Do Facial Expressions Rule Emotions? My One-Woman Experiment in the Field, Plus How Botox Could Help Depression

September 24, 2013
Margaret Severn by Nina Leen for Life Magazine

Photo of Margaret Severn by Nina Leen for Life Magazine

How do our faces convey emotion? Conventional thinking tells us that we smile because something made us happy, or we frown because we’re annoyed – that our faces move purely in response to external stimuli.


But there’s a new book that explores the topic in further detail, and posits that our faces create as many emotions as they communicate. And that may have interesting implications for how we approach emotional health.


This Time, It’s Personal


You might have noticed, I have a thing about faces. I’m a makeup artist, after all, but it goes deeper than that. I’ve always been fascinated by faces – how they look, how they move, what they’re doing…and if sometimes doing makeup is just an excuse for me to stare at them more, you’ll excuse me, please…


But this topic has a special appeal for me, as several years ago I unwittingly entered a three-month experiment on the emotional effects of a neutralized face. And I came to what seemed to be (at the time) unusual conclusions.


The Experiment


This was in no way a double-blind scientific experiment – it’s what researchers call anecdotal information. I had come out of denial about a lump in my neck – and found that I had a benign tumor in my salivary gland. I needed a full parotidectomy to remove it, which involves dissecting the neck enough to spare the major facial nerve that runs through the gland. The surgeon told me that I’d probably have some facial weakness for several weeks afterwards, as the nerve has to heal from the trauma of being moved out of the way.


But what it meant in practice is that for three months, I had little control over the left half of my face, and no ability to smile, wink, or sneer on that side. I’d long thought that verbal communication starts in the brain – our minds think up the words and our mouths form them, carrying out orders like dutiful servants. So this shouldn’t have been that big a deal – I would just have to be more precise in my words and, you know, not say like so much.


Except that somehow, it was a much bigger deal than it was supposed to be – not having full facial fluidity didn’t just lessen my non-verbal communication. Anyone who knows me knows I have a lot of words, and holding them back can be harder than letting them go. Except I couldn’t find them – I was tongue-tied in ways I’d never experienced.


More than Words



Manicure and photo by Marta at

And I was depressed. I couldn’t explain it, I just didn’t feel good. I was healthy in every physical way, the stitches were barely noticeable, but somehow the mute button was on my feelings. And it wasn’t just me who noticed the change – my Mom noticed it over the phone, and even the doctor who performed the surgery chastised me for “feeling sorry for myself” when there were much sicker patients out there. Not that I had actually said anything about it to anyone – it was too weird – I just wasn’t the ebullient “me” that everyone was used to.


And when the nerve function returned? As my face regained its ability to move on command, a switch happened. All my silliness, the natural kookiness that had so often been an embarrassment in front of more “serious” people, was back again. And boy, did I miss it – I was elated to the point of mania. Maybe other people accessed their words through the brain’s central database, but I realized that I was making it up as I went along, my face leading the way in an interpretive dance through life. And I was back.


My Bias Against Botox


I had long questioned the “expressive” side effects of Botox injections – after all, won’t we need those cues of age and emotion to show those youngsters who’s boss? But this experience sealed the deal for me: the isolation of not having my face to communicate as freely as it could convinced me that Botox was Evil Incarnate. Maybe I was the only person I knew – or knew of – who’d experienced this, but eventually they’d catch up. And when researchers noticed that the anti-aging effects of Botox included reduced ability to mirror other peoples’ emotions, and the headlines screamed “Botox Causes Depression”, I knew I’d been vindicated.


Except that I never imagined it could work in reverse. If having my happy face immobilized away from its happy self created depression, what about those whose faces unconsciously register sadness, displeasure, or anger?


Does Botox Help Depression?


It can, in some cases. Eric Finzi, MD, a dermatological surgeon, has been working with patients suffering from depression by using Botox to relax their engraved frowns. The relationship between emotions and our faces is more complex than we thought, and Finzi has compiled his own research into the history of the subject into The Face of Emotion: How Botox Affects Our Moods and Relationships, a fascinating book on how our facial expressions influence our underlying moods. This is not a new theory: Finzi relates the history of “face-first” emotionality, from the theories of Darwin and Freud, to early medical observations from psychiatrists (and surprisingly sunny stories from Saltpêtrière, France’s famous nineteenth-century mental hospital/theatre), to his own observations of patients and family.


