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Chatham Facial Plastic Surgery

A Case of Mistaken Expression!


Much is made about one’s face and facial expressions. With our active facial muscles capable of myriad expressions, sometimes just one look is all it takes to read a person’s face. Is that face happy or sad? Angry or frustrated? Quizzical or confused? Just a little more or less muscle action furrows the brows or changes the lips or brightens the eyes. In an expressive personality, feelings quickly come to the surface.

I can read your face in a second” she says. Women DO seem intuitively better at gauging facial expressions.

But what if she was wrong? What if we really did not mean to communicate THAT feeling? It was case of ‘mistaken expression’.

Patients often say to me “I come across angry” but I am really not angry, my brows make me look that way.” Or “the creases by my mouth make it look downturned and I look pouty and sad”.Recently a New York Times article addressed a common social phenomenon: the RBF. Not for the puritanical, but RBF stands for ‘resting bitch face.’ RBF is a face that, when at ease, is perceived as angry, irritated or simply … expressionless.  So now we reach the opposite facial spectrum, the imposingly negative face with no expression at all. (AKA, “my please don’t ask me what is wrong face”). Some celebrities seem well known for this look!

As a facial plastic surgeon, I commonly hear from patients who seek an improved neutral appearance,  longing to correct their “permafrowns” (primarily from women).

So what to do? Does it really matter what our face communicates when we are not thinking about it? Do others really judge us on this? Well maybe it matters a lot, or maybe not. Reality check: most of us do interact with others; our families, friends, co-workers, the public. And last time I checked, most of us cared at least a little what others think of us.

But how much should we try to please others? Does this mean putting on a fake happy face all the time? Well, no….but fake happy faces do have their place. Some research suggests that if we practice smiling, this can actually lift our mood. Research from Mindlab International in England found that a warm smile creates a ‘halo’ effect which helps us feel more optimistic, positive and motivated. People who look “happy” are generally deemed more trustworthy, too. Smiling also releases endorphins and relieves stress, in addition to preventing us from looking overwhelmed, worn out, or tired.

Several years ago, on a snow covered Colorado mountain ski trail, I hired an instructor to try to help me improve my efforts. After a few downhill runs, he said ‘Your form is not bad but you are very stiff. You need to loosen up”. How? “I want you to put on a big smile going down this next run.” I exclaimed: “How can I smile when looking down at this steep mountain of potential wipeout and injury?” But smile I did, all the way down. And the rest of my body followed my fake smile, loosening me up, leading to a much improved technique and easier run. I learned that day that changing my facial expression, even if forced, helped the rest of my body perform better.

We have treated many patients with Botox to reduce unwanted forehead furrows and fillers to plump up ‘sad mouth creases’. Does this really make a difference? First, the Botox or Dysport drug does indeed weaken the unwanted muscle action, leading to positive changes such as fewer creases and better elevation of a downward brow.

But equally important is what happens after people have received Botox or Dysport in the brow area and can no longer ‘furrow’ and scowl. The brain now unconsciously recognizes this as a very very good thing and an increased positive mood is the result. That’s right, they are happier. This was reported in 2009 at the University of Cardiff in Wales. My colleague Pat Treacy, MD of Ireland has researched this, as well. Since all the Botox in the world is manufactured in Ireland, this has intrigued him and he confirms that people are happier when they cannot scowl. (Will Botox and Dysport one day be used as a mainstay to treat depression? Maybe)

I argue that Botox and fillers are not for every adult. Who wants needles and discomfort and expense if you can avoid it? But there can be no denying that our unconscious facial expressions do have a significant impact on how other people perceive and feel about us. When we unwittingly communicate a negative mood such as anger or disgust or negativity, it makes it harder for others to appreciate our good side. When we are able to project a more positive expression we become more approachable and attractive. One of my facial plastic surgery colleagues, Rich Castellano, MD of Florida, actually teaches & lectures on  the benefits of smiling. 

So whether we achieve this by conscious behavior (smile even when we don’t feel like it), or just become more aware or our own facial effects or maybe we even undergo a cosmetic procedure or injection, all of these methods can reap positive benefits.

So enough with the RBF, and the furrowed brows. Smile and the world smiles with you.

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