In fiction, the people most likely to get plastic surgery — or other kinds of cosmetic procedures — are unpleasant (and probably rich). Maybe they mention a boob job in a throwaway line, regularly get Botox or lip fillers, or spend a whole episode getting a nose job. Regardless of the exact procedure, this instantly characterizes the character as vain and appearance-obsessed. Having the money to spend on cosmetic procedures is an easy way to show a character is a Rich Bitch. In addition, this could be used to show that these characters have insecurities about their appearance for all their haughtiness.
Because Vanity Is Feminine, this trope is mainly used for women or dandyish men. In a High School setting, the Alpha Bitch might mention getting plastic surgery, and her 'artificial' beauty will contrast the 'natural' beauty of the Girl Next Door and the Cool Loser. The same can be said for the Obnoxious Entitled Housewife in a neighborhood setting.
In real life, people get plastic surgery for a variety of non-vanity reasons, such as recovering from accidents. Attitudes towards plastic surgery vary across cultures; in South Korea, for example, it is relatively common.
Will often overlap with Buxom Is Better, Fake Boobs, and Breast Expansion, as a breast augmentation is a common cosmetic surgery. Examples of underage girls may fall into Troubling Unchildlike Behavior if they are trying to be Younger Than They Look.
Compare Just the Way You Are, where someone decides against getting cosmetic surgery and embraces their natural appearance, Makeup Is Evil, where makeup (a temporary way to enhance one's appearance) is also associated with vanity and villains, and Vain Sorceress, a villainess who uses magic, not cosmetic surgery, to remain youthful and beautiful, and Looks Worth Killing For.
- Marvel Knights (2002): The Brothers Grace are corrupt European businessmen who are addicted to plastic surgery provided to them by their Dragon Mister Tune. One of them even requests liposuction after a meal.
- Cat Grant from Superman getting a breast implants is portrayed this way by the narrative. She's shown flaunting her new figure and trying to seduce Clark, who just ignores her. However, she is given some sympathy, as it's suggested the surgery is part of her coping with the loss of her son.
- X-Men: Emma Frost has mentioned getting breast implants to explain her rather large bust size. She's also very much a Rich Bitch, being cold, arrogant, and snobby. She keeps these traits even after her HeelFace Turn.
- In Addams Family Values, Wednesday is forced by her stuck-up summer camp cabin buddies to participate in a ghost story telling game where each participant adds to the story. She ends it on the punchline that the ghost makes all of their old noses grow back, prompting all of the other girls to scream in sheer horror.
- Downplayed in a Rare Male Example in Bad Education (2019), where one of the most selfish ways Frank spends the money he stole from the school is by getting plastic surgery.
- Crazy Rich Asians: One of the rich Asian socialites at Araminta's bachelorette disses the middle-class Rachel's appearance, scoffing that she's probably never heard of plastic surgery.
- In A Girl Walks Home Alone at Night, Shaydah, the snobbish and unpleasant daughter of Arash's employers, has a bandage over her nose implying that she's just had work done to it.
- Invoked and played with in Goodnight Mommy. The mother has had a bump removed from her nose which leads her twin sons to become convinced that she's been replaced, especially as she returns from the surgery cold, distant, and aggressive, and she won't show them what's under the bandages. It makes a lot more sense once you find out that Lukas is Dead All Along and she's responding to the stress of losing him while Elias pretends he's still alive.
- Mamma Mia!: Tanya is a heroic example; she's a good, supportive friend to Donna and an Honorary Aunt to Sophie. However, she's still a vain and rich Serial Spouse, which fits with Rosie's lines about her having a bunch of cosmetic surgery done.
- The Neon Demon: Alpha Bitch Gigi is described by her plastic surgeon as "The Bionic Woman" for the amount of plastic surgery she's had. She starts the movie by bullying Jesse for being an orphan, and ends it by killing and eating her to try and consume youth. She regrets the cannibalism and kills herself, but it's still too late to redeem her.
- The wealthy GeneCo's CEO's selfish and entitled daughter Amber Sweet from Repo! The Genetic Opera is outright addicted to plastic surgery and the painkillers used.
