Botox and "Unrealistic Quest for Physical Perfection"

Blogger Mark Frauenfelder writes (here) that "The problem is that Botox prevents people from responding with appropriate anger to things that aren’t good for them. Facial paralysis blocks one of our most important and primal forms of communication."  He concludes by stating "The unrealistic quest for physical perfection that drives people to Botox is similar to the equally unrealistic quest for a life free of negative emotions. It looks like Botox may actually grant people both, and, in the process, leave them greatly impoverished." How do you respond to this author's view of Botox?

Doctor Answers 10

Extreme View of Botox & the Patients who use it

Hi Tom,

I agree in essence with Mr. Frauenfelder's concerns about a society wherein the quest for physical perfection and a perfect "trouble free" life is indeed unhealthy and quite far removed from a realistic perspective on our natural physical state and the "ups & downs" that life presents us all with.

However based on this excerpt of his blog, I also strongly feel that he does not possess a true understanding or experience of what Botox does and why the average Patient uses it.

In my experience, the overwhelming majority of my Botox Patients are not seeking perfection and in no way whatsoever do they want their faces paralyzed to the point that they can't express their natural emotions (good and bad).

The fact is they want the exact opposite - they wish to look a little refereshed and as natural as possible. Most experienced Botox injectors strive for this result - effective but not overly done.

I think tying in a Patient's desires for using Botox with an "unrealistic quest" for a life without negative emotions is also a bit of a stretch. After working with thousands of cosmetic patients, I can count on one hand the number that felt that getting Botox would somehow alleviate them from experiencing and having to deal with "negative emotions". Botox patients tend to be very realistic and well balanced individuals. As always there are exceptions but they are in the great minority in my experience.

I would ask Mr. Frauenfelder what is wrong with people focusing on positive changes and positive emotions? In my opinion remaining positive and focusing on solutions to negative feelings when they arise (as they always will at some time or another) is a great way to get through life.

Dr. Kamran Jafri

New York Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

The goal of Botox to achieve a positive facial dynamic


The intention of Botox is not to paralyze the face or to hide emotions. The intention is to soften or reduce the wrinkles and form a positive facial dynamic - maintaining facial animation. It is an over generalization to say that people using Botox are looking for perfection or looking for life without negative emotions. However, what is wrong with being happy? If the wrinkles on your forehead or around your eyes drive you crazy, then why not improve them. Additionally, it is an antiquated understanding of Botox to associate it with facial paralysis. While the underlying mechanism of Botox is to partially paralyze specifically targeted muscles, the goal is to achieve a positive facial dynamic between agonist and antagonist muscles groups - not to completely inhibit movement. The vast majority of patients with Botox, smile and frown, expressing their emotion - just with a few less wrinkles.

David Shafer, MD

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 77 reviews

Mark Frauenfelder article, or Would the World Be a Better Place Without Botox?


Great article/blog by Mark Frauenfelder, very thought provoking ( Studies have shown that depression is helped by Botox. The facial feedback hypothesis mentioned in the article may explain this finding.

Studies and real life are not the same though. Looking at pictures and imitating expressions of happiness and sadness or anger is completely different from real life situations where we are faced with emotional stimuli. When performed properly, patients should still have some movement, and frankly, no one should be able to tell that they have had Botox. The "Botox like" substance was not Botox Cosmetic, FDA approved, manufactured by Allergan. Properly injected, Botox treatments should not completely paralyze the facial muscles as it appears to have been done in this study.

There is a psychiatric / mental problem if people "do not respond with appropriate emotional responses to things that are bad for them". Botox has nothing to do with their real life emotional response to significant stimuli. Believe me; I am married to a wonderful woman who is fully capable of feeling and "communicating" all of her "appropriate" emotions and signals, even when her Botox is at its peak effectiveness. (Yes, you look great in those jeans).

I don't believe that my patients are "questing for perfection"; they just desire to look better, be that less wrinkled as well as less angry looking from the perpetual scowl projecting from their mid brow area. They prefer to look rested, appropriately youthful, and healthy. Let's do a study if feeling good is detrimental to our lives.

Lastly, we are all amazed at how or "unnaturally frightening" some Botox patients may appear. Blame should be placed on the practioners who have created these Botox "Stepford Wife’s" (or more currently "Desperate Housewife’s"), not patients questing for perfection.

Be well, happy, sad, angry, kind, all when appropriate or inappropriate. Most of all enjoy the beauty of life, and treat others well.

Michael A. Persky, MD, FACS

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

His view is wrong in several ways

Firstly, the statement that "Botox prevents people fromresponding with appropriate anger" is factually incorrect; Botox may soften expressions, but does not prevent anger! The better way to see this is that people who say that friends tell them that they look angry all the time when they aren't, use Botox to help convey their true state of mind more accurately and more positively.

Secondly, I take issue with the statement about an "unrealistic quest for physical perfection that drives people to Botx" which certainly does not describe the typical patient. I think most rational people will see the fallacy of describing anyone doing things as simple and safe as Botox being as being on some sort of quest. Time for a little more common sense here and less drama. "Greatly impoverished?" Give me a break.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 53 reviews

Botox is not opposition to the modern "natural state"

I normally try to avoid the "agree" type posts here, but Dr. Jafri has framed the issue wonderfully and I agree wholeheartedly.

Botox is a tool - it has risks and benefits. It is the physician's job to explain the issues clearly, determine whether the treatment is appropriate for the indvidual patient (taking into account all of the issues including psychological ones) and then perform the procedure in a safe manner.

