Does Botox Deaden Perception?

I read this article from USA Today about Botox deadening perception of others emotions. It says that because one can't mimic facial expressions when one has Botox, you may not be able to pick up on someone else's emotions. How concerned should patients be about this newly discovered side affect?

Doctor Answers 10

Botox and the perception of your own or others' feelings.

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This is a very interesting issue that comes up in the press in various forms: Botox reducing the ability to feel happy, Botox reducing the ability to feel sad, Botox reducing the ability to be empathetic to others' emotions. I recently had a new patient treated with Botox for the first time who came in at her follow up and told me that since the Botox she has felt happier and less stressed: and she thinks it's because she can't crease her muscles into the stressed/worried shape and she feels less tension. I had not asked about this at all. She volunteered it.

All of this is fascinating, and fairly anecdotal, even though small studies are showing some early suggestive results. I would not worry about not being able to perceive the emotions of others. The human body and mind are complex beyond our understanding and I have no doubt this study suggest a lab result that has little impact on all of the factors that truly relate to empathy and perception beyond just your ability to frown when someone else does.

New York Dermatologic Surgeon
4.7 out of 5 stars 41 reviews

Botox masking facial expressions

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Some actors avoid Botox as it will inhibit their full range of facial expressions as they demonstrate different emotions.  However, artful Botox treatment does not create full masks that don't move. I have not had pateints who have mentioned they're unhappy not to look angry or sad, in fact, most are so grateful that they're no longer told they look angry when they're frown lines are treated.  They also feel less stressed as the physical tightness of their frown muscles are relaxed.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox and perception

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It would be news to me if one's facial expressions have any connection with one's emotions at all. Emotions are involuntary and under the control of a completely different portion of the neurological system. Facial expressions are controlled by motor neurons which are inhibited after Botox treatment. Just because a person can't frown doesn't mean they cannot empathize with someone who is crying.

Peter L. Kopelson, MD
Beverly Hills Dermatologic Surgeon

Botox and the "Deadening of the Perception of Emotions"

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I am not sure what type of emotional response I should have to your question because my Botox just kicked in (just kidding, never had it).  Researchers with too much time on their hands can "prove" almost anything.  After 20 years of marriage, treating my wife with an occasional touch of Botox, I guarantee that even without moving her glabellar muscles she can perceive my emotions and those of our daughters, and is very empathetic for hours on the phone with friends.  I get SO ANGRY when we have to defend these ridiculous, far fetched studies!!!    Wait a minute, my wife is asking me why I am getting so emotional here.  Excuse me while I answer her, "Sorry darling, just answering a question on RealSelf, by the way, your forehead looks great."

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

These stories are extremely overstated.

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There are some extremely interesting neuropsychological studies looking at the effect of BOTOX injections of emotion.  These study the FDA approved glabellar treatment.  This is the part of the face that pinches the eyebrows together and are an important part of what makes an angry face.  People who have been treated score higher on scales that measure the emotion of happiness.  However, it is a big leap to suggest that botox deadens emotions.  Now on the other hand, I have seen patients who were improperly treated in the midface affecting the muscles that control the smile.  These people seem disproportionately disabled emotionally by this adverse treatment and this may reflect the interaction of the muscles of facial expression and the effect of BOTOX.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox cannot deaden a person's ability to sympathize with others' emotions

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A person is still able to feel all the emotions after their Botox treatment just as well as before.  Millions of people have been treated with Botox over the last decade, and this is the first study to show such results.

True that full mimicking of facial expressions may not be possible if a person has had Botox treatment to the glabella.  But the corrugators and procerus (the main muscles treated in the glabella) are responsible for frowning and bringing down the eyebrows, which is the expression of anger.  How is that facial expression a way of sympathizing and identifying with the emotions of others? 

Emily Altman, MD
Short Hills Dermatologic Surgeon

Does Botox Deaden Perception?

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When properly performed Botox softens dynamic wrinkles. These are wrinkles caused by motion (i.e. dynamic). A person should still be able to smile, frown, cry, etc. In other words, when done properly and naturally Botox will not prevent somebody from showing or perceiving emotion. This is the real world situation. Of course, if someone were to use enough Botox to stop all muscle activity on the forehead, between the eyebrows, and in the crows feet area then it might blunt the appearance of that person's emotion. But this is not the result that one should strive for when treating with Botox.

We have some examples of natural-appearing Botox treamtents on our RealSelf page and more on our website.

Andrew Kaufman, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 16 reviews

Does Botox alter the perception of emotions?

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I have heard a lot of things attributed to Botox by patients in my years of practice but this is not one of them. Just because you can measure something in the lab does not mean that it is significant in real life. We call this difference statistical significance (measurable under certain conditions) vs clinical significance (noticeably impacts your life).

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 42 reviews

Interesting Concept, But Unlikely

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Interesting concept but it would require a complete paralysis of all the muscles of facial expression which would be aesthetically unattractive, so I'd say not very likely.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

BOTOX® does not "deaden" perception of other's emotions

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In a laboratory experiment, under tightly controlled conditions, treatment of the muscles of facial expression with BOTOX® [or other fomulations of BTX-A like Dysport® or XEOMIN®] can [to a limited extent] modulate either the expression or the perception of certain emotions.

This modulation under laboratory conditions can be a positive or negative thing, depending on the experimental subject.

In the real world, it is common for people being properly treated with BOTOX® [as opposed to being grossly over treated] to note that after BOTOX® they are able to express themselves more accurately because they are not making unwanted or excessive facial expressions which could give others the wrong impresson.

For example, a person who frowns when they are simply concentrating might give the wrong impression that they were unhappy or concerned. After softening of the frowning by treatment with BOTOX®, that individual's emotional state would be more accurately percieved by others.

In a similar manner, someone who excessively mirrors the emotional state of others may find that relaxation of the muscles of facial expression reduces their "mirroring" to a more normal level, and makes it easier for them to accurately assess the emotional state of those around them.

I have a book chapter in press on this subject.

Kevin C. Smith, MD
Niagara Falls Dermatologic Surgeon

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.