The idea that facial expression can be a causative factor in our emotional life may have been dismissed because it was just too complex, Dr. Finzi posits. But now that we have Botox to control facial muscles (rather than electrodes, which even in the Dark Ages were considered inhumane), doctors and patients are freer to try it as an alternative to prescription antidepressants. And in many cases, it works: patients are finding that their emotions aren’t as out of control when their faces aren’t frozen into a scowl. Although the effect diminishes as the Botox wears off, and the feedback mechanism is reestablished.


Can You Just Turn That Frown Upside Down?


We can’t know for sure if getting out from a depressive state is as easy as just getting rid of angry or sad facial expressions. (And if you’ve ever had some stranger command: “Smile!” at you, you know it’s not a happy-inducing thing.) But patients and their doctors are finding more ways to work with their emotions. And Dr. Finzi points out that much of his work with Botox mimics the effects of some long-term meditation and therapy techniques, which work at changing our expressions towards others as a mechanism for changing our minds. So the Botox theory is part of a larger matrix of emotions and their causes.


Okay, so Botox isn’t the Bogeyman I’ve sometimes imagined it to be: as Dr. Finzi points out, one woman’s poison is another’s elixir. For those who find that their faces are registering anger or sadness they’re not feeling (or would rather not succumb to) there is another way to deal with it. There’s even a humorous article in W this month about a woman who had her face “happified” so that her family wouldn’t think she was angry at them all the time (she was not, and all concerned are pleased with the results).


Being on the “happy face” side of the facial expression spectrum myself, I still don’t think I’ll be going for Botox as an antiaging thing anytime soon – I enjoy the silliness of my underlying facial expressions, and I know I’d be less happy without them. But I respect the potential of Botox as a treatment for depression, and as an antiaging tool for those who don’t mind losing a little underlying gruffiness as well. Just don’t tell me to “Smile!”


The Face of Emotion: How Botox Affects Our Moods and Relationships by Eric Finzi, MD.

Photos by Nina Leen and Marta from


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  • MM Curator September 27, 2013 at 4:28 pm

    This was a really interesting read (although I’m sorry to hear you had to go through surgery and partial facial paralysis – that’s scary!) As someone who got her first Botox shots back in August, I have to wonder exactly where others got their injections and how much they’re getting injected in order to render them unable to make certain expressions. I just had my forehead done. I can still make all the same faces; the only difference is that the lines that used to form when I made them are gone. Having said that, I’m unhappy with the results not because I can’t have particular expressions, but because it’s changed how my face looks and it’s…creepy. Getting my forehead done had a rather unexpected effect – my brow drooped a bit into my eyes, causing them to change shape and not look all the way open/as large as they normally are – so it’s very strange to look in the mirror and see a pair of differently-shaped eyes staring back at you. Fortunately it’ll wear off in a few months, but right now my face looks odd to me and it’s pretty unnerving. Anyway, my point is that while Botox can cause negative emotions as the result of being unable to express oneself, it can also cause a bit of an identity crisis (I still find myself looking in the mirror at times going “That’s not what I look like! That’s not who I am!”) when it alters someone’s normal facial contours in unexpected ways.

    • Meli Pennington October 1, 2013 at 10:53 am

      Wow, thanks for sharing your experience, MM! I have heard one other person complain about Botox changing the way he looked to himself – he said his forehead drooped and made him look like the “village idiot”. I suppose everyone’s experience is different, and I expect that we will hear more as more people try it out!

  • Jennine October 3, 2013 at 12:22 pm

    I have done botox over the years a number of times to get rid of my 11’s (which started when I was 30) Botox weakens your frowning muscles, so if done properly, you don’t have to do it as much over time. I was down to once a year I’d get 18 units, which only paralyzed one part of my face for about 12 weeks, and really seriously for about 9ish weeks? No one noticed (not even my husband!!!) Of course the last year I’ve been pregnant, now I’m nursing, so my (and before that I was trying to get pregnant, so it’s been almost 2 years since I’ve done it) and I will have to wait until after I’m done nursing to get it again, but I will. It’s not to look ‘younger’ because Botox does not make you look younger, at best, it just makes you look rested. I just don’t like having that frown line and people ask me if I’m tired or mad or whatever. So that’s my defense of the ‘tox!

    • Meli Pennington October 3, 2013 at 12:30 pm

      It’s funny, Jennine, even as I have had an “anti-Botox” stance I still find myself looking at women who have the 11’s and wondering why they look so angry, and whether perhaps they could do something about it… It would be annoying having people ask whether you are angry or tired when you’re not, so I can easily see the benefits there!

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