The Big B.
Perhaps you think of it as an entry-level cosmetic procedure; perhaps the ultimate anti-feminist swindle, interfering with our natural ageing process; or maybe even a gift from God, interfering with our natural ageing process. Whatever your stance, your understanding of Botox is probably thus: it's an injectable neurotoxin that temporarily paralyses muscles, thereby erasing or preventing lines and wrinkles. All true, yes, but that's not what it was initially approved for.
As with many cosmetic breakthroughs, it was a noticeable side effect from treating eyelid tics, muscle spasms and excessive sweating. A few years later, in 2002, the FDA approved Botox for cosmetic use to treat wrinkles. So, 15 years later, here we are: botox is a $2.9 billion business and about as shocking as dropping three paracetomol instead of the recommended two.
My own stance was one of ambiguity. I appreciate its capabilities with professional interest, but no personal one. That is, until I suffered medication-induced hot flushes, which caused spontaneous hairline sweats that obliterated my composure and ruined my blowdries. 'Mum, I think I'm going to have Botox.' 'You're what?' she said. 'It's ok- it's to help stop the hairline sweats, not the wrinkles.' (I won't lie, the aesthetic side effects were a bonus,) 'Oh, OK, that's clever!' But why, Mum, is that more clever than cleverly obliterating unwanted lines and wrinkles? Well, that depends on where your priorities and moral stance.
The fact is that, today, botox still has its uses far beyond mere aesthetics. It's commonly associated with treatment for migraines (granted as a last resort), or to reduce oil production, which can lead to acne, to calm excessive sweating or even to treat spasticity movement disorders such as multiple sclerosis or cerebral palsy. All physical issues, and all understandable when you consider how a muscle relaxant works. But mood alteration? Courtesy of a drug that doesn't fit into the standard foil-wrapped-and-boxed category? The new thinking is that botox could treat anxiety and depression.
You already know about the 'look good, feel better' philosophy. You've most likely felt the mood-boosting effects of a glossy blowdry or a perfectly applied lipstick. So why not the anti-ageing aesthetic of some frown-line obliteration? Dr Frances Prenna Jones has experience of this in her clinic. 'With all patients, it's not just about how they look, but how the way they look makes them . Many people come to see me with a lack of self-confidence, or just needing "something", and it is often triggered by life-changing events. After a series of treatments, we note a change in the mood of the patient, and, more importantly, they notice a difference.'
The new thinking is that botox could treat anxiety and depression
And so it seems that part of the appeal of botox is how you feel once you've seen your reflection improve by degrees after the treatment.
But what if it goes deeper than that? It makes sense if you really think about it: you've heard that smiling has mental health benefits, but why? The facial feedback hypothesis, first conceived by Charles Darwin, suggests that a smiling expression, for example, uses muscles that play a key role in how the brain evaluates mood. In other words, our facial expressions contribute to the way we feel. So just employing the same muscles that we subconsciously use to smile naturally can put us in a better mood.
So, what if you relax the muscles that you use when you're feeling anxious or angry? Does it follow that you won't feel the same emotional intensity of your bad mood? Aesthetic doctor (and arguably the most prolific administrator of botox in Europe) Dr Michael Prager thinks so: 'What most people appreciate about a botox treatment is that it makes them feel better, whether that's due to their perceived improved looks or changes in their neurology. The motion creates the emotion, so if one cannot frown, one might not be able to feel sad or depressed.'
This idea has scientific accreditation, too. The Journal of Psychiatric Research has published the results of several studies, concluding that botox is a viable way to treat real depression. Eric Finzi, professor of psychiatry at George Washington University, first started thinking about the effects of botox on depression after watching his own mother suffer. 'I started the first clinical trial of botox for depression in 2003. I became aware of a body of research supporting the facial feedback hypothesis, showing that facial expressions are universal in humans, and that negative emotions are expressed by the muscles between the eyebrows.'
He conducted a controlled trial where patients, all diagnosed with depression and who had never had Botox (and were not specifically bothered by lines or wrinkles), were split into two groups. Some were treated with Botox and some with a placebo, injected into an area known as 'the grief muscles', which express sadness.
