Does Botox Make You Depressed? What the Research Says

Your face talks back to your brain

We tend to think of expressions as a readout. You feel happy, so you smile. But the conversation runs both ways. Charles Darwin suggested as much in 1872,¹ and the idea now has a name: the facial feedback hypothesis.

For years the evidence went back and forth. Then in 2022, a large group of researchers (sceptics included) ran the same experiment with 3,878 people across 19 countries. Deliberately smiling nudged happiness up, both on its own and when people were already looking at something pleasant.² The effect is modest, but it's there.

What Botox does to that conversation

Botox works by relaxing the muscle it's injected into. Fewer frowns, softer lines. It also means that muscle sends a quieter signal back to the brain, and researchers have been curious about what that changes.

Two studies stand out. In the first, women who'd had Botox for frown lines were slower to read sentences describing angry or sad situations afterwards, as if their brains had to work a little harder without the frown to help.³ In the second, people who'd had Botox were less accurate at reading emotion in other people's faces than people who'd had filler, which plumps the skin without stilling the muscles.⁴

So does it make you depressed?

Frown lines: the research leans the other way

A 2009 Cardiff study found that people treated for frown lines reported less negative mood than people who'd had other cosmetic treatments.⁵ The thinking is simple: if you can't frown as fully, low feelings have a little less to hold on to.

That idea has since been tested in people living with depression. In a 2012 randomised trial, a single round of injections between the brows eased symptoms more than a placebo in people whose medication hadn't been enough on its own.⁶ And a 2020 analysis of more than 40,000 reports in the US drug safety database found that people having Botox (for wrinkles, migraines and other conditions) reported depression less often than people treated another way for the same thing.⁷

It isn't an approved treatment for depression, and the trials have a built-in wrinkle: it's hard to hide from someone that their frown has gone. But across very different kinds of study, the direction is consistent.

Crow's feet: a small question mark

Laughter lines are a different muscle with a different job. They come from the ring of muscle around the eye that crinkles when you smile properly, the kind of smile psychologists call a Duchenne smile.

In 2018, the same Cardiff researcher compared 36 women: some treated for frown lines only, some for frown lines and crow's feet, and some who'd had no Botox at all. The frown-lines-only group's mood improved. The crow's feet group's didn't, and their depression scores edged up instead.⁸ It was a small study and that rise wasn't statistically significant, so it's a question rather than a finding. Still, it's exactly the kind of thing I'd want to know.

What I make of it

Botox and filler work well for plenty of women, and feeling good in your own face is a fine reason to choose either. What I find interesting is what this research adds to the picture.

Your face isn't only how you look. It's part of how you feel. So if you're weighing it up, it's worth asking your practitioner which muscles they plan to treat, and having a think about which expressions you'd miss.

And if you'd rather keep every line and simply look after the skin around them, that's what we make things for. Our Face & Neck Firming Oil carries 25% bakuchiol, the plant extract we reach for as a gentle alternative to retinol, and our Divine Skin Beeswax Super Balm is the one I'd hand to anyone whose skin feels tight and dry.

Try this

Check in with how you feel right now. Then pull the corners of your mouth up towards your ears and hold a big, slightly silly smile for 40 seconds (best done alone). Check in again.

Notice a small lift? That's your face talking back.