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Face of Emotion: Dr. Eric Finzi On How Botox Affects Feelings, Moods

Face of Emotion

We’re all pretty familiar with the “Did she? Did he? Oh, they definitely did!” of celebrity plastic surgery.

Face lifts, breast implants, nose jobs – for some, they seem like a Hollywood rite of passage.

Look fresher! Younger! Sexier!

However, one board-certified dermasurgeon, Dr. Eric Finzi, proposes a new use for Botox, one of the less-invasive cosmetic procedures that’s popular among everyone from housewives to Hollywood starlets.

That new use?

Helping depressed patients.

Below, Dr. Finzi explains how his interest in the way Botox affects our moods began (HINT: Finzi’s also an accomplished artist and sculptor), the kinds of clinical trials he conducted to test his hypothesis, and whether he’d recommend Botox for depressed patients for whom traditional therapy and medication hasn’t worked.

In my book, The Face of Emotion: How Botox Affects Our Moods and Relationships, I discuss how our facial expressions help drive our feelings and moods.

It all began when I was working on a series of paintings about Augustine, a famous French hysteric patient from the 19th century, and was struck by the powerful facial expressions that she and other depressed inpatients showed. That got me reading two great 19th century thinkers, Charles Darwin and William James.

They proposed a radical theory of emotion: Essentially, they hypothesized that the expressions and actions of the human face and body directly feed back to the brain, thereby causing or diminishing emotions.

For example, Darwin (1872) noted that “the free expression, by outward signs, of an emotion intensifies it [whereas] repression, as far as this is possible, of all outward signs softens our emotions.” He called the characteristic frown of depressed people “omega melancholium,” noting that it disappears when depression resolves, and termed the corrugator muscles “the grief muscles.” Likewise, James noted that we do not cry because we are sad, we are sad because we cry.

Observations such as these led to a sizeable body of research showing a direct effect of facial muscles on mood — the so-called “facial feedback hypothesis.”

In 2003 I began a clinical trial to test my hypothesis that Botox inhibition of the frown muscle could help depressed patients. Two months after the Botox injection, the majority of patients were no longer clinically depressed. Some of the patients in the study didn’t have any visible frown lines before the injections, suggesting that they didn’t feel better just because they looked better, since there was no cosmetic improvement.


Our brain uses our body – in this case our facial muscles- as a yardstick, a reference, for our emotional states.


Since I published my initial trial in 2006, the results have been replicated by Wollmer and coworkers in Switzerland and Germany, in a randomized, double-blind, placebo-controlled clinical trial of Botox treatment of the frown for chronic depression. Compared to the placebo, the Botox-injected group had a highly statistically significant improvement in depressive symptoms that was seen throughout the course of the study. Six weeks after one treatment with Botox, patients experienced a 47 percent reduction in scores that qualified them as depressed, compared with a nine percent reduction for those who received placebo.

In December of 2012, I presented at the American College of Neuropsychopharmacology the results of randomized, blinded, placebo-controlled trial of Botox for depression that I performed with Dr. Norman Rosenthal. Our study of 74 patients who completed the trial showed a significant improvement in the Botox group and found that 27 percent of Botox patients went into remission, as compared to 7 percent of the placebo group.

The mechanism of Botox’s improvement of mood is not yet known. However, I propose it works by a process that I call “emotional proprioception.” Every time that you frown the muscles between your eyebrows contract, and send negative emotional signals back to your brain. The brain measures the strength of the frown muscle contraction, weighing it against the strength of the smile, which can be seen as the pulse of the positive feelings of happiness — and then produces an emotion. Just as your mind tracks the smallest movement of your hands or feet, it is tracking those little muscles that control your face. Our brain uses our body — in this case our facial muscles — as a yardstick, a reference, for our emotional states.

When there is no tension in the frown muscles, when those muscles have been temporally inhibited by Botox, there is no negative feedback to report to the brain. The lack of this negativity then creates a tremendously significant positive effect on our brain’s assessment of our mental state.

Here is how one patient described her response to Botox treatment of her frown muscle:

I took the same diagnostic that I had taken at the onset of the study and I was amazed at the difference in my scores. It was a dramatic improvement. The reality is that I was feeling lighter. It’s almost like when you carry around a weight for a long time, you don’t consciously realize you’re carrying a weight until you set it down and you feel lighter… I think I had just kind of grown acclimated to carrying that weight around… After Botox, I started doing things that were important to me, reconnecting with friends, becoming more social, becoming more spiritual again.

Botox is a very safe medicine when properly used. Therefore I would not hesitate to use it on someone suffering from depression not responding to traditional therapy. We have used it on patients taking antidepressant medications or not, with good success.

Since Botox wears off in three to four months on average, I would expect that treatments would need to be repeated at least several times a year. For those who are depressed, the treatment is administered only as a depression fighting treatment, not for wrinkles.

I am currently exhibiting paintings about Augustine, who inspired my research, at Mark Wolfe Contemporary Art in San Francisco. The show is called “Feel” and I will be talking at the gallery on March 19.

Want to learn more about Finzi’s theories of Botox and moods? Both Amazon and Barnes & Noble carry The Face of Emotion: How Botox Affects Our Moods and Relationships in hardcover and ebook formats. You can also head over to Goodreads to see what folks who’ve already picked up a copy are saying!

In the meantime, what do YOU think, readers? Have any of you ever had Botox? Did it affect your moods and emotions?

What about those of you who are dealing with depression? Would you consider Botox as an alternative treatment option?

Let us know what you think in the comments below!

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Face of Emotion: Dr. Eric Finzi On How Botox Affects Feelings, Moods

Alicia Sparks

Alicia Sparks is a freelance writer and editor and the creator of, where she blogs to help new freelance writers get their quills in the pot, so to speak. Among animal rights, music, and physical wellness, her passions include mental health and advocacy. Here at Psych Central she works as Syndication Editor as well as authors Your Body, Your Mind, Unleash Your Creativity, and World of Psychology's weekly "Psychology Around the Net."

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APA Reference
Sparks, A. (2019). Face of Emotion: Dr. Eric Finzi On How Botox Affects Feelings, Moods. Psych Central. Retrieved on October 31, 2020, from


Last updated: 23 Mar 2019
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