- Downplayed in Us. Kitty's Establishing Character Moment shows off that she has had (subtle) plastic surgery since Adelaide saw her last. Although she is the matriarch of a well-off Nuclear Family, she spends the rest of her screentime miserable at her husband and sniping both at and about him and her twin daughters.
- About Face (one of the Commissario Brunetti novels by Donna Leon) has a woman whose beautiful face is immobile from her plastic surgery. However while she's presented by the Italian media as this, Brunetti discovers that it's not her fault and she was the victim of bungled facial surgery thanks to an incompetent doctor.
- The Clique: Mean girl Alicia is shown to have an unusually well developed breasts for a girl her age (she's about 12-13). It's later revealed that she has implants.
- Gillian Flynn:
- Played with in Sharp Objects. Jackie is Adora's best childhood friend and Camille's surrogate mom. Camille mentions that she has obviously just had a face lift, which is still swollen and frightening to look at. Although she shows Camille more love than Adora ever did or does, Jackie is also shown getting into vicious arguments with her "friends" and clearly lived in denial that Adora murdered Marion.
- Although it happens to a bitchy character in Dark Places, it serves to make her more pathetic and adds sympathy to her bitchiness. When Libby catches up with Kristy, she's a Single Mom Stripper and Jaded Washout but still expects Libby to feel sorry for her after she falsely accused Libby's brother Ben of rape (although, in fairness, she was also manipulated by corrupt police). She also has an extremely crooked boob job that she was convinced into getting by her "manager"/pimp.
- The Hunger Games: Plastic surgery is common in the Capitol, the part of Panem famous for its vanity, luxury, and extravagance. It's mentioned that Caesar Flickerman hasn't aged a day in almost a quarter century due to a reliance on the practice.
- Let Me Call You Sweetheart plays with this, with its overall message seeming to be less that getting cosmetic surgery is a sign of being a bad person and more that it won't fix a crappy personality or poor attitude.
- It's revealed that Suzanne Reardon received plastic surgery to make her physically beautiful but she subsequently became conceited and hedonistic with little regard for others' feelings. It's indicated that she was never an especially pleasant person to begin with, being extremely envious of others and whining about the unfairness of it while doing little to improve herself and overlooking her other qualities. Getting plastic surgery merely amplified or added to her negative traits while still not fully removing her insecurities; she would even tell lies to her friends about how she was always considered beautiful and had to put up with other girls being envious.
- Averted with Barbara Tompkins, who is depicted as a genuinely kind and polite young woman who merely lacked confidence due to her insecurities around her looks. After receiving surgery, she blossoms both in her professional and personal lives, and she's never depicted as a bad person for it. In fact, her biggest issue is that she's too polite to tell Dr Smith all his attention is making her uncomfortable, not wanting to seem ungrateful.
- Moon Base Alpha: Sonja Sjoberg is a greedy and temperamental woman who's had lots of plastic surgery, though she does draw the line at letting her husband use their daughter as The Scapegoat for his crimes.
- In an episode of Blackish, Zoey wants to help her nerdy brother Junior hook up with an Asian Airhead at their school. Junior mentions he heard a rumor she got a boob job. Zoey confirms these rumors are true and that she also had some "light butt work". The girl establishes herself as an Alpha Bitch when she uses Junior to edit an audition video for The Bachelor.
- Charmed offers two examples:
- The Season 1 finale plays it straight with Joanne Hertz, Piper's former classmate who married rich and got her own segment at The Food Network. She is very condescending towards Piper, and when Phoebe starts naming random facts about her to prove to Piper they're in a time loop, she adds that Joanne got a nose job. In a later loop, Piper lashes back at Joanne and mentions the thing too.
- Season 5 subverts it with Jessica, the fiancé of Paige's ex boyfriend Glenn. While under a hex, Paige brushes Jessica off as a bimbette who got her boobs and nose done, but ultimately her antagonism is one-sided and rooted in her lingering feelings for Glenn; Jessica, on her part, is actually a nice person who genuinely loves Glenn.
- The Crown (2016): In her later years, Wallis Simpson has gotten numerous procedures to cope with aging. Lord Mountbatten even states that she goes "flapping around like a demented bat." She's also a Nazi sympathizer.
