MODULATION OF EMOTIONS USING BOTULINUM TOXIN IN INDIVIDUALS WITHOUT PSYCHIATRIC DISORDERS: A NARRATIVE REVIEW

Klaudia Czech; Duszan Leja; Zuzanna Michalik; Klaudia Kapelka; Stanisław Malik; Przemysław Paduch; Zofia Bułka; Joanna Mazur; Dawid Kłos; Kaja Zdrojewska; Lena Apanowicz; Klaudia Gogół-Fijał

doi:10.31435/ijitss.2(50).2026.5408

Authors

Klaudia Czech University Hospital in Krakow, Kraków, Poland https://orcid.org/0009-0004-3281-1374
Duszan Leja University Hospital in Krakow, Kraków, Poland https://orcid.org/0009-0008-9121-9310
Zuzanna Michalik Hospital of the Ministry of the Interior and Administration in Kraków, Kraków, Poland https://orcid.org/0009-0003-5031-1173
Klaudia Kapelka Wojewódzki Szpital Specjalistyczny im. Najświętszej Maryi Panny w Częstochowie, Częstochowa, Poland https://orcid.org/0009-0002-5579-9852
Stanisław Malik St. Anne’s Hospital in Miechów, Miechów, Poland https://orcid.org/0009-0006-5634-308X
Przemysław Paduch Copernicus Memorial Hospital, Łódź, Poland https://orcid.org/0009-0004-1721-2621
Zofia Bułka St. Anne’s Hospital in Miechów, Miechów, Poland https://orcid.org/0009-0009-1720-7335
Joanna Mazur Hospital of the Ministry of the Interior and Administration in Kraków, Kraków, Poland https://orcid.org/0009-0009-5722-9301
Dawid Kłos St. Anne’s Hospital in Miechów, Miechów, Poland https://orcid.org/0009-0009-9110-975X
Kaja Zdrojewska University Hospital in Krakow, Kraków, Poland https://orcid.org/0009-0005-4008-5584
Lena Apanowicz Medical University of Lodz, Łódź, Poland https://orcid.org/0009-0005-9482-5293
Klaudia Gogół-Fijał Medical Center in Gdów, Gdów, Poland https://orcid.org/0009-0007-1051-8427

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5408

Keywords:

Botulinum Toxin, Emotional Modulation, Facial Feedback, Well-Being

Abstract

Aim: This review aims to discuss the mechanisms by which reducing facial muscle activity in the glabellar region may influence emotional processing and regulation in individuals without diagnosed mental disorders.

Material and Methods: A literature search was conducted using MedLine/PubMed databases in both Polish and English. Additionally, reference lists of selected articles were screened to identify further relevant studies.

Results: Botulinum toxin exerts its effect by blocking acetylcholine release at the neuromuscular junction, resulting in temporary muscle paralysis. According to the facial feedback hypothesis, facial expressions not only reflect emotions but also influence their experience and regulation. Limiting the activity of muscles responsible for negative emotional expressions may modulate subjective emotional experience. Available studies suggest that botulinum toxin injections in the glabellar region may be associated with improved mood and increased subjective well-being in individuals without psychiatric disorders.

Conclusions: Botulinum toxin may influence emotional regulation by altering feedback from facial muscles in individuals without mental disorders. However, high-quality studies are still needed to confirm these findings.

References

Darwin, C. (1872). The expression of the emotions in man and animals. Oxford University Press.

Strack, F., Martin, L. L., & Stepper, S. (1988). Inhibiting and facilitating conditions of the human smile: A nonobtrusive test of the facial feedback hypothesis. Journal of Personality and Social Psychology, 54(5), 768–777. https://doi.org/10.1037/0022-3514.54.5.768

Larsen, R. J., Kasimatis, M., & Frey, K. (1992). Facilitating the furrowed brow: An unobtrusive test of the facial feedback hypothesis applied to unpleasant affect. Cognition and Emotion, 6, 321–338. https://doi.org/10.1080/02699939208409696

Monheit, G. D., & Pickett, A. (2017). AbobotulinumtoxinA: A 25-year history. Aesthetic Surgery Journal, 37(Suppl. 1), S4–S11. https://doi.org/10.1093/asj/sjw284

Finzi, E., & Wasserman, E. (2006). Treatment of depression with botulinum toxin A: A case series. Dermatologic Surgery, 32, 645–650. https://doi.org/10.1111/j.1524-4725.2006.32136.x

Zhu, C., Wang, K., Yu, T., & Liu, H. (2021). Effects of botulinum toxin type A on mood and cognitive function in patients with Parkinson's disease and depression. American Journal of Translational Research, 13, 2717–2723.