If the author of the blog wishes to return to a "more natural state" then he may also need to leave behind grocery stores, cars, clothing... how natural do you want to be?

I hope this helps.

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Properly done Botox lets you express emotion.


This is basically nonsense, except the part about unrealistic quest for perfection.  With properly done Botox, you can experience emotion and you can express emotion with your face. 

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

A Very Deep Interpretation of Botox

While we respect this author's opinion of the reasons consumers use Botox, we would respectfully disagree.

Our patients use Botox not to hide or mask anger, but to help their outside appearance look as young as their inner self feels. We hear over and over from our patients that they still feel 20 years old but that their appearance no longer reflects that attitude. Botox helps patients accomplish this.

We find the analysis of this author a bit far reaching when it comes to the reason why consumers use Botox. Not everyone is angry!

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Botox is effective for Dynamic Wrinkles of the Face: Reduce Wrinkles with Botox

Botox is effective and extremely gratifying for patients with wrinkles. It is purely an elective procedure with an outstanding safety profile in experienced hands. However, it is an elective procedure for those wishing to maintain a more youthful look.

Just like anything else in this great nation we live in, Botox is an elective choice and everyone has the right to choose to have Botox or not. Judgements aside, it is not up to the social public to judge anyone who wishes to spend their hard earned dollars to improve a stigmata of aging.

For those interested in Botox, it is a safe and non-invasive product for dynamic rhytids.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews


I was not a philosophy major, but.....Botox in my practice is used to soften facial lines of animation so that they appear less obvious. Botox in my hands does not remove all facial expression. I don't want that, and my patients certainly don't want that. No one wants to look like a robot. I go for the more natural freshened look.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

I disagree, but there is some truth in the blog

Hi Tom,

I read the blog, and it makes some interesting comments and references, but from a very superficial and uninformed point of view. If a patient with Body Dysmorphic Disorder (BDD) intentionally wanted to have zero movement and zero facial expression to their face, this is possible to do this with botox. This is the point of view the blogger is coming from, but how many people actually do this? Few if any. This point of view comes from some television personalities who have recently had some Botox injections prior to the television taping, or from movies which may satirize the used of Botox and fillers (Tim Allen and Goldie Hawn). The initial complete paralysis can appear to be an unusual appearance for the casual viewer and may elicit certain preconceptions of Botox. So there is some truth to the Blog, but I have to disagree.

The real life scenario for most physicians and surgeons who administer Botox is that patients have "stubborn" lines which make them look angry when in fact they are not angry. So just as we don't want a person to be expressionless, these people don't want to have a negative expression imprinted on their face. The old wive's tale for children making funny faces is, "Don't make that face, or it will stick that way" is essentially the repetitive habit of making certain facial expressions. Botox is essentially trying to temporarily break the "bad habit." Of course, with anything, food, exercise, grooming, etc, if these things are used in moderation, it's fine, but when it is used to an excess it can be detrimental. So for some people seeking "perfection" the blog may have a point, but in general real life situations this is not the case. Most "regular" people who have Botox are not "wrinkle-free" nor are they seeking to be "expressionless." The opposite is true, most people have gradually worsening wrinkles which were not there in the past, and now makes them appear to have a negative emotion, when in fact they aren't feeling that way.

Most of my Botox patients are on a budget, so I guide them towards an effective and cost-reducing means of spacing out the injections over time as well as treating only the problem areas, where the lines are starting to imprint themselves onto the skin. If the lines are not too deep yet, and they are truly tight on their budget, they can either wait longer to treat the lines or only treat the worst areas first. So, I beg to differ with the blogger that I am trying to make my patients "impoverished."

Botox is a controversial issue, and I think that education and better understanding of an "unknown" always puts things into better perspective. I educate my patients using a lot of analogies which makes understanding these concepts easier.

This is the analogy I like to use for how Botox works. If we imagine our faces as a crisp white dress shirt, if we regularly iron this shirt it should stay relatively wrinkle free over the years. If we wear the shirt and it accumulates a few wrinkles which are not deep, a "single-pass" with an iron should be sufficient to eliminate the wrinkles. This would be similar to what a single treatment of Botox can do. If a person has a wrinkle which is not too deep yet, it would be helpful to Botox (iron-out) that wrinkle before it gets too deep. This way a person would not allow themselves to get deep creases which may not be able to be treated non-surgically. Hopefully people will see this as a preventative measure, and not such a "bad thing."

There are some people who have such deep frown lines (elevens) that one treatment of Botox will not smooth out those lines. At that point it may take many consecutive sessions of Botox (every 3-4 months) to smooth out the deep wrinkles or it may not be able to be completely smoothed out (another possibility.) The shirt and iron analogy would be leaving the white shirt crumpled up at the bottom of the hamper for weeks, then finding it completely wrinkled with deep creases. A single pass of the iron will unlikely smooth out the creases, but it may take several passes with the steam burst on to smooth it out. Instead if we take care of the shirt by ironing it periodically, it would not need such an "intense" ironing treatment.

So for people who use Botox, but now feel the crunch of the economic downturn, they could allow the wrinkle to form just deep enough (but not too deep) to be completely eliminated with a single treatment of Botox (maybe 5-10 months+), instead of getting Botox every 3-4 months based on a calendar schedule.


Dr. Yang

George Yang, MD
New York Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.