Using the same muscles that we subconsciously use to smile naturally can put us in a better mood
After six weeks, there was a significant improvement in depressive symptoms in the botox group, over the placebo. Finzi explains: 'More than half the depressed subjects had major improvement in their mood. About a third went into remission, and most subjects had already unsuccessfully tried conventional antidepressants.' And remember, this had nothing to do with improving appearance but everything to do with inhibiting expression. 'Many people who have no lines to improve have improvement in depression. Imaging studies of the brain also show that botox of the frown quiets the amygdala, a structure important for your negative emotions.'
The conclusion? It is possible to influence mood just by restricting the face's ability to frown.
Frances Prenna Jones sees it regularly. 'I have noted that some people do report feeling happier following botox treatment. Once the face is set into a relaxed natural resting state, the mechanisms of the body behave differently and less stress response is created.'
The results were convincing enough that the maker of botox, Allergan, has moved the study of botox for depression into phase III clinical trials, the final phase for FDA approval in the USA.
For some, the fear around using an injectable toxin is counterintuitive to the anti-anxiety effects they'd be looking for. Whilst there is no substitute for the positive results of using traditional prescribed medication and counselling to treat mood disorders, there are some advantages to botox where traditional treatments may have failed. Eric Finzi explains; 'Botox does not have the side effects we commonly see from oral antidepressants, such as sexual dysfunction and weight gain.'
Is it safe, though? Botox has been around since the early Nineties and is licensed for use in children from as little as two years old. Indeed, it is widely used worldwide for all sorts of medical conditions other than cosmetic use. 'The chances that one improves the patient either neurologically, psychologically or cosmetically are far greater than the potential side effects.'
The study's conclusion? It is possible to influence mood just by restricting the face's ability to frown
Still, we're talking about taking a very real leap into the world of injectables that many people- about half of the ELLE office included- would not be comfortable with. Nichola Joss is a facialist and skincare expert, who agrees that relaxing muscles can help affect mood, but says that botox, while certainly a decent alternative, is not the best treatment. 'I think you'll get a more all-encompassing wellbeing effect by massaging the face.' The idea is that, as organic beings with nerve endings and pressure points, massage and touch therapy will naturally stimulate our 'happy' chemicals.
'It's a more holistic response; what the Botox is doing is basically what I do with massage. When you relax the muscle, you also release toxins that have built up to not only hold tension, but also create an imbalance that can enhance anxiety and depression.'
Joss specifically developed her 'inner facial' to also address inner issues such as stress, anxiety and tension. 'My intention was to contour the face, but also to remove tension that builds there. It's particularly effective because I work on the core of the muscle, while stimulating the lymphatic system deeply, so it has a long lasting effect on mood and appearance.'
The chances that botox improves the patient are far greater than the potential side effects.
Joss explains that we hold different stresses in different parts of our face. 'If we're upset and emotional, we hold it in chin and along the jawbone. If our digestive system is upset- we're bloated or suffer from wind, say- we hold it under the cheekbone. You can massage these points to relieve the specific anxiety.'
It's certainly true that relaxing the jawline can be key in releasing tension. Dr Frances Prenna Jones says, 'It is common to inject Botox to prevent teeth and jaw clenching, and when you relax those muscles, less stress response is created.'
So whether you adhere to the idea of injecting bad moods away, or massaging tension out of your jawline and eyebrows, it seems that your face can and will play a huge part in manipulating your frame of mind. The idea that botox – something mainly associated with vanity - could have such a profound effect on our moods might seem flippant initially; incredible, even. But then most thought-provoking scientific discoveries are only logical in hindsight.
Do It Yourself
How to do facialist extraordinaire Nichola Joss' muscle-release mood-boost massage step by step...
Use two fingers on each hand and sweep across the jawbone from the chin out to under the ear. Then bend the fingers, using the knuckle, and go deep as you can. You will feel points of muscular tension, so work on them there.
Very slightly open your mouth, place the heel of the palm of each hand under the cheekbone on both sides and let your face drop fully into your hand. Hold for one minute: you will naturally feel pressure release from cheekbones.
Take fingers from bridge of the nose, where the eyebrow starts, and push upwards and inwards into the muscle tissue that sits on the brow. Press in and massage out to the edge of the eyebrow. Then use an index finger to lightly sweep under the eye.