Modern Morals: Should I tell my friend she’s gone too far with Botox?

She’s beginning to look silly and I think it’s time to say something. My concern is she has always been a little bit self-conscious and I don’t want to make her feel bad about herself. What should I do?

Answer: Thanks to social media and more attainable prices, the stigma around cosmetic intervention has dramatically decreased in recent years. Yet while procedures such as Botox and fillers have been normalised, they are still, for the most part, a touchy subject.

Botched jobs and looking ‘done’ are still legitimate fears for people who want natural and realistic results. For older generations, cosmetic procedures are still shrouded in shame and secrecy.

We’re all aware of these anxieties, as well as the unspoken etiquette around cosmetic procedures. We don’t ask people if they’ve had something done. Likewise, we don’t tell them if we think they’ve had too much done.

But what happens when it’s a family member or, in your case, a close friend? Do you sit back and say nothing or do you gently intervene with some well-chosen words?

I shared your dilemma with three experts, who each offered advice based on the assumption that your friend doesn’t have any underlying mental health conditions. Specifically, they assumed there was no suggestion of body dysmorphic disorder, which would raise complex ethical concerns that go beyond the scope of this column.

So we’re going to assume that your friend is able to make sound, informed decisions and exercise her right to bodily autonomy. The question then, asks Dublin-based psychotherapist Amy Plant, is whether you, as her friend, have any right to interfere.

“People often step in and say something for ‘someone’s own good’,” she says. “But I’m cautious around that because, often, stepping in for someone’s own good operates under the assumption that you would know what is best for someone better than they know themselves, and when we are talking about adults, that is quite a big assumption.”

Plant encourages you to dig a little deeper into what it is you want to achieve before broaching this conversation. “Has the friend given any indication that something is wrong or that she isn’t happy?” she asks. “If no, then what would be gained from saying, ‘I don’t think you look well’?

“What are they concerned about?” she adds. “Their friend’s well-being, their emotional state, their confidence and so forth? Or are they concerned about how they look and what people think? Because one of the main things she says in her letter is, ‘I’m not the only person who thinks this’, and that could be an assumption.

“The writer may be very concerned with what people think and her friend may not. Her friend’s colleagues, who she also mentions, might be unbothered.”

Plant also encourages you to consider the inherent subjectivity of “too far”. “It’s interesting that the writer says they are not opposed to cosmetic treatments — “whatever makes you happy”, they write — but that is contradicted in their writing because the implication is, ‘whatever makes you happy, as long as I think you look well or as long as you don’t look silly’. So where is the line between those two things?

“I have to assume the friend is a competent adult; she knows how she looks. It makes me think of that infamous Cher quote: ‘If I want to put my tits on my back, it’s nobody’s business but my own.’”

Cork City-based psychotherapist Jennifer Barton offered similar advice. “The best part of being an adult is that you get to make your own decisions, even though others may not agree with your choices,” she says.

“Perhaps social media has perpetuated this notion that our opinions matter when they are not needed. I would caution against sharing unsolicited advice, as by your own account, she hasn’t asked you for it. To avoid any misunderstandings, I would mind your opinions until your friend makes it your business by asking you.”

I was also curious to hear a cosmetic doctor’s opinion on your dilemma. Dublin-based Dr Dallas Walker, who is known for taking a conservative approach to cosmetic intervention, says the responsibility here ultimately lies with the practitioner “because they have the ability to say no and guide someone to a natural aesthetic outcome”.

“I think of lot of this is down to practitioners who are doing work that shouldn’t be done and over-treating,” he says. “It’s almost like preying on the vulnerable, which I’m definitely not a fan of.”

Walker acknowledges that this is a “delicate and tender” situation. Your friend probably had something done “because they’re self-conscious already”, he notes. Still, he thinks you could gently inquire into the work your friend has had done and perhaps propose different options.

I’d be of a similar opinion and only because I understand how easily one can lose their sense of judgement when they start experimenting with Botox and fillers. Yes, a good practitioner should help you make prudent decisions, but a second opinion can help too.

If you have a dilemma, email [email protected].