- Exaggerated and parodied in Doctor Who with the rich and haughty last human Cassandra, who has had so many plastic surgeries she's been reduced to what Rose Tyler rather accurately describes as a "bitchy trampoline."
- In GCB, Cricket gets breast implants for her daughter, who acts as the Alpha Bitch for the current generation at high school. It's implied that all the popular girls have gotten implants, with one of Cricket's friends mentioning she's planning on giving her daughter the surgery for Christmas. This ends up backfiring on Cricket's daughter when she suffers a Wardrobe Malfunction because her clothes weren't big enough for her new breasts.
- While not a bitch, Summer is the ditziest member of Girls5eva and the one who lives the most lavish lifestyle. A season two episode has her continuously deny she's ever gotten work done even though it's transparently obvious that she has. When Dawn tries to get her to stop, citing societal pressure on women, she eventually agrees with Summer getting cosmetic surgery done as long as she gets it done somewhere safe.
- Happens a few times in Glee:
- Santana starts Season Two as the head cheerleader and the most popular girl in school. However, the cheer coach discovers that she got a boob job over the summer so she can get more attention from guys. Her coach disapproves of underaged plastic surgery and demotes her from head cheerleader.
- Played with in an episode when Cool Loser Rachel considers getting a nose job. She wants her nose to look like head cheerleader Quinn. However, it's then revealed that Quinn got a nose job when she was younger. Unusually for this trope, this is used to give Quinn some more depth as opposed to marking her as an Alpha Bitch (which she started off as).
- The Good Life: In A rare male example, a minor recurring plot point is Jerry's ongoing rivalry in the company with the smug and odious fellow executive Snetterton, who it is rumoured to have had plastic surgery, and at least a nose job. Towards the end of the show when "Sir" is planning to retire, and their both competing to be named his successor, Jerry even tries to find evidence the rumour is true hoping it will be his ace to get the job, much to Tom and Barbara's amusement.
- One episode of Hope & Faith had Hope mention how Faith had surgery on her nose. Faith is, of course, depicted as the more shallow and irresponsible of the two sisters.
- Modern Family: When Cam and Tucker's friend Sal is first introduced, she's proudly showing off her new breast implants. She's shown to be a Hard-Drinking Party Girl and emotionally stunted, getting jealous that Cam and Tucker's daughter Lily is taking attention away from her.
- The Mick: Sabrina, the niece of the show's protagonist, is extremely spoiled due to her wealthy upbringing. One episode revolves around her getting breast implants with her mother's approval. Her aunt finds this irresponsible and tries to talk her out of the surgery. In the end, Sabrina doesn't get the implants, but only because they broke while she was trying to see how they would look on her.
- Jan gets a breast augmentation in The Office (US). It's explicitly stated she got the surgery to better manipulate her ex Michael.
- One Tree Hill: Rachel Gatina is a slutty, manipulative Alpha Bitch. It's revealed that she was Formerly Fat before she's had plastic surgery.
- Raising Hope:
- One episode has Jimmy getting drunk and dreaming of a world where he didn't conceive Hope. One change is that his love interest Sabrina has gotten breast implants after her job made their female employees wear skimpy outfits. This version of Sabrina is also much more jaded and mean than in the regular timeline.
- Subverted in an episode where the Chance family finds out that Sabrina comes from a wealthy family. They end up getting invited to a party at her family home. Sabrina warns Jimmy that the people in attendance are all awful people. One of them is a woman who had various plastic surgeries, something Sabrina gleefully points out. However, it becomes clear that she and the rest of the guests are actually nice people and Sabrina is just lashing out because of her insecurities.
- Scrubs: Jordan Sullivan gives her ex-husband Perry Cox a run for his money in the Jerkass department and has been mentioned to have undergone several cosmetic operations, including a boob job.
- The villain, Elise Fine, is a cosmetic surgeon who has had work done herself, having undergone seven surgeries to get what she considered the perfect look. She performed an operation on her daughter to treat her acne using Kryptonite. Elise is shown as callous to her daughter's discomfort and the trauma other people have suffered because of her experiments.
