Can Botox and Cosmetic Surgery Chill Our Relationships With Others?

Let’s say you’re walking down the street and coming toward you is someone pushing a baby in a stroller. The baby looks right at you and bursts into a big, gummy grin. What do you do?

If you’re like most people, you reflexively smile back and your insides just melt. The baby might react by smiling even more broadly and maybe kicking its feet with delight, which will only deepen your smile and add to the warm feeling spreading in your chest.

But what if you couldn’t smile naturally, with the usual crinkles around your eyes and creases in your cheeks? There’s convincing scientific evidence that the same kind of mutual engagement and interplay — with infants, or anyone else — would be difficult to achieve. Experts say mirroring another person’s facial expressions is essential for not only recognizing emotion, but also feeling it.

That’s why anything that disrupts one’s ability to emote is cause for concern, particularly in an age when Botox and other cosmetic procedures that paralyze, stretch, plump or otherwise alter the face are commonplace. Permanently pouty lips and smooth brows might be good for selfies, but research suggests they flatten your affect, disconnecting you from your feelings and the feelings of others.

“People these days are constantly rearranging their facial appearance in ways that prevent engaging in facial mimicry, having no idea how much we use our faces to coordinate and manage social interactions,” said Paula Niedenthal, a professor of psychology at the University of Wisconsin-Madison who has published several studies on facial mimicry and its emotional and social importance.

Following the example of celebrities like the Kardashians, the use of Botox injections is up more than 800 percent since 2000, and the use of soft tissue fillers is up 300 percent. Plus, there has been the advent of so-called “mini-facelifts” whereby people can take a more incremental approach to cosmetic surgery, getting their eyes, foreheads, chins or cheeks done à la carte.

Moreover, the latest annual member survey by the American Academy of Facial Plastic and Reconstructive Surgery points to the growing trend of so-called “prejuvenation,” in which people — both men and women — have cosmetic work done in their 20s and 30s to get out ahead of aging by immobilizing, filling or surgically lifting their faces before wrinkles and sagging can even start.

It’s worrying because every time you interact with another person — romantic partners, friends, family, colleagues, clients, babies in strollers — the two of you subconsciously and subtly reflect each other’s facial expressions. By mirroring the other person’s expressions, you not only signal you are engaged and participating, but it’s also a kind of feedback loop that helps you empathize. If you hinder your ability to do that even slightly, you’re changing the social dynamic between you and the other person. (Let’s not get started on the impact of always having your face in your phone.)

Facial mimicry is almost instantaneous as we humans have this miraculous ability to track the slightest flicker of change in one another’s faces. These micro-expressions are often so subtle and hard to detect that they can only be measured through electromyography, or EMG, which uses electrodes that are sensitive to the faintest movements of the facial muscles. Most of the time, you’re not even consciously aware that you and the other person are involved in this micro-mirroring exercise, but the brain registers it, and it contributes to your feelings of connectedness. Likewise, if you or your partner fail to reflect each other, you may feel unsettled and disconnected, without knowing why.

Researchers have found that when the ability to make facial expressions has been hindered, either by mechanical means (wearing a hockey mouth guard, or biting on a chopstick or chewing gum) or by temporary paralysis (Botox injections), individuals are less able to interpret other people’s facial expressions and experience related emotions. In fMRI scans, people who have had Botox injections have less activation in areas of the brain used to interpret and modulate emotional states. Other studies have shown a decrease in the intensity of emotional experience following Botox injections, which is why some have suggested it as a treatment for depression. The trouble is that you might end up losing the ability to feel very happy just as you lose the ability to feel very sad.

People who have had a stroke or who have other medical conditions that impair facial expressiveness, such as Parkinson’s disease, may have similar trouble recognizing and internalizing emotions. So, too, do people who grew up in households where their parents or caregivers were emotionally flat or often angry. The thinking is that, as children, they didn’t have the opportunity to mirror a range of emotions and thereby develop the facility to recognize, express and feel them. There is also some indication that people high in psychopathic or callous behavioral traits demonstrate less spontaneous mimicking behavior, which may be why they are not moved by the fearful or angry faces of their victims.

“Muscle movements in the face sustain interactions between people, and if you take that out, you’re working with a blank slate,” said Jeffrey Cohn, a professor of psychology and psychiatry at the University of Pittsburgh, who studies the link between the lack of facial expressiveness and depression. “That’s not an effective way of maintaining rapport or establishing connection.”

Interestingly, researchers have also found that people injected with Botox in the crucial expressive muscles around the eyes and forehead also had greater difficulty and were slower at interpreting and understanding emotions expressed in written statements like “You spring up the stairs to your lover’s apartment,” or “Reeling from the fight with that stubborn bigot, you slam the car door.” Another study showed that people had greater difficulty remembering emotional words when their faces were immobilized by wearing a face-hardening algae mask.

“I think we might be grossly underestimating just how powerful our facial expressions are,” said David Havas, associate professor of psychology at the University of Wisconsin-Whitewater who studies facial mimicry. “We have to recognize how informationally rich facial feedback is and when we block it, we are cutting off a major channel about our own emotions and information about social emotions.”

While primates also engage in facial mimicry, evolution gave humans the advantage of more refined musculature, especially around the eyes, and we have thinner and smoother skin, making it easier to see the tiniest twitches. The result is humans have a greater variety of facial expressions — thousands, in fact — that we detect with amazing speed and precision. This ability to read one another and empathize has arguably been fundamental to all human achievement.

“Facial mimicry is a very ancient mechanism of connecting and not something you want disrupted by Botox or other procedures,” said Frans de Waal, a primatologist and ethologist at Emory University. “Today I think primates are sometimes more perceptive than humans at reading facial expressions and body language because that’s all they have to go by, whereas we are always waiting for the words — and words can be highly misleading.”

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