Unfurrow your brow, if you're a Botox virgin, and take this little test:
Why do you think people opt to have the toxin injected into the frown lines between their eyes?
(a) Peer pressure
(b) To convey the right message so the inside mood is reflected on the exterior
(c) Vanity
(d) To improve their marriage because their partner doesn't need to know when they're annoyed
(e) To help treat clinical depression
(f) All of the above.
If you said (f), you're right. In the perfumed salons of Rosedale, Toronto's gilded midtown neighbourhood, I have heard people whisper about another that "she really should do something about those lines" as though a shot of Botox is a matter of simple maintenance, like having your leaves blown off your lawn. To not do it is seen as a failure of community manners.
I have also observed women who submit to the facial needle out of a sense of obligation to their physical beauty. They may never say this, of course, but the sentiment is there. That their effort to preserve it often goes awry and they end up looking like plastic versions of themselves (I'm looking at you, Nicole Kidman) is not the point. It's often a function of identity: They are their beauty. Not to try to sustain it is akin to not fully using the brain you were born with.
And then there are many who simply don't want to look like a grouch when they don't feel they are. In her book Lots of Candles, Plenty of Cake, Anna Quindlen, the 60-year-old novelist and journalist who famously chronicled thirtysomething life back in the 1980s, wrote that she started using Botox for her frown lines in her mid-50s because she didn't want to look cross when she wasn't. "And it's addictive," she told me with a laugh when I interviewed her about the book. This is where the Botox-as-sex metaphor comes in. Once you get a taste of it, it's hard not to want a repeat, er, injection.
It is the treatment of depression through Botox, though, that is as new as a baby's skin. In The Face of Emotion: How Botox Affects Our Moodsand Relationships, released two weeks ago, Eric Finzi, a dermatological surgeon, writes of the link between facial expressions and emotions. His theories and anecdotal evidence have recently been corroborated by thorough medical studies. (Incidentally, he is also the source for Botox reason (d) above, which he heard from one of his patients.)
It's not simply that a Botox injection to the face can make you feel happier because you look better.
That's the assumption many make, Finzi acknowledges in an interview from Chevy Chase, Md., where he lives and works. And he doesn't dispute that looking good makes you feel good – that's his business after all.
Rather, Finzi's work centres around the new and controversial idea that our facial expressions not only reflect our emotions, but also cause them. It's a "facial feedback theory of emotion" that he describes as a continuous looping of signals or pathways between muscles and the brain. Basically, the more you frown, the more the brain experiences negative messaging. So when Botox inhibits the frown muscle, "that electrical circuit is clamped off," Finzi explains over the phone.
In 2003, he started a clinical trial to test his hypothesis that Botox inhibition of the frown muscle eases depression. He had been reading scientific theories from the 19th century, including Charles Darwin's The Expression of the Emotions in Manand Animals, in which the celebrated scientist wrote: "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."
Finally, Finzi realized that he had a way to test ancient hypotheses with a modern tool: Botox.
His small studies also piqued the interest of Axel Wollmer, a psychiatrist at the University of Basel in Switzerland. Last year, results of his randomized controlled study on the effects of Botox on depression were published in the Journal of Psychiatric Research, showing significant statistical results. The study investigated whether patients who suffered from clinical depression and had not responded to antidepressant medications could be helped with Botox injections in their frown lines.
Participants in the treatment group were given a single dose of Botox (five injections) between and just above their eyebrows. An equal-sized group was given placebo injections. Among those injected with Botox, symptoms of depression decreased 47 per cent after six weeks and lasted through the 16-week study period. In the placebo group, there was a nine per cent reduction in symptoms. Wollmer concluded that Botox "interrupts feedback from the facial musculature to the brain, which may be involved in the development and maintenance of negative emotion."
What has hindered investigations into Botox and depression is the stigma it carries as merely a tool for the vain even though its uses for medical conditions such as cerebral palsy, Parkinson's disease and migraines are well known, Finzi says.
"Don't blame the molecule!" he implores with a laugh. "Don't attach whatever feelings you have about cosmetic procedures to its potential usefulness for other things. I would predict that, by the end of 2013, there will be not only one but three randomized, controlled, double-blind tests that will have been completed.
And when all three are published, that will be very powerful stuff."
None of them, he added, are funded by pharmaceutical companies.
Depression, of course, is a serious problem. And anything that can help alleviate it is significant. But I can't help but think that this news would provide the perfect excuse for indulging in Botox from here on in. "It's not for my vanity, darling," you could say at swishy soirees as your friends notice your newly unfurrowed brow.
"It's for my state of mind."