first, thus starting with a perspective that focused on young women’s fears of being invisible, which led to their Botox injections. Then I read Brooks’ book, which included reflections about what it actually is like to feel invisible, which also led to cosmetic interventions. Beauty privilege, which Berkowitz names in her concluding chapter, is linked with this fear or experience of invisibility. “Women with beauty privilege are more likely than those who have not experienced these privileges to see aging as a crucial threat to their embodied cultural capital” (Berkowitz, p. 169), and thus they engage in Botox as a means of preventing their loss of beauty privilege. Older women who partake in cosmetic interventions, similarly, have identities that are strongly tied to being someone who, in the past, was recognized by others as attractive, and they therefore see their age-related changes as a loss. How beauty is defined may be key. Notably, the naturally aging women in Brooks’ study still received the broader messages about heterosexual femininity and youth-focused beauty, and many of them still felt a sense of loss in response to their changing faces and bodies. But they found ways to redefine beauty. For example, “the increased capacity of the aging body to communicate the complexity of lived experience, and inner character, over time” (p. 75) was now seen as beautiful.
Nevertheless, it is not just as simple as women changing their definitions of aging, which focuses on individual responsibility and can blame women themselves for how they respond to aging. Moreover, there is a danger in simply describing women’s decisions to partake in cosmetic interventions as empowering, individual decisions, given that their decision making takes place within a context whereby they are regularly bombarded from multiple angles about what they should look like and what they should be concerned about. Some may try to resist these messages, but then simply “[resign] their bodies to their ageist culture” (Berkowitz, p. 151). Both books are very clear about the role of the medical industrial complex in creating anxieties in people that, when acted upon, financially benefit anti-aging technology providers and pharmaceutical companies. Brooks also discusses the media’s role (e.g., the increasing number of Botoxed female actors seen on the screen and in social media). Finally, Brooks and Berkowitz both point out the danger implicit in increasing numbers of women using such technologies, which is that women who do not partake in such procedures will be both vilified and shamed for not “aging well” and also for not doing anything about it.
Botox Nation and The Ways Women Age show how women approach aging and raise broader questions about what it means to “age successfully”. The authors demonstrate intersections between race, class, sexual orientation, and gender; bring to the forefront the multidimensional layers of women’s decision making regarding cosmetic intervention; and show the complexity of women’s experiences of aging, which are “simultaneously individual and social, cultural, and economic” (Brooks, p. 28). These books will interest researchers studying women and aging, and they will also be great additions to gerontology courses on topics such as women and aging, healthy aging, health systems, and ethical issues in aging.
