Botox and Emotional Expressivity

New research suggests Botox can impact interpersonal communication.

Posted Dec 17, 2019

Jane Drobot/Shutterstock, used with permission
Source: Jane Drobot/Shutterstock, used with permission

Botox (onabotulinum A) is one member of a class of neurotoxic medications that blocks muscle activation.  Injecting Botox into facial muscles underneath wrinkles causes relaxation of those muscles resulting in the smoothing of the overlying skin. While this treatment can make one’s skin appear younger, it can also affect the ability to express emotions, the ability to experience emotions, and the ability to effectively communicate with others.

In a recent study published in the Aesthetic Surgery Journal, one group examined the spontaneous facial expressions of research subjects before and after Botox injections into the corrugator muscles, responsible for making the vertical lines between the eyebrows seen in the expression of a variety of emotions.  This region of the face is commonly referred to as the “elevens” area. It is not surprising that Botox treatment had a significant effect on the perception of anger and surprise in the patients that were studied.

Not only does Botox affect the way others perceive one’s emotions but it can also impact the emotional experience of those who have received the injections. In one study, participants either received Botox injections or a wrinkle filler (Restylane), which does not paralyze muscles, and were instructed to watch emotional video clips. Participants who received Botox had a lower self-reported emotional response to the video clips. This finding supports something called the facial feedback hypothesis, which suggests that our facial expressions can affect our emotional experience.

The concept of the interplay between facial expression and emotional experience was first explored in study by Strack et al. in 1988. In this novel undertaking, researchers found that having subjects hold a pen in between their teeth (activating the muscles responsible for smiling) while watching cartoons resulted in subjects reporting more intense humor compared to subjects that watched the same cartoon with pens held between their lips (inhibiting the ability to properly smile).  Another study showed that injection of the “elevens” area lead to decreased activation of key brain emotional centers (for example, the amygdala) on functional MRI when subjects were passively viewing pictures of anger. This supports the concept that the facial musculature not only expresses, but also regulates mood states and may explain some of the success that has been seen with the use of Botox for the treatment of depression.

Lastly, consideration should be given to the phenomenon of embodiment. The embodiment theory states that the processing of emotional information, such as facial expressions, includes reproducing the same emotions on one’s own face. For example, when we observe a smile, our faces tend to smile in an automatic and often imperceptible way as we try to make sense of that expression. Therefore, if one or both members of a two-person interaction are dealing with an altered ability to make facial expressions, the non-verbal communication between those two parties will be impacted and understanding one another may be more difficult.

In addition to the obvious reduction in wrinkles with Botox injections, there is a corresponding alteration in emotional expression, emotional experience, and interpersonal communication.  Given the implications of these lesser-considered effects, great care should be taken in the counseling and decision-making regarding these treatments.