The facial feedback hypothesis states that facial movement can influence emotional experience. Charles Darwin was among the first to suggest that physiological changes caused by an emotion had a direct impact on, rather than being just the consequence of that emotion. Recently, strong experimental support for a facial feedback mechanism is provided through the use of Botox to temporarily paralyze facial muscles. In a functional neuroimaging study, Andreas Hennenlotter and colleagues, Botox decreased activation of brain regions implicated in emotional processing and emotional experience (namely, the amygdala and the brainstem). These studies suggest that botox can dampen the ability to understand another's emotions, and they lend considerable support to Darwin's original notion.

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Botox: The Brain Effect
Dr. Patrick Treacy IACD Sao Paulo BRAZIL 2014

2. Article Rejuvenate Magazine 2006

3. Can Botox Treat Depression?
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2006

5. Addendum from the Editor of the
Journal of Dermatological Surgery
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However, this report must be considered anecdotal as there were no
appropriate methods of control utilized. In addition, there were other
methodological weaknesses including limited follow-up, lack of
randomization, the absence of blind evaluation, and especially the small
number of individuals included. The method evaluating depression should
be more rigorous. Patients’ self-report of depressive symptoms by
administration of the BDI-II introduces a significant self-report bias. This is
of more concern because of the potential for secondary gain.
2006

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While the BDI-II is an accepted method of evaluating an individual’s level of
symptoms over time, self-report in isolation is not an acceptable method of
diagnosing depression. In order to ensure that patients’ psychiatric
symptoms are accurately classified, a thorough psychiatric interview must
be conducted, and a second blind evaluator would add some credibility.
That being said, this is an intriguing report, which fits with our clinical
impression. Obviously further work is merited on this important
observation.
ALASTAIR CARRUTHERS, FRCPC
Vancouver, Canada

7. I must say that I was initially heartened to see
the study of the treatment of depression with
Botox as many doctors will reveal a similar
picture from their patient's own experience. I
examined Finzi's paper in the Journal of
Dermatologic Surgery and have concerns that
this doctor used a very small number of patients,
lacked a control group, had no assessing the patients and even t
psychiatrist
allowed the
patients to assess themselves. I noted in an
accompanying commentary, that editor Alastair
Carruthers, also cited a series of flaws with the
study and concluded that its finding must be
considered anecdotal. It is of more than passing
interest that this doctor has now filed a patent
concerning this treatment. If Botox does relieve
depression then this is not the paper to prove it. .
Dr. Patrick Treacy
Dublin Ireland .
2006

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Does Botox effect the Brain?

9. In a functional neuroimaging study, Andreas Hennenlotter and
colleagues asked participants to perform a facial expression
imitation task in an fMRI scanner before and two weeks after
receiving botox injections in the corrugator supercilii muscle
used in frowning. During imitation of angry facial expressions,
botox decreased activation of t
brain regions implicated in
emotional processing and emotional experience (namely, the
amygdala and the brainstem), relative to activations before
botox injection. These findings show that facial feedback
modulates neural processing of emotional content, and that
botox changes how the human brain responds to emotional
situations. Hennenlotter et al., 2008
Functional MRI and glabellar botulinum injection
2008

10. These findings show that facial feedback modulates neural processing of emotional content,
and that botox changes how the human brain responds to emotional situations.
Hennenlotter et al., 2008
2008

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2012

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2012

14. In the first randomized, controlled study on the effect of
botulinum toxin—known commercially as Botox—on
depression, researchers investigated whether it might aid
patients with major depressive disorder who had not
responded to antidepressant medications. Participants in the
treatment group were given a t
single dose (consisting of five
injections) of botulinum toxin in the area of the face between
and just above the eyebrows, whereas the control group was
given placebo injections. Depressive symptoms in the
treatment group decreased 47 percent after six weeks, an
improvement that remained through the 16-week study
period. The placebo group had a 9 percent reduction in
symptoms. The findings appeared in May in the Journal of
Psychiatric Research.

15. 2012

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Charles Darwin concluded work on The Descent of Man on 15 January 1871. On
17 January 1871, he started work on The Expression of the Emotions, employing
the unused material on emotional expression. He published on 22 August 1872.

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25. Facial expressions are motions or positions of the muscles
beneath the skin of the face. There are two brain pathways
associated with facial expression;
(1) voluntary expression involving the cortex.
(2) emotional expression originating in the extrapyramidal
motor system involving the subcortical nuclei.
Primary emotions are not t
associated with the cortex and are
displayed unconsciously.
2008
This is demonstrated in infants
before the age of two; they
display happiness, sadness,
fear, anger, degust and
surprise. Infants’ displays of
these emotions indicate that
they are not cortically related.

26. Similarly, blind children also display emotions, proving that they
are subconscious rather than learned. The amygdala have a
significant role in the recognition of fear and negative emotions.
It is believed that the emotion disgust is recognized through
activation of the insula and basal ganglia.
t
2008
Happiness
Sadness
Fear
Anger
Disgust
Surprise.

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2008

28. Charles Darwin was among the first to suggest that physiological
changes caused by an emotion had a direct impact on, rather than
being just the consequence of that emotion.
t

29. The facial feedback hypothesis
states that facial movement can
influence emotional experience.
For example, an individual who is
forced to smile during a social event
will actually come to find the event
more of an enjoyable experience.
t
The free expression by outward
signs of an emotion intensifies it.
On the other hand, the repression,
as far as this is possible, of all
outward signs softens our
emotions... Even the simulation of
an emotion tends to arouse it in our
minds. Charles Darwin 1872
2008

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2008

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When the muscles that control frowning are frozen, a person tends to smile more –
the act of smiling produces feelings of happiness. Displaying expressions of positive
emotions can actually put you in a good mood

32. 2014

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eEffect on where we inject patient

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Obrigado!