- Her daughter Abigail herself is an inversion, being a kind person who is being bullied by others including her mother, which drives her to undergo her mother's operation. While it works her beautiful, it also causes her to drive anyone insane if she kisses them, because of the Kryptonite that was used. Abigail is more of a reluctant villain and is portrayed as sympathetic throughout the episode.
- Dawn Stiles, the Alpha Bitch villain of "Spirit", was voted "most likely to have plastic surgery" according to the high school yearbook.
- Suburgatory: The people of Chatswin, who are shown to be very shallow, regularly get plastic surgery. In the pilot, a woman falls into the pool at the country club, but doesn't drown due to her breast implants making her buoyant. Of the main cast, Dallas is mentioned to have had numerous cosmetic procedures. However, she's shown to be kind, if a bit shallow and ditzy.
- Two and a Half Men:
- Judith is mentioned to have gotten various procedures, including breast implants and liposuction. The bitch part comes in because she's paying for the surgeries using her husband's alimony, to the point he can barely afford to support himself.
- Evelyn Harper, Charlie and Alan's emotionally abusive mother, has been mentioned to have word cosmetic work done. In one episode, she claims that Charlie's fiancée will blow all his money on unnecessary plastic surgery, and insists her surgeries were necessary.
- In an episode of Victorious, Trina (a diva who thinks she's better than everyone) expresses interest in getting cosmetic surgery. Given it's a kid's show, it's not stated what surgery she wants, but she is shown briefly looking down at her breasts. Unlike most examples of this trope, Trina doesn't seem to have the approval of her parents to get the procedure, as she mentions she has to wait until she's eighteen. This is likely due to her status as The Unfavorite in her family.
- Karen Walker from Will & Grace has been mentioned to have undergone cosmetic surgery a few times and is a shallow, gold-digging jerk.
- Wizards of Waverly Place: A Running Gag with the Alpha Bitch Gigi was that she'd keep getting plastic surgery. Her extremely loyal Girl Posse would then also get the same surgery afterward, in an effort to look like her.
- In Eminem:
- In "A Kiss", Slim's annoyed at his girl for leading him on:
And if you ain't sucking a dick, why you sitting there with puckered lips?
Oh. That's collagen. Muhfuckin' bitch.
- In "Remind Me", Slim (a Villain Protagonist with dreadful taste in women) lusts after a heavily surgically altered girl - "fake tits are better than real ones!" - because her garish tastelessness and artificiality reminds him of himself.
- In "A Kiss", Slim's annoyed at his girl for leading him on:
- Exploited in American Dad!. Steve wants to get revenge on a group of popular girls who he believes sabotaged his girlfriend's run for student body president. One of them goes to a plastic surgery clinic to get liposuction. While she's under anesthesia, Steve sneaks in and reverses the flow of the liposuction device, so she gets extra fat placed inside of her.
- Implied with Chloe, the rich Alpha Bitch from Miraculous Ladybug. People accusing her looks of being plastic surgery is apparently a Berserk Button for her.
- The Simpsons: In "The Hateful Eight Year Olds" Lisa is invited to the birthday party of her friend Addy. At the party, she meets Addy's other friends who are all alpha bitches. One of these friends is a girl who can't express emotions because she was exposed to botox in the womb. Addy is jealous of this, suggesting that their influence is rubbing off on her.
- South Park: In "Bebe's Boobs Destroy Society", Bebe's breasts start to develop and become more noticeable, which attracts all the guys in the fourth grade, but earns her the ire of the other girls who call her a slut because of it. Wendy, who was one of those girls, eventually resorts to getting breast implants in a desperate attempt to get the guys to notice her, resulting in her having ridiculous Gag Boobs that only wind up getting her laughed at, as by that time all the guys had gotten over Bebe.
- From My Little Pony: Friendship Is Magic, Spoiled Rich is a Rich Bitch who emotionally abuses her daughter—it's implied Spoiled is the main reason why said daughter is such a bully to her own classmates. In her first appearance in the present day, Spoiled Rich's snout is much daintier than most other mares', subtly implying she got a nose job. This is all but confirmed when a later episode has a flashback revealing that, when she was a young mare, she had a bigger, rounder snout than most other mares.