Li, Y., Zhu, T., Shen, T., Wu, W., Cao, J., Sun, J., et al. (2022). Botulinum toxin A (BoNT/A) for the treatment of depression: A randomized, double-blind, placebo-controlled trial. Journal of Affective Disorders, 318, 48–53. https://doi.org/10.1016/j.jad.2022.08.098

Schwartz, G. E., Fair, P. L., Salt, P., Mandel, M. R., & Klerman, G. L. (1976). Facial muscle patterning to affective imagery in depressed and nondepressed subjects. Science, 192, 489–491. https://doi.org/10.1126/science.775637

Lundqvist, L. O. (1995). Facial EMG reactions to facial expressions: A case of facial emotional contagion? Scandinavian Journal of Psychology, 36(2), 130–141. https://doi.org/10.1111/j.1467-9450.1995.tb00974.x

Hennenlotter, A., Dresel, C., Castrop, F., Ceballos-Baumann, A. O., Wohlschläger, A. M., & Haslinger, B. (2009). The link between facial feedback and neural activity within central circuitries of emotion: New insights from botulinum toxin-induced denervation of frown muscles. Cerebral Cortex, 19, 537–542. https://doi.org/10.1093/cercor/bhn104

Kim, M. J., Neta, M., Davis, F. C., Ruberry, E. J., Dinescu, D., Heatherton, T. F., et al. (2014). Botulinum toxin-induced facial muscle paralysis affects amygdala responses to the perception of emotional expressions: Preliminary findings from an A-B-A design. Biology of Mood & Anxiety Disorders, 4, Article 11. https://doi.org/10.1186/2045-5380-4-11

Lanteaume, L., Khalfa, S., Régis, J., Marquis, P., Chauvel, P., & Bartolomei, F. (2007). Emotion induction after direct intracerebral stimulations of human amygdala. Cerebral Cortex, 17, 1307–1313. https://doi.org/10.1093/cercor/bhl041

Ekman, P., Davidson, R. J., & Friesen, W. V. (1990). The Duchenne smile: Emotional expression and brain physiology II. Journal of Personality and Social Psychology, 58(2), 342–353. https://doi.org/10.1037/0022-3514.58.2.342

Nowińska, M., Kozyra, M., Raczkiewicz, P., Kaczerska, M., Śmiech, N., & Milanowska, J. (2021). Botox or the new face of the fight against depression: Literature review. Journal of Education, Health and Sport, 11(8), 268–275.

Hanayama, H., Tada, J., & Terashi, H. (2024). Botulinum toxin A therapy for glabellar lines improves emotional states: Evaluation of 47 cases without mental disorders. Journal of Plastic and Reconstructive Surgery, 4(2), 75–80. https://doi.org/10.53045/jprs.2023-0057

Lewis, M. B. (2018). The interactions between botulinum-toxin-based facial treatments and embodied emotions. Scientific Reports, 8, Article 14720. https://doi.org/10.1038/s41598-018-33119-1

Lewis, M. B., & Bowler, P. J. (2009). Botulinum toxin cosmetic therapy correlates with a more positive mood. Journal of Cosmetic Dermatology, 8(1), 24–26. https://doi.org/10.1111/j.1473-2165.2009.00419.x

Hirsch, J., Zhang, X., Noah, J. A., & Bhattacharya, A. (2023). Neural mechanisms for emotional contagion and spontaneous mimicry of live facial expressions. Philosophical Transactions of the Royal Society B, 378. https://doi.org/10.1098/rstb.2021.0348

Japee, S. (2024). On the role of sensorimotor experience in facial expression perception. Journal of Cognitive Neuroscience. https://doi.org/10.1162/jocn_a_02015

Reichenberg, J. S., Hauptman, A. J., Robertson, H. T., Finzi, E., Kruger, T. H., Wollmer, M. A., et al. (2016). Botulinum toxin for depression: Does patient appearance matter? Journal of the American Academy of Dermatology, 74(1), 171–173.e1. https://doi.org/10.1016/j.jaad.2015.08.051

Sommer, B., Zschocke, I., Bergfeld, D., et al. (2003). Satisfaction of patients after treatment with botulinum toxin for dynamic facial lines. Dermatologic Surgery, 29(5), 456–460.

Hexsel, D., Brum, C., Siega, C., et al. (2013). Evaluation of self-esteem and depression symptoms in depressed and nondepressed subjects treated with onabotulinumtoxinA for glabellar lines. Dermatologic Surgery, 39(7), 1088–1096. https://doi.org/10.1111/dsu.12216

Alam, M., Barrett, K. C., Hodapp, R. M., et al. (2008). Botulinum toxin and the facial feedback hypothesis: Can looking better make you feel happier? Journal of the American Academy of Dermatology, 58(6), 1061–1072. https://doi.org/10.1016/j.jaad.2008.01.022

Davis, J. I., Senghas, A., Brandt, F., & Ochsner, K. N. (2010). The effects of BOTOX injections on emotional experience. Emotion, 10(3), 433–440. https://doi.org/10.1037/a0018690

Havas, D. A., Glenberg, A. M., Gutowski, K. A., Lucarelli, M. J., & Davidson, R. J. (2010). Cosmetic use of botulinum toxin-A affects processing of emotional language. Psychological Science, 21(7), 895–900. https://doi.org/10.1177/0956797610374742

Nestor, M. S., Fischer, D. L., & Arnold, D. (2020). Masking our emotions: Botulinum toxin, facial expression, and well-being in the age of COVID-19. Journal of Cosmetic Dermatology, 19(9), 2154–2160. https://doi.org/10.1111/jocd.13569

Baumeister, J. C., Papa, G., & Foroni, F. (2016). Deeper than skin deep: The effect of botulinum toxin-A on emotion processing. Toxicon, 118, 86–90. https://doi.org/10.1016/j.toxicon.2016.04.044