Plastic Surgery 101

Sad patient asks doctor to fix ‘resting b---h face’

Q: I’ve had several people tell me that I have an RBF (“resting b---h face). I’ve tried fillers to no avail. Is there anything else that can fix this?

A: I’m sorry to hear that your friends think that, but at least you know they’re good friends because they don’t hold back! The reason you have an RBF is because you have a learned behavior of gestures that you saw while you were growing up. Look at family members, it’s just a gesture that they do. With modern social media, people just give names to these things!

Carlos Wolf 2018
Dr. Carlos Wolf

The primary reason you have RBF is because you have an overactive depressor oral angularis muscle. This muscle tends to pull the lip down thus appearing that you are either sad or angry. Many people use fillers to improve — often without good results — these areas called “marionette lines.”

In my practice, I often try to fix this problem with fillers initially. If the fillers do not completely get rid of the RBF, then we go to a secondary process using either Botox or Dysport. By injecting a small amount of Botox or Dysport, the muscle is relaxed. The action of the zygomaticus muscle, which pulls up the corner of the mouth, is then enhanced, thus giving you a more relaxed and happy look.

While this process seems easy, it is not. This is the type of Botox and Dysport injection that should be done by very experienced injectors. Potential problems with this injection technique include an asymmetric smile that may need to be tweaked with more or less Botox or Dysport, as needed. Most people really like the effect. However, some people feel like their smile is changed too much or they may have difficulty in talking. These sensations generally go away after three or four days.

There are not many people who need this procedure, but it is just one more use of Botox or Dysport to enhance patients looks that really works.

Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board-certified. Email your questions to him at Follow him at @CarlosWolfMD.